Microbiological aspects of osteonecrosis of the jaw

Abstract

BIONJ is generally defined by the presence of necrotic bone (sequestrum) in the oral cavity following the administration of a drug belonging to the category of bisphosphonates (BPs). In this clinical status, the infection of the exposed bone derives from the microbial flora of the oral cavity. The literature now increasingly contains reports invoking subclinical forms of BIONJ, suggesting that BIONJ occurs even in the absence of exposed bone, with nonspecific symptoms of pain, loose teeth not explained by periodontal disease, and intraoral fistula not explained by pulp necrosis. The pathogenesis of BIONJ may represent a microbial-biofilm-mediated infectious disease in the context of BP therapy. Accordingly, biofilms are a potential target for clinical therapy, with specific antibiofilm agents used in the treatment and prevention of BIONJ.