**Osteonecrosis of the Jaws. Prevalence, Risk Factors and Role of Microbiota and Inflammation in a Population of Spain**

Mario Pérez-Sayáns, Carmen Vidal-Real, José M. Suárez-Peñaranda and Abel García-García

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.69315

#### **Abstract**

**Introduction:** The purpose of this article is to determine the prevalence of ONJ in patients who have undergone intravenous bisphosphonate therapy, and relate the risk factors described (including Actinomices); indeed, to establish a protocol to reduce the risk of developing ONJ and to evaluate the evolution of the patient according to the sample's antibiogram.

**Results:** The prevalence of ONJ was 12.9%. Most of the non-diabetic patients did not develop ONJ (92.3%) (p = 0.048). In regards to the periodontal state, 94.3% of patients without periodontal problems did not develop ONJ (p = 0.001). Almost 50% of the necrosis were unifocal and located on the mandible (p < 0.001). The number of affected patients and the aggressiveness of the disease increased significantly three years after starting treatment (p < 0.001). 87.5% of biopsies showed the presence of Actinomyces. The inflammatory response was very variable, ranging from absent to intense but it increased with age (p = 0.005). The combination of amoxicillin with clavulanic acid showed good sensitivity in the majority of patients (82.6%).

**Conclusions:** As the etiology of ONJ remains unknown, it is essential to prioritize prevention while assessing the risk factors.

**Keywords:** osteonecrosis, bisphosphonates, prevalence, risk factors, microbiota, inflammation, actinomyces

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