Carmen Gavaldá

Osteonecrosis of the jaws in intravenous bisphosphonate use: Proposal for a modification of the clinical classification

Osteonecrosis of the jaws induced by bisphosphonates, first reported by Marx is now widely recognised: more than 260 reports appear in Medline-PubMed. There are many series of cases presented in the last years. A clinical stage classification has been proposed, based on clinical symptoms (mainly pain) and the presence of lesions and complications such as jaw fractures and skin fistulas by Ruggiero et al. There are three stages in this Ruggiero classification: Stage 1 is exposed bone necrosis without symptoms; Stage 2 is exposed bone necrosis with symptoms; and Stage 3 is where there are jaw fractures, skin fistulas or osteolysis extending to the inferior border. This classification is used to guide treatment and may also be useful to establish international criteria. However, based on observations made since the original paper, we now propose the following two modifications of Stages 1 and 2; Stage 1. That the inclusion criteria include patients with an oral fistula without obvious bone exposure, since these patients cannot be classified in the original Ruggiero’s classification and yet must have a small intraoral fistula (Table 1). Stage 2. That the Ruggiero classification, which consists of a patient who has an exposed necrotic jaw bone with symptoms, should be divided.

Oxidative stress and recurrent aphthous stomatitis

ObjectivesThis study analyzed the oxidative stress status in patients with recurrent aphthous stomatitis (RAS) in the presence and absence of active ulceration.Material and methodsOxidative stress was analyzed in peripheral mononuclear cells of 28 RAS patients with active ulceration and 29 controls. A further blood sample was collected from nine subjects randomly selected from the 28 RAS cases, during the period in which the patients did not have active oral ulceration. The reduced glutathione (GSH), malondialdehyde (MDA), and oxidized glutathione (GSSG) levels were measured in these samples.ResultsThe mean MDA and GSSG levels were significantly higher in patients with active RAS than in the controls, while GSH was lower in the RAS group (p < 0.01). There was a nonsignificant tendency toward higher MDA and GSSG levels in patients with major RAS compared with minor RAS. On comparing the serum findings in the nine RAS patients in the presence and absence of lesions, the presence of ulceration was associated with even higher MDA and GSSG levels and lower GSH concentrations (p < 0.05)ConclusionsOxidative stress was detected in our RAS patients.

Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws. A review of the literature.

Background Bisphosphonates (BPs) and other antiresorptive agents such as denosumab are widely prescribed for the treatment of osteoporosis and are also used in patients with multiple myeloma and metastatic breast or prostate cancer for avoiding bone reabsorption and fractures that result in increased morbidity-mortality among such individuals. Material and Methods We made a bibliographic search to analyze the concept, diagnosis and the different classifications for bisphosphonate-associated osteonecrosis of the jaws. Results Osteonecrosis of the jaws (ONJ) is an important complication of exposure to BPs or other antiresorptive agents, and although its prevalence is low, it can pose management problems. The definition, diagnosis and classification of osteonecrosis have evolved since Marx reported the first cases in 2003. Conclusions The present study offers a literature review and update on the existing diagnostic methods and classification of the disorder, with a view to facilitating earlier and more effective treatment. Key words:Osteonecrosis, jaws, bisphosphonates.