Medication Related Osteonecrosis of the Jaw in osteoporosis patient treated with oral bisphosphonates: Case Report

Abstract

Bisphosphonates are used to treat osteoporosis or to inhibit bone metastasis in cancer patients andin Paget’s disease. Use of these medications may cause necrotic areas in jaw bones where intenseremodelation occurs. MRONJ mostly seen in intravenous route, oral route is known as safer. Infollowing case 75-year-old female patient administered our clinic with complaint of jaw pain anddifficulty in nutrition. She had only osteoporosis with no other disease, but her general situationwasn’t quite good. It is learnt that she ibandronic acid for 4 years with oral route. In intraoralexamination bone necrosis with purulent leakage was seen at left posterior mandible. Patient take1.200,00 EU Penicillin V 2 tablets for a day along 2 weeks. In control session there was no notablerecovery, so 500 mg Ornidazole is added to antibiotherapy. End of one month there wasn’t anyrecovery but also patient started to have gastrointestinal problems due to antibiotic use for 4months. For that, antibiotherapy was totally finished and essential oil protocol which includesmyrrh, coconut oil, palmrosa,neem and niaouli oils was initiated. In one week control session,purulent leakage decreased and mucosal recovery was noted. Patient perform this protocol for 3month and as a consequence infection pacificated and patient is prevented for any gastrointestinalcomplication due to antibiotic use.