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Osteonecrose induzida por medicação em medicina dentária
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Abstract(s)
A osteonecrose maxilar associada a medicação (MRONJ), é considerada um efeito adverso grave da medicação antireabsortiva e antiangiogénica. Estes fármacos são utilizados na prevenção da osteoporose, em terapêuticas oncológicas prevenindo as metástases ósseas, e no caso dos agentes antiangiogénicos são utilizados na quimioterapia. A MRONJ é caracterizada por uma exposição óssea necrótica num período de tempo superior a 8 semanas, não tendo a zona da cabeça ou pescoço sido irradiada ou apresente sinais de metástases ósseas. Estando esta exposição óssea, bem como o desenvolvimento da MRONJ associados a fatores de risco como extrações dentárias, próteses desadaptadas, duração prolongada da terapia, diabetes, entre outros.
A sua fisiopatologia permanece ainda em grande extensão desconhecida, sabe-se apenas que poderá estar relacionada com a inibição da remodelação óssea, bem como com a presença de inflamação e infeção, inibição da angiogénese, toxicidade dos tecidos moles ou disfunção imunitária. Existem duas abordagens no tratamento desta patologia, a via conservativa onde se opta por aliviar a sintomatologia, tentando obter uma qualquer melhoria na situação clínica ou a via cirúrgica onde se tenta remover o osso necrótico.
No entanto, a melhor opção passa pela prevenção, sendo importante informar os pacientes dos riscos da medicação que lhes foi prescrita, bem como da importância de uma correta higiene oral e da necessidade de realizar controlos regulares por parte de um médico dentista quer antes, quer durante e após a terapêutica com agentes antireabsortivos ou antiangiogénicos ter sido terminada.
Medication-associated maxillary osteonecrosis (MRONJ) is considered a serious adverse effect of anti-resorptive and antiangiogenic medication. These drugs are used in the prevention of osteoporosis as well as in cancer therapies preventing bone metástases and in the case of antiangiogenic agents are also used in chemotherapy. MRONJ is characterized by a necrotic bone with a duration of more than 8 weeks, when the head and neck area has not been irradiated or shows signs of bone metástases. This bone exposure, and the development of MRONJ are associated with risk factors such as, dental extractions, misadjusted prosthesis, long term duration of therapy, diabetes, among others. Its pathophysiology remains to a large extent unknown, it is only known that it may be related to bone remodelling inhibition, as well as the presence of inflammation and infection, inhibition of angiogenesis, soft tissue toxicity or immune dysfunction. There are two approaches in the treatment of this pathology, the conservative way in which the objective is to reduce symptomatology, trying to obtain any improvement in the clinical situation, or the surgical way in which it is tried to remove all of the necrotic bone. However, the best option is preventing it from happening, being of the most importance to inform patients of the risks of the medication prescribed to them, as well as the importance of correct oral hygiene and the need to perform regular check-ups by a dentist before, during and after therapy with anti-resorptive or antiangiogenic agents have been terminated.
Medication-associated maxillary osteonecrosis (MRONJ) is considered a serious adverse effect of anti-resorptive and antiangiogenic medication. These drugs are used in the prevention of osteoporosis as well as in cancer therapies preventing bone metástases and in the case of antiangiogenic agents are also used in chemotherapy. MRONJ is characterized by a necrotic bone with a duration of more than 8 weeks, when the head and neck area has not been irradiated or shows signs of bone metástases. This bone exposure, and the development of MRONJ are associated with risk factors such as, dental extractions, misadjusted prosthesis, long term duration of therapy, diabetes, among others. Its pathophysiology remains to a large extent unknown, it is only known that it may be related to bone remodelling inhibition, as well as the presence of inflammation and infection, inhibition of angiogenesis, soft tissue toxicity or immune dysfunction. There are two approaches in the treatment of this pathology, the conservative way in which the objective is to reduce symptomatology, trying to obtain any improvement in the clinical situation, or the surgical way in which it is tried to remove all of the necrotic bone. However, the best option is preventing it from happening, being of the most importance to inform patients of the risks of the medication prescribed to them, as well as the importance of correct oral hygiene and the need to perform regular check-ups by a dentist before, during and after therapy with anti-resorptive or antiangiogenic agents have been terminated.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Osteonecrose maxilar associada a medicação Terapêutica MRONJ Agentes antireabsortivos Agentes antiangiogénicos