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01-01-2019 | Original Article

Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study

Authors: T. Hasegawa, S. Hayashida, E. Kondo, Y. Takeda, H. Miyamoto, Y. Kawaoka, N. Ueda, E. Iwata, H. Nakahara, M. Kobayashi, S. Soutome, SI. Yamada, I. Tojyo, Y. Kojima, M. Umeda, S. Fujita, H. Kurita, Y. Shibuya, T. Kirita, T. Komori, Japanese Study Group of Co-operative Dentistry with Medicine (JCDM)

Published in: Osteoporosis International | Issue 1/2019

Abstract

Summary

Root amputation, immunosuppressive therapy, mandibular tooth extraction, pre-existing inflammation, and longer duration of treatment with bone-modifying agents were significantly associated with an increased risk of medication-related osteonecrosis of the jaw. Hopeless teeth should be extracted without drug holiday before the development of inflammation in cancer patients receiving high-dose bone-modifying agents.

Introduction

No studies have comprehensively analyzed the influence of pre-existing inflammation, surgical procedure–related factors such as primary wound closure, demographic factors, and drug holiday on the incidence of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this study was to retrospectively investigate the relationships between these various factors and the development of MRONJ after tooth extraction in cancer patients receiving high-dose bone-modifying agents (BMAs) such as bisphosphonates or denosumab.

Methods

Risk factors for MRONJ after tooth extraction were evaluated with univariate and multivariate analyses. The following parameters were investigated in all patients: demographics, type and duration of BMA use, whether BMA use was discontinued before tooth extraction (drug holiday), the duration of such discontinuation, the presence of pre-existing inflammation, and whether additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed.

Results

We found that root amputation (OR = 22.62), immunosuppressive therapy (OR = 16.61), extraction of mandibular teeth (OR = 12.14), extraction of teeth with pre-existing inflammation, and longer duration (≥ 8 months) of high-dose BMA (OR = 7.85) were all significantly associated with MRONJ.

Conclusions

Tooth extraction should not necessarily be postponed in cancer patients receiving high-dose BMA. The effectiveness of a short-term drug holiday was not confirmed, as drug holidays had no significant impact on MRONJ incidence. Tooth extraction may be acceptable during high-dose BMA therapy until 8 months after initiation.

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Title: Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study
Authors: T. Hasegawa
S. Hayashida
E. Kondo
Y. Takeda
H. Miyamoto
Y. Kawaoka
N. Ueda
E. Iwata
H. Nakahara
M. Kobayashi
S. Soutome
SI. Yamada
I. Tojyo
Y. Kojima
M. Umeda
S. Fujita
H. Kurita
Y. Shibuya
T. Kirita
T. Komori
Japanese Study Group of Co-operative Dentistry with Medicine (JCDM)
Publication date: 01-01-2019
Publisher: Springer London
Published in: Osteoporosis International / Issue 1/2019
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-018-4746-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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