What are the major academic medical centers in the US with oral and maxillofacial surgery departments that specialize in osteonecrosis management?

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

Patients with osteonecrosis of the jaw should seek care at academic medical centers with oral and maxillofacial surgery departments that specialize in osteonecrosis management, as recommended by the American Society of Clinical Oncology (ASCO) and Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). 1

How to Locate Specialized Centers

Academic medical centers with expertise in osteonecrosis management can be identified through:

1. American Dental Education Association (ADEA) dental schools directory
2. American Academy of Oral Medicine (AAOM) member directory
3. American Association of Oral and Maxillofacial Surgeons (AAOMS) directory

These centers typically have multidisciplinary teams that manage various forms of osteonecrosis, including:

• Medication-related osteonecrosis of the jaw (MRONJ)
• Osteoradionecrosis (ORN) in head and neck cancer patients
• Avascular necrosis (AVN) affecting the jaw 1

Key Features of Specialized Centers

Centers with expertise in osteonecrosis management typically offer:

• Advanced diagnostic capabilities - Early diagnosis significantly improves outcomes 1
• Staging expertise - Proper staging requires specialized knowledge and experience 1
• Multidisciplinary approach - Collaboration between oral surgeons, oncologists, dentists, and oral medicine specialists 2
• Treatment options - Both surgical and non-surgical management approaches based on disease stage 3, 4, 5

Management Approaches at Specialized Centers

These centers typically follow structured approaches to osteonecrosis management:

1. Comprehensive assessment and staging
2. Conservative management for early-stage disease - Including local wound care, which has shown to increase the likelihood of MRONJ resolution 5
3. Surgical intervention for advanced disease - Surgical therapy is associated with better disease resolution (70% vs 36% with non-surgical therapy alone) 4
4. Specialized protocols - Following evidence-based guidelines from organizations like AAOMS 6

Importance of Specialized Care

Specialized care is critical because:

• Osteonecrosis can lead to significant morbidity if not properly managed
• Early intervention can prevent progression to more severe stages
• Different types of osteonecrosis require specific management approaches
• Treatment decisions must consider the underlying condition and medications 1, 3

Barriers to Accessing Specialized Care

Patients should be aware of potential barriers to accessing specialized care:

• Geographic location and distance from treatment facilities
• Insurance coverage issues (particularly separate medical and dental insurance)
• Racial and ethnic disparities in access to specialized dental care 1

Proper management at specialized centers with experience in osteonecrosis can significantly improve outcomes and quality of life for affected patients.