Dental risk factors for osteonecrosis of the jaws: a CONDOR case–control study

Abstract

Background Reports of osteonecrosis of the jaw (ONJ) have associated this lesion to treatment with bisphosphonates (BPs) and dental procedures. In this study, we investigated the association of specific dental diagnoses and procedures with ONJ among patients with past BP use. Methods Dentists from three Practice-Based Research Networks provided ONJ cases and controls (1:3). Data gathered from patients and dental offices with two respective standard questionnaires included demographic, medical, pharmaceutical, and dental information. Diagnoses and procedures up to three years prior to ONJ (prior to interview for controls) were analyzed within risk strata, defined by BP use and cancer status, using interaction terms within conditional logistic regression models. Results We enrolled 191 ONJ cases and 573 controls from 119 dental offices. Among participants who had used only oral BP, extraction was the only dental risk factor for ONJ (OR=12, p=0.01). Suppuration was also more prevalent in cases (18%) than in controls (9%), but not statistically significant (OR=9, p=0.06). Among participants who had not used either oral or IV BP (a majority of whom received RT to the head and neck), suppuration was the only dental risk factor for ONJ (prevalence=34% for cases and 8% for controls; OR=7, p=0.01). The prevalence of extractions in this group was also higher, but not statistically significant (44% vs 10%; OR=3). Limited power precludes definitive findings among participants exposed to IV BP. Conclusions Among patients taking oral BP, extraction was the only dental procedure associated with subsequent ONJ development. Clinical Relevance Results of this study suggest that routine dental procedures are not associated with development of ONJ in patients exposed to BPs.

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

“…The drug dose and the cumulative dose play a role in the initiation of necrosis, as well as the specific type of BP used [4]. Even if the longer-term use of oral BPs should have a dose equivalence effect [48], it is notable that the mean time of presentation was approximately 3 yrs (38 months) in the patients in this study, as already described in the literature [12,16,35].…”

Osteonecrosis of the Jaw Developed in Mice

“…gingiva or palatal tissue, is composed of stratified epithelium and thin connective tissue; furthermore, it is considered to be one of the most protective tissue barriers against physical and chemical damage, bacterial infection, and environmental stress (14). Case control studies of patients with ONJ have indicated an increased risk of developing this condition with tooth extraction or the use of ill-fitting removable dental prostheses (15,16). These "event-related" oral conditions among BPtreated patients can lead to inflammation in the oral mucosa tissue that likely activates oral barrier immunity.…”

Use of bisphosphonates and the risk of osteonecrosis among cancer patients: a systemic review and meta-analysis of the observational studies

“…Finally, eight studies met the inclusion criteria. The eight included studies were comprised of 1,389 cases and 569,620 controls [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Of the included studies, two were case-control studies, and the remaining six were cohort studies.…”