Clinical Problem Solving in Periodontology and Implantology by Francis J. Hughes, Kevin G. Seymour, Wendy Turner, Shakeel

By Francis J. Hughes, Kevin G. Seymour, Wendy Turner, Shakeel Shahdad, Francis Nohl

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It is now recognized that bisphosphonate therapy results in the risk of the very serious complication of osteonecrosis of the jaw, which may occur, for example, following tooth extractions. This is particularly the case for those who are being treated with intravenous bisphosphonate therapy. Therefore, although people taking oral bisphosphonates can be managed normally, in those with a history of intravenous bisphosphonate therapy, tooth extractions are best avoided if possible, and where necessary, it may be appropriate to refer to a specialist centre for management.

As such, antibiotic prophylaxis prior to invasive dental procedures is not currently recommended. , the presence of bony secondary metastases from carcinomas). These drugs include alendronate, zoledronate, and pamidronate. Most patients take these drugs orally, but some patients, particularly those with neoplastic bone disease, may be given intravenous bisphosphonates. It is now recognized that bisphosphonate therapy results in the risk of the very serious complication of osteonecrosis of the jaw, which may occur, for example, following tooth extractions.

Once pregnancy gingivitis is established, it is still managed by normal plaque control measures, but achieving full resolution can be quite a challenge and may occasionally benefit from the use of adjunctive local antimicrobial agents such as chlorhexidine mouthwash or gel. Occasionally, the inflammation may be sufficiently severe as to result in the formation of a localized pyogenic granuloma known as a pregnancy epulis. 2). Management of a large pregnancy epulis is a particular challenge because surgical removal during pregnancy results in considerable bleeding and is best avoided until after the pregnancy term is complete, if possible.

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