"Expert Panel Recommendations for the
Prevention, Diagnosis, and Treatment of
Osteonecrosis of the Jaws: June 2004"

http://www.ada.org/prof/resources/topics/
topics_osteonecrosis_whitepaper.pdf

This pamphlet outlines the symptoms of ONJ
and the different procedures doctors may
perform in order to make an accurate diagnosis.
The pamphlet also provides a list of factors
that may increase one’s risk of developing
ONJ, as well as how to manage the disease
and treat patients with ONJ.

Http://www.fda.gov/medwatch/SAFETY/
2004/safety04.htm#zometa

This website will direct you to the US Food
and Drug Administration’s Zometa Safety Alert,
first posted on September 30, 2004.

http://www.fda.gov/medwatch/SAFETY/
2004/ZometaHCP.pdf

This September 2004 letter was sent from
Novartis to doctors, making them aware of the
changes they recently made to the Aredia and
Zometa US package inserts, now including a
precautionary statement regarding a
possible risk of developing ONJ.

http://www.fda.gov/medwatch/SAFETY/
2004/Zometa_PI.pdf

(In particular pages 9-11, 20)
In August 2004, Novartis revised the product
information label for Zometa, adding the risk
of developing ONJ to their list of precautions,
as well as to their Post-Marketing Experience notes.

"Coping with Cancer: Dental Health and
Osteonecrosis of the Jaw"

http://www.us.novartisoncology.com/info/
coping/dental_health.jsp

The Novartis Oncology website provides an overview
of what a person’s dental hygiene
routine should include if he or she has cancer. It also
discusses the risk of developing osteonecrosis of the
jaw and the factors that may increase the risk. Finally,
it provides information regarding diagnosis and treatment.

"Pamidronate (Aredia) and Zoledronate (Zometa)
Induced Avascular Necrosis of the Jaws: A Growing Epidemic

Robert E. Marx, Letter to the Editor, Journal
of Oral Maxillofacial Surgery. 61:1115-1118, 2003

Robert E. Marx, Letter to the Editor.pdf

Dr. Marx’s letter describes his study of 36 ONJ cases.
He explains how he reached the conclusion that a connection
exists between ONJ and bisphosphonates.
He describes common ONJ symptoms and how
bisphosphonates may affect the jawbone’s ability to regrow.
He concludes his letter by discussing methods of
prevention and possible treatments for ONJ.

"Bisphosphonates and Osteonecrosis of the jaw"
Patrick M Purcell and Ian W Boyd, Australian Health
Review, eMJA (Medical Journal of Australia)

https://www.mja.com.au/public/issues/182_08_180405/
pur10144_fm.html

This article provides the clinical characteristics
of 13 ONJ patients, reported to the Adverse Drug Reactions
Advisory Committee (ADRAC).
It provides the patients’ age and sex, which bisphosphonate(s)
they were treated with and why, how long they were receiving
bisphosphonate therapy before the onset of their ONJ,
and their related symptoms.

ADA.org: A-Z Topics: Osteonecrosis of the Jaw

http://www.ada.org/prof/resources/topics/
osteonecrosis.asp

This article provides information regarding dental
management for patients currently receiving intravenous
bisphosphonate therapy. It also includes a link to a
document providing information on obtaining informed
consent regarding the risks associated
with long-term bisphosphonate use.

"Osteonecrosis of the Jaw"

http://courses.washington.edu/bonephys/opjawON.html

This article provides a simple overview of ONJ and
includes a detailed picture of exposed necrotic bone.
It also includes simple graphs displaying incidence
of ONJ in cancer patients taking a variety of bisphosphonates
and a graph showing incidence of ONJ
after prolonged bisphosphonate use.

"Bisphosphonates May Put Patients At Risk
For Deterioration Of The Jaw, American
Association of Endondontists"
Medical News Today, April 3, 2006

http://www.medicalnewstoday.com/
medicalnews.php?newsid=40774

This article explains the American Association of
Endodontists’ position statement regarding the recent
findings regarding ONJ and bisphosphonates.
The AAE consider themselves at the forefront of this emerging
ONJ problem based on the fact that endodontists are experts at
finding the cause of oral and facial pain that has been difficult to diagnose.
The article explains the AAE’s recommendations to those
individuals currently taking bisphosphonates and
those individuals that think they may be experiencing ONJ symptoms.

"Jaw Disease Found in Patients Using Cancer Drug"
Miguel Sanchez, Oral Cancer Foundation, March 6, 2006

http://www.oralcancerfoundation.org/
news/story.asp?newsId=640

While this article discusses general information
regarding ONJ and the effects of prolonged bisphosphonate use,
it also provides an outline of the medical reasons
why bisphosphonates, meant to strengthen bones,
can actually have an adverse affect on individuals’ jawbones.

Marx, Robert. Bisphosphonate-Induced Exposed Bone
(Osteonecrosis/Osteopetrosis) of the Jaws: Risk Factors,
Recognition, Prevention and Treatment.
J Oral Maxillofac Surg 2005; 63 (11): 1567-75.

isphosphonate-Induced Exposed Bone (
Osteonecrosis/Osteopetrosis) of the Jaws

Dr. Marx presents a detailed article regarding
his study of 119 ONJ patients, all who were treated with
either oral or intravenous bisphosphonates. He presents
all of his findings, which demonstrate that there exists a
direct correlation between ONJ and the use of bisphosphonates.
The article includes Dr. Marx’s recommendations for
preventing and treating ONJ. The article contains many pictures
of exposed bone, tissue loss, drainage, x-rays of bone loss,
and pictures of infected, non-healing areas
where extractions occurred.

"Jaw Ailment Shows Industry Moves
Slowly on Drug Warnings"
Geeta Anana, The Wall Street Journal Online,
Health, December 8, 2004.

http://online.wsj.com/public/resources/
documents/SB110245057172293526.htm

Anana’s article describes Dr. Ruggiero’s research and
findings regarding his 90 bisphosphonate related ONJ cases.
The article also focuses on Novartis’ position on the link between
ONJ and Aredia and Zometa, as of December 2004.
Anana describes what steps the company has taken
to issue warnings, how it plans to continue investigating
the problem, and what it plans to do in the future.

"Drug Linked to Death of Jawbone"
Rita Rubin, USA TODAY, Health and
Behavios, March 13, 2005

http://www.usatoday.com/news/health/
2005-03-13-jawbone-deaths_x.htm

This article is a report on Dr. Salvatore Ruggiero’s
findings regarding the link between bisphosphonates and ONJ.
The article explains the effects that long-term use of
bisphosphonates may have on the body based on the
fact that the drugs may remain in bones for years
after individuals stop taking them