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Dental Preclearance and Careful Tracking Can Prevent Osteonecrosis of the Jaw Due to Bisphosphonates

Dental Preclearance and Careful Tracking Can Prevent Osteonecrosis of the Jaw Due to Bisphosphonates

BOSTON—Bisphosphonates are an important part of managing bony metastasis of prostate, breast, lung, and other cancers but can cause osteonecrosis of the jaw (ONJ) in some patients. The condition usually occurs after minor trauma such as dental procedures involving tooth extractions.

Oncology nurses at the Helen F. Graham Cancer Center at the Christiana Care Health System, Newark, Delaware, are part of a new program designed to prevent this emerging problem.

Cynthia Waddington, RN, MSN, AOCN, described this initiative at the Oncology Nursing Society 31st Annual Congress (abstract 9).

The Nurse's Role

"The nurse's role in patient education, supporting patient decision-making, and coordination of prebisphosphonate dental evaluations, is integral to patient safety and outcome management," Ms. Waddington said. "Completion of thorough assessments and prompt recognition of complications during and after bisphosphonate therapy are also essential."

She stressed that the process used at the Helen F. Graham Cancer Center can be modified to facilitate efforts of pre-bisphosphonate dental evaluations at other institutions.

Dental Clearance Required

A dental examination and clearance from the dentist are required before the patient can begin bisphosphonate therapy. At Ms. Waddington's institution, the pretreatment assessment includes consideration of the patient's type of cancer, history of treatment with steroids, presence of diabetes, and smoking history.

"If the dentist says that the patient is not cleared to begin bisphosphonate treatment, he or she also reports which dental procedures the patient is scheduled to undergo," she said.

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