1. Which cells does bisphosphonates act on ?
A. osteoblast
B. osteoclast
C. fibroblast
D. mesenchymal cells
ANSWER : B
-Bone tissue undergoes constant remodeling via deposition and resorption of bone. Bisphosphonates acts by binding irreversibly to osteoclasts, inhibiting the bone resorption mechanism, allowing for slower bone loss.
2. Which of the following medications are associated with osteonecrosis of the jaw (MIONJ) ?
A. Interferon-gamma
B. Calcitonin
C. Denosumab
D. Perindopril
ANSWER : C
-Anti-resorptive agents (Bisphophonates : alendronic acid, zolendronic acid) are not the only drugs that are associated with MIONJ
-RANKL inhibitors (Denosumab) and Anti-angiogenic agents (bevacizumab, sunitnib, aflibercept) are also associated with MIONJ
3. Medication induced osteonecrosis of the jaw (MIONJ) is induced by a variety of drugs that :
A. Inhibit osteoclast activity or angiogenesis
B. Promote osteoclast activity or angiogenesis
C. Inhibit osteoblast activity and collagen synthesis
D. Promote osteoblast activity and collagen synthesis
ANSWER : A
-Bisphosphonates and RANKL inhibitors act by inhibiting osteoclastic activity while anti-angiogenic drugs act by inhibiting angiogenesis, which in turns slows down bone resorption activity
4. 50 year old patient, with history of breast cancer since 10 years is on IV bisphosphonates for more than 7 years. Patient is now having a severe toothache on tooth 46. Intraorally, presence of deep carious lesion is noted, and tooth is tender on percussion. What is the best immediate management for this patient?
A. Extraction of tooth 46
B. Immediate pulp extirpation of tooth 46
C. Referral to oral surgeon for further management
D. Provide analgesics and send patient home
ANSWER : B
-Patients who are on IV bisphosphonates or oral bisphosphonates for more than 5 years are at a much higher risk to develop osteonecrosis of the jaw. Hence, extractions and procedures involving bone manipulation should be avoided. Pulp extirpation should be considered as an immediate management to provide immediate pain relief for the patient.
5. In order for us to consider a case of MIONJ, the bone exposure should have persisted for ?
A. 3 weeks
B. 4 weeks
C. 8 weeks
D. 10 weeks
ANSWER : C
-Definition of MIONJ is “exposed bone or bone that can be probed through an intraoral or extraoral fistula, which have persisted for >8 weeks. No history of radiation therapy to the jaw or no obvious metastatic disease of the jaws should be present”
-I’VE ALSO PREPARED SOME NOTES ON MIONJ FOR A MORE THOROUGH UNDERSTANDING. DO LOOK THROUGH IT-