Seminario I

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Seminario I

  1. 1. Pía Fuenzalida DíazDra. Katina Marincovik
  2. 2. Pregunta ¿Qué precauciones se deben tener en la atenciónodontológica al tratar a pacientes mujeres sometidas a tratamientos con Bifosfonatos?
  3. 3. Estrategia de búsqueda Pacientes mujeres que reciben tratamiento con bifosfonatos sometidas a tratamientos odontológico Atención de pacientes que reciben tratamientos con bifosfonatos Pacientes que no reciben tratamientos con bifosfonatos Se deben tener precauciones en la atención de pacientes que reciben tratamiento con bifosfonatos Terapia/Prevención
  4. 4. Tipo de Estudio o Publicación Meta- Revisión Análisis sistemática Ensayo Ensayo controlado clínico aleatorizado
  5. 5. Temas Principales y términosalternativosBiphosphonate treatmentsBiphosphonate osteonecrosisOral BiphosphonatesBiphosphonates dental
  6. 6. Criterios de InclusiónGénero: MujeresEdad: Adultas (mayores de 19 años)Año de publicación: 2010 hacia adelanteIdioma: Ingles – EspañolEspecie: Humanos
  7. 7. Criterios de Exclusión Polimorfimos genéticos Tratamientos con asociados Implantes Dentales
  8. 8. Bases de Datos* PubMed:- Términos MeSH: (("diphosphonates"[MeSH Terms] OR "diphosphonates"[All Fields] OR "biphosphonates"[All Fields]) AND ("dental clinics"[MeSH Terms] OR ("dental"[All Fields]- Límites: Publicados en los últimos 2 años, Ingles, Humanos, Mujeres, Adultos mayores de 19 años.- Resultados:Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim.Practical considerations for treatment of patients taking bisphosphonate medications: an update.Brock G, Barker K, Butterworth CJ, Rogers S.Liverpool Dental Hospital.J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3.Oral health considerations in older women receiving oral bisphosphonate therapy.Lo JC, ORyan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang B, Go AS.Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. joan.c.lo@kp.org * A pesar de haber realizado la búsqueda en otras bases de datos (Cochrane), consideré sólo la detallada, pues en ella encontré la información requerida para responder la pregunta planteada.
  9. 9. J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3.Oral health considerations in older women receiving oral bisphosphonate therapy.Lo JC, ORyan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang B, Go AS.Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. joan.c.lo@kp.orgAbstractRecent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older undergoing oral bisphosphonate treatment who returned a mailed questionnaire pertaining to dental symptoms. The study, as previously reported, was conducted within Kaiser Permanente Northern California, a large, integrated healthcare delivery system. The cohort included 7,909women with bisphosphonate exposure of at least 1 year, with a subset of 923 women reporting dental symptoms who underwent clinical examination. Overall, the average age was 71 ± 9; 70% were white, and 74% had at least some college education. Nearly two-thirds had received oral bisphosphonate therapy for 3 or more years. Most reported daily tooth brushing, 85% had had a dental examination in the past year, 22% reported denture use, and 6% reported moderate to severe periodontal disease. Oral healthcare patterns varied according to age and race and ethnicity. Five hundred seven (6.4%) women reported a tooth extraction in the prior year, of whom two developed BRONJ (0.4%). Tori or exostoses were found in 28% of examined participants with dental symptoms; these were predominantly in the lingual mandible and palate, with palatal BRONJ occurring in 1.6% of symptomatic participants with palatal tori. In summary, among older women with bisphosphonate exposure, oral health varied according to patient characteristics, and BRONJ occurred more frequently after tooth extraction or on palatal tori. These data support efforts to optimize oral health and to identify risk factors for BRONJ in older individuals receiving bisphosphonate drugs.
  10. 10. Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim.Practical considerations for treatment of patients taking bisphosphonate medications: an update.Brock G, Barker K, Butterworth CJ, Rogers S.Liverpool Dental Hospital.AbstractOsteonecrosis of the jaw--bisphosphonate-related (ONJ-BR) is an established clinical entity associated with both oral and intravenous (IV) bisphosphonate therapy. An update for the general practitioner on the indications for bisphosphonate therapy and both risk assessment and prevalence of ONJ-BR is provided. Management philosophy within a local unit is illustrated through four brief case studies. It is not uncommon to encounter patients on bisphosphonate therapy in the dental practice environment; the vast majority of these will be on oral bisphosphonates as part of their management for osteoporosis. The risk of developing ONJ-BR is rare in these patients compared with those receiving treatment for skeletal complications associated with cancer, many of whom will be managed with IV bisphosphonates. Although rare, it is important to recognize the potential risk of ONJ-BR. Whilst most patients on oral bisphosphonates can be managed no differently from other patients, it should be appreciated that the relative risk of long- term cumulative exposure, comorbidity and other factors are still to be determined. Surgical intervention and extractions can place the patient at risk of ONJ-BR and vigilance is necessary to ensure that healing progresses satisfactorily. Early referral to the local hospital should be sought if there is cause for concern. CLINICAL RELEVANCE: Although the risk of ONJ-BR is low in non-oncological indications, it is important to be aware that it exists and to know how the risk may be minimized.

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