Does inflammatory dental disease affect the development of medication-related osteonecrosis of the jaw in patients using high-dose bone-modifying agents?
| Autor: | Hajime Yoshioka, Yuichiro Imai, Nobuhiro Ueda, Kazuhiko Nakaue, Tadaaki Kirita, Hiroko Shimotsuji, Satoshi Kurokawa, Kumiko Aoki, Chie Nakashima |
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| Rok vydání: | 2020 |
| Předmět: |
Molar
medicine.medical_treatment Dentistry 03 medical and health sciences 0302 clinical medicine stomatognathic system Neoplasms Oral and maxillofacial pathology medicine Humans General Dentistry Bone Density Conservation Agents Diphosphonates business.industry Proportional hazards model Mandible Cancer 030206 dentistry Bisphosphonate medicine.disease stomatognathic diseases Denosumab 030220 oncology & carcinogenesis Tooth Extraction Bisphosphonate-Associated Osteonecrosis of the Jaw business Osteonecrosis of the jaw medicine.drug |
| Zdroj: | Clinical Oral Investigations. 25:3087-3093 |
| ISSN: | 1436-3771 1432-6981 |
| DOI: | 10.1007/s00784-020-03632-7 |
| Popis: | High-dose bone–modifying agents (BMAs), such as bisphosphonates and denosumab, are essential for the treatment of cancer patients with bone metastases. The incidence of medication-related osteonecrosis of the jaw (MRONJ) is increasing. Inflammatory dental diseases could lead to MRONJ, and hence, they should be managed appropriately. Tooth extractions are commonly advised to prevent dental inflammation; however, the accurate indications for tooth extractions before starting BMA therapy have not been established. Hence, we assessed teeth with inflammatory dental diseases to identify indicators for prophylactic extraction before starting BMA therapy. We included 745 teeth with inflammatory dental diseases of 212 cancer patients on high-dose BMA therapy. We assessed the relationship between inflammatory dental disease and risk of MRONJ development. Multivariate Cox regression analysis was used for statistical analysis. The cumulative occurrence rate of MRONJ was calculated using the Kaplan–Meier method. MRONJ occurred in 43 of 745 teeth. Teeth characteristics significantly correlated with MRONJ occurrence were mandible (p = 0.009), molar region (p = 0.005), radiopaque changes in bone surrounding the root on orthopantograms obtained at patients’ first visits (p < 0.001), and tooth extractions after starting BMA therapy (p < 0.001). Radiopaque changes in bone surrounding the root are an important radiographic finding that indicates the need for prophylactic tooth extractions before starting BMA therapy. Our results suggest that the prophylactic extraction of teeth with radiopaque changes in bone surrounding the root before starting BMA therapy could prevent the onset of MRONJ. |
| Databáze: | OpenAIRE |
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