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‘The risk of MRONJ after dental extraction was significantly higher in patients treated with ARD (antiresorptive drugs) for oncological reasons (3.2%) than in those treated with ARD for OP (osteoporosis) (0.15%) (p < 0.0001). Dental extraction performed with adjusted extraction protocols decreased MRONJ development significantly.
Pain, inflammation of the surrounding soft tissue, secondary infection or drainage may or may not be present. The development of lesions is most frequent after invasive dental procedures, such as extractions, and is also known to occur spontaneously. There may be no symptoms for weeks or months, until lesions with exposed bone appear. [5]
Socket preservation or alveolar ridge preservation is a procedure to reduce bone loss after tooth extraction. [1] [2] After tooth extraction, the jaw bone has a natural tendency to become narrow, and lose its original shape because the bone quickly resorbs, resulting in 30–60% loss in bone volume in the first six months. [3]
In order to obtain permission from patient for extraction of tooth, the dentist should explain that other treatment options are available, what is involved in the dental extraction procedure, the potential risks of the procedure and the benefits of the procedure. [2] The process of gaining consent should be documented in clinical notes. [2]
The menstrual cycle could be a determinant risk factor in the frequency of alveolar osteitis. Studies have shown that because of hormonal changes, women in the middle of menstrual cycle and the ones taking oral contraceptives (birth control pills) have a higher tendency of having alveolar osteitis after their tooth extraction surgery.
A practical recommendation is provided in some case where it is necessary to extract teeth from the jaw after radiotherapy. [31] An assessment of the risk of ORN should be done based on the dose of radiation, the site and how easy is the extraction. Any information on risk and early signs of ORN should be given to the patient.
The prognosis for a tooth should be considered carefully. If multiple treatment procedures are necessary, each procedure costs time and money with potential for failures/complications. Thus, tooth extraction may be a reasonable treatment option. The tooth could then be replaced with a dental implant.
Oral and maxillofacial surgery requires an extensive 4-6 year surgical residency training covering the U.S. specialty's scope of practice: surgery of the oral cavity, dental implant surgery, dentoalveolar surgery, surgery of the temporomandibular joint, general surgery, reconstructive surgery of the face, head and neck, mouth, and jaws, facial ...