Ask the Expert
In each publication of Risk Review, an outside guest or a member of our team of expert risk management and loss prevention consultants will answer a question from a reader. If you are concerned about a risk management or safety issue at your practice or facility, let us know and we may answer it in a future issue.
Expert: Phyllis DeCola (pictured), Princeton Insurance Healthcare Risk Consultant, with input from our dental expert community.
Question: How do I manage my liability risks while the "jury is still out" on a particular protocol? Specifically, I’m interested in the topic of patients undergoing dental work who have received, or are candidates for bisphosphonates for medical conditions.
Answer: This is a good example of not only an emerging concern, but one that also reveals the need for inter-disciplinary (medical and dental) cooperation in treatment selection and timing. Critically evaluating the issue, including reviewing the most current literature, and combining traditional risk management with sound decision making and heightened awareness is a good approach. Patient selection becomes more important than ever and effective and thorough communication with your patient is very important. This systematic approach can be applied to any emerging concern/protocol that has yet to be firmly established.
There is growing evidence that supports concerns that the administration of bisphosphonates, especially higher doses of infusible bisphosphonates used to treat cancers, may predispose a patient to avascular osteonecrosis of the jaw (ONJ) following certain dental procedures. These procedures, which place demands on bone physiology, include tooth extractions, implant placement, other oral surgeries, and in some cases denture placement. Bear in mind, however, that while lower oral doses have not been shown to result in ONJ, the potential cannot yet be completely ruled out.
The Journal of the American Dental Association (JADA), Vol. 136; No. 12 (Dec. ’05); pgs. 1658-1681, presents an excellent overview, with case studies and a complete bibliography of issues related to osseous integrity following administration of this family of drugs. |