Curious Case of Rodent Poison: A Case Report

Osteonecrosis was first described as a consequence of ionizing radiation used in the treatment of malignant tumors but later a variety of causes for osteonecrosis were found which include, Medication induced, radiation induced, chemical induced and infection induced. Terms such as: bisphosphonate osteonecrosis (BON), Bisphosphonate Associated Osteonecrosis of the Jaws (BONJ), Bisphosphonate Related Osteonecrosis of the Jaws (BRONJ), Antiresorptive Osteonecrosis of the Jaw (ARONJ) and Medication Related Osteonecrosis of the Jaw (MRONJ) have all had proponents and all continue to be utilized. However, Migliorati first proposed a designation of the disease as osteochemonecrosis. This case report is about a chemical induced osteonecrosis patient who placed rat poison inside the mouth.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) in cancer patients

This literature review focuses on the latest advances in the study of osteonecrosis of the jaw in cancer patients taking bisphosphonates. Prescribing bisphosphonates for the treatment of metastatic bone disease is justifiable and unavoidable measure. The action of bisphosphonates leads to increase in bone tissue strength, but significantly suppressing normal bone remodelling, essential for repair, and becomes vulnerable to mechanical trauma and bacterial invasion. The unique anatomical and physiological features of the jaw bones determine their selective damage. The disease is characterized by progressive jaw necrosis, chronic inflammation of the surrounding tissues complicated by a pathological fracture and persistent oroantral fistula, which aggravates chronic pain and leads to a deterioration in the quality of life of patients. The occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a multifactorial process. Most often, it occurs in patients with long term treatment with zoledronic acid preparations against after tooth extraction. The fact of an increase in the incidence of osteonecrosis is undeniable for objective reasons, the main of which are an increase in cancer, an increase in the life expectancy of cancer patients and their need for bisphosphonate therapy. In the article, it was analyzed the latest scientific reports on the causes of the disease, risk factors and the pathogenesis of the disease. Data on the frequency of jaw osteonecrosis in different countries are presented. It was shown promising developments and summarizes information on existing methods for diagnosing jaw bisphosphonate osteonecrosis. Questions about the key approaches in the treatment of the disease, as well as about new experimental techniques, are examined. The main problems of the prevention of bisphosphonate-related osteonecrosis of the jaws are formulated.

Prevention of bisphosphonate osteonecrosis in dental patient with osteoporosis

The analysis of scientific literature on the use of bisphosphonates in the treatment of osteoporosis. This effective group of drugs was included in the first line of appointments by specialists dealing with the problem of osteoporosis. At the same time, a number of authors associate the appearance of medicinal osteonecrosis of the jaws, called BONJ (bisphosphonate osteonecrosis of the jaws), in patients with the administration of bisphosphonates. One of the triggering mechanisms of the emergence of BONJ are surgical dental interventions performed in patients receiving bisphosphonates. Today, patients may not understand the seriousness of taking these drugs and often do not warn the dentist before manipulation, as well as not all dentists attach importance to the danger of drugs from osteoporosis. In this paper, based on the analysis of scientific literature, the attention of dentists to the problem of possible complications in the treatment of patients with osteoporosis, taking bisphosphonates. A questionnaire included in the questionnaire of a dental patient, taking into account the name of the drug and the duration of its administration, is proposed.

ASSESSMENT OF BONE METABOLISM IN PATIENTS WITH BISPHOSPHONATE OSTEONECROSIS OF THE JAWS

The aim of the study was to evaluate bone metabolism in cancer patients with bisphosphonate osteonecrosis of the jaws. The study included 45 people of the main group (patients with cancer with osteonecrosis of the jaw in patients receiving bisphosphonates) and 25 in the control group (cancer patients treated with bisphosphonates, but did not have osteonecrosis of the jaw), which had a stabilization of the underlying disease. Bone metabolism was evaluated by the level of osteocalcin (OC), bone-specific alkaline phosphatase (bALP), aminoterminal of propeptide of procollagen type I (P1NP), tartrate-resistant acid phosphatase (TRAP5b), calcium (Cа), phosphorus (P) in blood serum before treatment and after 6 months. Compared to the average levels of marker patients of the main and control groups using the Mann-Whitney test for p < 0,05. A baseline level of СТХ (0,23±0,02 ng/ml) and OС (11,58±0,54 ng/ml) in the treatment group was significantly (p < 0.05) lower than control group (0,43±0,01 ng/ml and 17,94±0,83 ng/ml), and the level of osteocalcin in the main group (11,58±0,54 ng/ml) was on average below normal 2,59 times. Recorded significantly higher (p < 0,05) levels bALP (133,24±14,03 U/l) and TRAP5b (3,54±0,38 U/l) in patients with osteonecrosis compared with a control group (73,32±3,41 U/l and 3,12±0,12 U/l). Reliably detected differences in the levels of P1NP, Ca and P were not detected (p > 0,05). In the main group after 6 months of treatment was observed a tendency of growth of СТХ, TRAP5b, OK, bALP, P1NP, Ca, but only for the markers of resorption and СТХ, TRAP5b these differences were significant. Indicators of patients in the control group were stable and did not differ in the dynamics. The development of bisphosphonate osteonecrosis of the jaws is directly related to bone metabolism and occurs with predominance of the processes of bone resorption and inhibition of bone formation processes.