Proposal for a preventive protocol for medication-related osteonecrosis of the jaw.

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some patients exposed to certain drugs (antiresorptives such as bisphosphonates or denosumab, and antiangiogenic drugs). From a review of the literature it appears that there is no uniform criterion when selecting preventive measures; these vary according to author. Likewise, the measures recommended are usually general, so that in few cases they result in specific actions to be applied depending on the different variables involved such as the type of drug used, the duration of its application, the underlying pathology, the presence or absence of risk factors, etc. The aim of this study has been to design a preventive protocol which can be easily applied in any clinic or by any dental care service. MATERIAL AND METHODS: We undertook an exhaustive literature review to find any articles related to the topic of study, namely, preventive measures for medication-related osteonecrosis of the jaw, on the one hand generically and on the other focusing on dental implant treatment. The most part the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. From 3946 items, we selected a total of 21 items. RESULTS: From the analysis of the selected articles, several protocols have been developed that are easy to apply in a dental clinic.: Protocol 1. Before starting treatment with antiresorptives (Patients who are going to be treated for osteoporosis / Patients who are going to be treated for cancer). Protocol 2. Once treatment is initiated with antiresorptives (Patients being treated for osteoporosis / Patients being treated for cancer). CONCLUSIONS: The application of these protocols requires an interdisciplinary team which can handle the various treatments and apply the measures contained in them. Along with a team of well-educated and trained dentists, it is equally important to maintain contact with the medical team involved in the treatment of the underlying pathology, especially rheumatologists, oncologists, internists and gynaecologists. All the above requires a great staff learning and organization effort, continuous training and coordination of the whole team involved in the preventive management of these patients.

[Prevalence of dental caries in a 6-year old population from San Fernando (Cádiz)]. / Prevalencia de la caries dental en la población de 6 años de San Fernando (Cádiz).

AIM: The aim of this survey was to know the dental caries prevalence and severity in the 6 years old population from San Fernando (Cádiz). DESIGN: This is a cross sectional survey. EMPLACEMENT: We studied every schoolchildren at this age (100%) from the 27 city schools, in 1993. PARTICIPANTS: We studied 1439 schoolchildren of this age. This is one of the ages recommended by WHO in this class of surveys. INTERVENTIONS: We made an oral exploration following the WHO recommendations in this type of surveys. RESULTS: Dental caries prevalence reached 79% at this age. Dental decay index were; df-t index was 3.19; DMF-T was 0.68 and filling index was 11.2%. CONCLUSIONS: Our results of caries prevalence and epidemiological dental index, are higher in comparison with the results of other studies, which shows the severity of the dental decay problem in San Fernando. We still need educational and preventive programs in order to decrease dental caries prevalence and severity.