Bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma.

PURPOSE To review the main clinical-radiographic, therapeutic, and preventive aspects of osteonecrosis related to intravenous bisphosphonate therapy in patients with multiple myeloma. MATERIALS AND METHODS Between 2005 and 2006, we studied four patients with previous diagnosis of multiple myeloma treated with intravenous zoledronic acid, presenting nonhealing extraction sockets and intraoral exposed bone. We assessed the location of lesions, the relation with previous history of dento-alveolar surgery procedures, the clinical features, the treatments carried out, and the outcomes achieved. RESULTS All the patients were treated with chlorhexidine mouthwashes and oral amoxycillin-clavulanic acid for long periods of time. Two patients did not respond to the conservative management and needed surgical bone debridement. CONCLUSIONS Dental extractions seem to contribute the development of osteonecrosis of the jaw in patients with multiple myeloma treated with intravenous bisphosphonate therapy. Whereas the pathologic mechanisms are not known, these patients should undergo frequent check-ups before, during, and after bisphosphonate therapy. The management must be symptomatic and palliative, including systemic antibiotics, control of pain, and chlorhexidine mouthwashes during long periods of time.