EMERGENCY TRAINING:Every quarter, our group meets to act out different emergency scenarios. Our goal is to make certain each team member is fully prepared to know how to respond no matter what situation arises. This quarter’s hands on training was arranged by our very own Dr. Ruba Khader.

CONGRATULATIONS TO OUR SCHOLARSHIP WINNER:We would like to extend a big Congratulations to Deep Patel from Beloit Memorial High School on winning this year's scholarship. Deep plans to attend Marquette University in the fall to pursue a career in Dentistry. Best wishes to all graduates of 2019!

ANNUAL VICTORY RUN / WALK:Edgerton Hospital’s annual Victory Run / Walk is now taking registrations for the run on Saturday, September 14th 2019. Premier sponsors and participates in this event every year, and we would love to see more familiar faces. All of the proceeds raised from this event will go towards Edgerton Hospital purchasing a 3D Digital Mammography system. Visit Edgerton Hospitals site for more information and sign up to join us in supporting this great cause!

Note: Current treatment strategies and recommendations are based updated position papers (AAOMS 2014)† and expert opinion, not scientific conclusions derived from controlled clinical trials.

Osteonecrosis of the jaw (dead bone) can occur when the blood supply to the upper and lower jaws is compromised and by a problem with the bone’s ability to regrow. Some researchers suggest that antiresorptive drugs (bisphosphonates, and Denosumab) lessen the body’s ability to resorb bone (osteoclastic inhibition). This is a process that naturally takes place in order to allow the formation of new bone cells (osteoblasts). When the ability to remodel and grow new bone is impaired, blood flow through the bone can be reduced or stopped. This results in bone loss, bone spurs and breaking loose of pieces of dead bone. The soft tissues around that bone and within the bone itself, which depend on that blood flow for health, also begin to die (or fail to heal). Significantly more patients diagnosed with MRONJ have cancer, and taken IV bisphosphonates (Zoledronic acid and Palmidronate), Denosumab, another antiresorptive drug and the antiangiogenic drugs Bevacizumab (Avastic) and Sunitinib (Sutent).

The risk of MRONJ in osteoporosis patients taking oral antiresorptives, compared to cancer patients receiving IV antiresorptive medications is about 100 times smaller.

• Exposed bone (more frequent in the mandible)

• Non-healing extraction site / ulceration

• Undiagnosed bone pain (localized) / enlargement

• Prolonged jaw pain

• Numbness and loss of sensation

• Sudden change in health of periodontal or mucosal tissue

• Soft tissue swelling, inflammation, and erythema

• Loosening of previously stable teeth

• Purulent discharge

• Non–responsive to conservative debridement and antibiotic therapy

A. Reported Signs and Symptoms of MRONJ B. Common Findings of Patients with MRONJ

What is MRONJ? (Medication-Related Osteonecrosis of the Jaw)

DIAGNOSIS

• Current or previous treatment with antiresorptive or antiangiogenic agents

• Presence of exposed bone in the oral cavity for more 8 weeks

• Rule out cysts, impactions or metastatic disease to the jaw with

panoramic and tomographic images

• Clinically and radiographically apparent periodontitis

• Widening of ligament around tooth, seen on x-ray as a radiolucency

between teeth

• Subtle radiographic bone change, Osseous Sclerosis

• Rule out refractory osteomyelitis and osteoradionecrosis

• Rule out TMJ disorders

• Tissue biopsy only if metastatic disease is suspected

Patients may be considered to have MRONJ if they have the following characteristics.

• Current or previous treatment with antiresorptive or antiangiogenic agents.• Exposed bone or bone that can be probed through an intraoral or extraoral fistulae, in the maxillofacial

region and has persisted for more than eight weeks.

• No history of radiation therapy to, or obvious metastatic disease in the jaw.

When exposed bone in the jaw is identified by the dentist or oncologist, a multi-disciplinary approach to patient care should be taken. This would include consultation between oncologist, general dentist, oral surgeon and patient, over the risks, benefits and timing for dental treatment and initiation of antiresorptive and antiangiogenic therapy. Appropriate screening and dental treatment prior to initiating therapy has significantly reduced cases of ONJ.

DIAGNOSIS, PREVENTION & MANAGEMENT OF MEDICATION RELATED OSTEONECROSIS OF THE JAW (MRONJ) - PART 1:

Issue 26 Issue 262 3

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OFFICE INFORMATION:

www.PremierOralMaxSurgery.comRichard D. Meister, DDS • Jason J. Swantek, DDS

Kevin C. Gams, DDS • Ruba N. Khader, BDS

Janesville Office1602 N. Randall Ave • Janesville, WI 53545Phone: 608-756-8744 • Fax: 608-756-5344

jvl@premieroralmaxsurgery.com

Monroe Office121 6th Street • Monroe, WI 53566

Phone: 608-325-7177 • Fax: 608-329-5840monroe@premieroralmaxsurgery.com

IN NETWORK CARRIERS:

Issue 26Summer 2019

Janesville, WI (608) 756–8744

Monroe, WI (608) 325–7177

www.PremierOralMaxSurgery.com

Office News and Other Announcements ............................................ (1–3)

Handling a Stroke in the Office .......................................................... (3)

Office Information ............................................................................... (4)

DID YOU KNOW:Did you know... that all of the paperwork patients are required to complete at check-in is available through our website? Completing the New Patient Registration form prior to their appointment results in less to worry about upon arrival for surgery. If you assist a patient in scheduling at our office, please encourage them to take advantage of this benefit.

Did you know... that we offer the option of an “All-in-One” appointment for patients who have been recommended to have their wisdom teeth removed?

An “All-in-One” appointment includes both the exam and surgery under general anesthesia, eliminating the need for several appointments. Ideal candidates are under the age of 40 with a clear medical history, and no known allergies.

If you have a patient that fits the criteria and might be interested in combining the exam and procedure in to one appointment, have them contact our Patient Service Representatives to learn more! You and your team can help by forwarding the panoramic image and referral to aid in the evaluation.

RED NOSE DAY:The Premier Team joined the nation on Red Nose Day, a campaign to raise awareness on ending child poverty by funding programs that keep children safe, healthy, and educated.

MEDICALAlliance

Anthem BCBS PPODeanMercy

Health EOSPhysicians PlusPrairie StatesUnity / Quartz

DENTALAetna Dental PPO

Anthem BCBS GRIDCigna DPPODelta Dental

HumanaMetlife

DHA / Sunlife DentalUnited Concordia Active Duty and TDP

United Health CareCareington Dental

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