Does inflammatory dental disease affect the development of medication-related osteonecrosis of the jaw in patients using
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ORIGINAL ARTICLE
Does inflammatory dental disease affect the development of medication-related osteonecrosis of the jaw in patients using high-dose bone-modifying agents? Nobuhiro Ueda 1 & Chie Nakashima 1 & Kumiko Aoki 1 & Hiroko Shimotsuji 1 & Kazuhiko Nakaue 1 & Hajime Yoshioka 1 & Satoshi Kurokawa 1,2 & Yuichiro Imai 1,2 & Tadaaki Kirita 1 Received: 27 May 2020 / Accepted: 7 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives 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. Materials and methods 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. Results 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). Conclusions Radiopaque changes in bone surrounding the root are an important radiographic finding that indicates the need for prophylactic tooth extractions before starting BMA therapy. Clinical relevance 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. Keywords Bisphosphonate . Bone-modifying agent . Denosumab . Inflammatory dental disease . Medication-related osteonecrosis of the jaw (MRONJ)
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00784-020-03632-7) contains supplementary material, which is available to authorized users. * Nobuhiro Ueda [email protected] 1
Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
2
Department of Oral and Maxillofacial Surgery, Rakuwakai Otowa Hospital, Yamashina-ku, Kyoto 607-8062, Japan
Bone-modifying agents (BMAs), such as bisphosphonates (BP) and denosumab (Dmab), are essential for the treatment of cancer patients with bone metastases. By suppressing bone remodeling, BMAs reduce not only the o
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