Strategie preventive e management odontoiatrico nel paziente a rischio di osteonecrosi delle ossa mascellari associata a farmaco

Osteonecrosis of the jaw (ONJ) drug relatedis an uncommon but serious and debilitatingdisease, whose epidemiology andpathogenesis are still unclear. However,in the recent years, knowledge regardingONJ risk factors has lead to substantialprogress in ONJ prevention. Anti-resorptivemedicines (e.g. bisphosphonates, denosumab)and anti-angiogenic medicines (e.gbevacizumab, sunitinib) are being used inthe treatment of various cancers and in thetreatment of several non-oncological conditions,mainly for the osteoporosis.Despite the higher frequencies of ONJcases in cancer patients, ONJ is becomingmore frequent in everyday practice inosteometabolic patients. This due to thehigher number of osteoporotic patientsin therapy with antiresorptive drugs inthe population. In order to optimize ONJpreventive strategies, several specialistsare involved; specifically, dentists andhygienists are key figures for eliminatinglocal risk factors.The aim of this paper is to describe thepreventive strategies for patients at risk ofONJ and the management of dental procedures.The latter aimed at obtaining andmaintaining an appropriate state of dental-periodontal health in all the categoriesof patients at risk.