Duchenne Dental Dilemmas: Bisphosphonates & Osteonecrosis of the Jaw

Medication-related osteonecrosis of the jaw (MRONJ),  or osteonecrosis of the jaw (ONJ), is a condition that results when the bones of the jaw are exposed and then do not heal  generally when a tooth is removed. It has been stated that bisphosphonates (medications that help improve the health of bones, such as fosomax, zolendronate and others) can increase the incidence of ONJ. For that reason, many dentists have been hesitant to perform dental extractions and/or surgery on patients who are using bisphosphonates.   


After our recent post about Wisdom Teeth and Duchenne, we received several questions about ONJ and wisdom teeth removal. We reached out to Dr. Leanne Ward, MD (Director of the Pediatric Bone health Clinical and Research Programs, Children’s Hospital Eastern Ontario, Canada) to ask about the incidence and management of ONJ.


Per Dr. Ward, there have been no cases of osteonecrosis of the jaw (ONJ) in pediatric patients. In a recent article that she has written, she says:

"ONJ is defined as exposed bone in the maxillofacial area that does not heal within 8 weeks following identification by a health care provider, in the absence of radiation therapy. In children, there are no reports of ONJ despite three studies which examined over 350 bisphosphonate-treated children with osteogenesis imperfect (OI) following dental procedures. Despite the lack of reported ONJ in children to date, one position statement has nevertheless recommended to safeguard the bisphosphonate-treated child’s oral health by referral to a dentist prior to bisphosphonate initiation, completion of necessary invasive dental procedures prior to treatment initiation, regular dental evaluations by a dentist during treatment and good daily oral hygiene.”

(references may be found below)


Duchenne Pearls:

  • There have been no cases of ONJ in pediatric patients
  • If possible, as a precaution, teeth should be extracted prior to bisphosphonate initiation
  • Regular dental evaluations during bisphosphonate treatment and good daily oral hygiene are important, and may help in the prevention of ONJ


  • Bhatt, R., Hibbert, S. A., & Munns, C. F. (2014). The use of bisphosphonates in children: Review of the literature and guidelines for dental management. Australian Dental Journal, 59(1), 9–19. http://doi.org/10.1111/adj.12140
  • Brown, J. J., Ramalingam, L., & Zacharin, M. R. (2008). Bisphosphonate-associated osteonecrosis of the jaw: Does it occur in children? Clinical Endocrinology, 68(6), 863–867. http://doi.org/10.1111/j.1365-2265.2008.03189.x
  • Chahine, C., Cheung, M. S., Head, T. W., Schwartz, S., Glorieux, F. H., & Rauch, F. (2008). Tooth Extraction Socket Healing in Pediatric Patients Treated with Intravenous Pamidronate. Journal of Pediatrics, 153(5), 719–720. http://doi.org/10.1016/j.jpeds.2008.05.003
  • Khosla, S., Burr, D., Cauley, J., Dempster, D. W., Ebeling, P. R., Felsenberg, D., … Research, A. S. for B. and M. (2007). Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research : The Official Journal of the American Society for Bone and Mineral Research, 22(10), 1479–1491. http://doi.org/10.1359/JBMR.0707ONJ
  • Malmgren, B., Åström, E., & Söderhäll, S. (2008). No osteonecrosis in jaws of young patients with osteogenesis imperfecta treated with bisphosphonates. Journal of Oral Pathology and Medicine, 37(4), 196–200. http://doi.org/10.1111/j.1600-0714.2007.00607.x

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