Diagnóstico, tratamento e prevenção da osteonecrose maxilar relacionada a medicamentos

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Mileny Hochmuller
Danielle Pereira Velaski
Valesca Sander Koth
Silene Barbieri

Resumo

A osteonecrose maxilar relacionada a medicamentos (MRONJ) é um raro e grave efeito adverso de terapia antirreabsortiva e/ou antiangiogênica que pode causar exposição de osso necrótico em cavidade bucal, o que implica na qualidade de vida dos pacientes. O presente trabalho teve por objetivo revisar a literatura sobre MRONJ enfatizando os critérios de diagnóstico e tratamento. As bases de dados PubMed, Scielo e Google scholar foram consultadas em busca de artigos que abordassem o tema. Embora apresente baixa resposta ao tratamento, o diagnóstico e tratamento precoce aumentam a chance de cura. Dessa forma, o acompanhamento odontológico sistemático de pacientes que estejam em terapia antirreabsortiva e/ou antiangiogênica é fundamental para a identificação de sinais ou sintomas sugestivos de MRONJ como dor, tumefação ou mobilidade dentária. Alterações radiográficas ou tomográficas como aumento da densidade óssea, esclerose óssea ou osteólise, persistência de alvéolo dentário, neoformação periosteal, espessamento da lâmina dura e estreitamento do canal mandibular podem ser indicativos da presença de necrose óssea. Como ainda não existe um tratamento universalmente aceito capaz de curar a MRONJ, a abordagem envolve paliação de sintomas e controle da infecção associada, reservando-se a remoção cirúrgica da área necrótica para casos mais graves. Salienta-se que cada caso deve ser avaliado individualmente por uma equipe multidisciplinar que permita a discussão entre a equipe de saúde bucal e equipe médica. A prevenção da MRONJ por meio da educação dos pacientes, eliminação dos fatores de risco e manutenção da saúde bucal constitui ainda a medida mais importante no manejo desses indivíduos.

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Hochmuller, M., Pereira Velaski, D. ., Koth, V. S., & Barbieri, S. . (2021). Diagnóstico, tratamento e prevenção da osteonecrose maxilar relacionada a medicamentos. Revista Brasileira Multidisciplinar, 24(2), 233-247. https://doi.org/10.25061/2527-2675/ReBraM/2021.v24i2.1132
Seção
Artigos de Revisão
Biografia do Autor

Mileny Hochmuller, Curso de Odontologia, Faculdade CNEC Santo Ângelo, RS, Brasil

Acadêmica do Curso de Odontologia, Faculdade CNEC Santo Ângelo, RS, Brasil

Danielle Pereira Velaski, Curso de Odontologia, Faculdade CNEC Santo Ângelo, RS, Brasil

Acadêmica do Curso de Odontologia, Faculdade CNEC Santo Ângelo, RS, Brasil

Valesca Sander Koth, Pontifícia Universidade Católica do Rio Grande do Sul, Brasil(2020)

Doutorado em Odontologia (Estomatologia) pela Pontifícia Universidade Católica do Rio Grande do Sul, Brasil(2020)

Silene Barbieri, Curso de Odontologia, Faculdade CNEC Santo Ângelo, RS, Brasil

Graduada pela Faculdade de Odontologia de Pelotas, UFPEL, 2010

Mestre em Odontologia (Diagnóstico bucal), pela Faculdade de Odontologia de Pelotas, UFPEL, 2015  

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