What are major academic medical centers in the US with oral and maxillofacial surgery (OMS) departments that participate in osteonecrosis management?

Major Academic Medical Centers in the US with Oral and Maxillofacial Surgery Departments for Osteonecrosis Management

Major academic medical centers in the US with oral and maxillofacial surgery departments that specialize in osteonecrosis management include dental schools affiliated with the American Dental Education Association (ADEA) and centers with specialists from the American Academy of Oral Medicine (AAOM) or American Association of Oral and Maxillofacial Surgeons (AAOMS). 1

Recommended Centers for Osteonecrosis Management

How to Identify Specialized Centers

The American Society of Clinical Oncology (ASCO) and Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) recommend patients seek care at academic medical centers with:

• Oral and maxillofacial surgery departments with expertise in medication-related osteonecrosis of the jaw (MRONJ)
• Dental specialists with experience in staging and managing osteonecrosis
• Interprofessional teams including oncologists, dentists, and oral medicine specialists

Finding Specialized Centers

Patients can locate appropriate centers through:

• American Dental Education Association dental schools directory (www.adea.org/dentalschools/)
• American Academy of Oral Medicine (www.aaom.com)
• American Association of Oral and Maxillofacial Surgeons (www.aaoms.org) 1

Types of Osteonecrosis Requiring Specialized Management

Academic medical centers with OMS departments typically manage several forms of osteonecrosis:

1. Medication-Related Osteonecrosis of the Jaw (MRONJ)

   • Associated with bone-modifying agents (bisphosphonates, denosumab) and angiogenic inhibitors
   • Requires specialized staging and management protocols 1

2. Osteoradionecrosis (ORN)

   • Occurs in patients with head and neck cancer treated with radiation therapy
   • Requires specialized prevention and management approaches 1

3. Avascular Necrosis (AVN)

   • While primarily affecting the femoral head, management principles apply to jaw osteonecrosis
   • Often requires multidisciplinary care 2

What to Look for in a Specialized Center

When seeking treatment for osteonecrosis, look for centers with:

• Experienced dental specialists - Oral medicine specialists, oral maxillofacial surgeons, hospital dentists, clinical oral pathologists, and/or periodontists with expertise in osteonecrosis management 1

• Interprofessional teams - Collaboration between oncologists, dentists, and dental specialists is essential for optimal management 1

• Staging expertise - Centers should have clinicians experienced in proper staging of osteonecrosis using established criteria 1

• Conservative and surgical management capabilities - Centers should offer both conservative approaches and surgical interventions when necessary 1

Management Approach at Academic Centers

Specialized centers typically follow a structured approach to osteonecrosis management:

For MRONJ:

1. Staging assessment by experienced clinicians
2. Conservative management for early stages:
   • Oral hygiene improvement
   • Topical antibiotic mouth rinses
   • Treatment of dental/periodontal disease
3. Advanced management for progressive disease:
   • Systemic antibiotics
   • Surgical debridement when indicated
   • Jaw reconstruction in severe cases 1

For Osteoradionecrosis:

Similar principles apply with specialized protocols for radiation-induced necrosis 1

Importance of Specialized Care

Academic centers with expertise in osteonecrosis management are crucial because:

• Early and proper diagnosis significantly improves outcomes
• Staging requires specialized knowledge and experience
• Management strategies differ based on stage and type of osteonecrosis
• Interprofessional collaboration improves patient outcomes 1

Access Considerations

When seeking specialized care for osteonecrosis management:

• Be aware that racial and ethnic disparities may affect access to specialized dental care
• Geographic location and distance from treatment facilities can be barriers
• Insurance coverage (particularly separate medical and dental insurance) may create challenges
• Communication between oncology teams and dental specialists is essential 1

By seeking care at academic medical centers with specialized oral and maxillofacial surgery departments, patients with osteonecrosis can receive optimal diagnosis, staging, and management from experienced interprofessional teams.