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routine treatment. Pre-Ramadan
dental checkups may be organized.
These considerations optimize dental
treatment of Muslim patients during
Ramadan while respecting their religious practices.
Drs. Nakul Uppal and Deep Shikha
Manipal University
Karnataka, India
References
1. Darwish S. The management of the Muslim
dental patient. Br Dent J. 2005;199(8):503.
2. Niazi AK, Niazi SK. Need for Ramadan
guidelines in various aspects of health. Indian J
Endocrinol Metab. 2012;16(4):663-4.
CTX as a Marker for BRONJ
J Can Dent Assoc 2013;79:d173
I
n the article1 titled C-Terminal CrossLinking Telopeptide as a Serologic
Marker for Bisphosphonate-Related
Osteonecrosis of the Jaw, a condensed
version 2 of which was published in
print JCDA Issue 4, 2013, the author
presents a case report involving the
treatment of a patient with multiple myeloma who had previously
been treated with intravenous (IV)
bisphosphonates.
We would like to congratulate the
author for the treatment results and
the quality of the figures provided.
However, we disagree with the author’s conclusions to the effect that “…
patients with low CTX values should
not be indefinitely categorized as
‘high risk’…”.1 As mentioned in the
introduction of the article, the use of
CTX to assess the risk of potential
osteonecrosis of the jaw is highly controversial, and no professional association (e.g., American Association
of Oral and Maxillofacial Surgeons,
Canadian Association of Oral and
Maxillofacial Surgeons, Professional
Association of Oral and Maxillofacial
Surgeons of Quebec) recommends this
test for stratifying the risk of developing this complication. 3,4 The case
• 16 •
ca
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
presented in the article demonstrates
a high risk given the patient’s pharmacological history (oncological-dose
zolendronate and corticosteroids),
independent of the CTX value.
The author also proclaims that
the patient was treated “on the basis
of the expert panel recommendations
for patients receiving bisphosphonate
therapy…”.1 However, the recommendations cited by the author refer to
patients treated with oral bisphosphonates, and do not apply to this particular case. 5 Moreover, more recent
recommendations exist.6 We believe
it is risky to formulate a scientific
opinion based on a case report, and
is in fact, contrary to the principle of
evidence-based medicine.
Drs. Carl Bouchard and Michel Fortin
Quebec City, QC
References
The complete list of references is available online.
The Author Responds
I
would like to thank Drs. Bouchard
and Fortin for their letter and would
put forth the following clarifications.
As the abridged print version of my
article1 contained only one case to
pique readers’ interest, it may be possible to draw incorrect or incomplete
conclusions, namely that intravenous
(IV) bisphosphonate (BP) patients
should no