The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 1: an overview

Patel, Virjen; Grossman, Sebastian P.; Wali, Rana; Burns, Megan; Patel, Sheelen; Sassoon, Isabel; Henien, Marianne

doi:10.1038/s41415-021-3825-y

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…On the contrary, less is known about the role of immunotherapy and its role and impact on ORN as this novel treatment is not routinely used in the curative HNC setting. Finally, one patient received intravenous bisphosphonates which is routinely used to manage bone metastases 17 . This medicine is well recognised to cause ONJ and provides yet another complexity to the management of ORN in this palliative group.…”

Section: Discussionmentioning

confidence: 99%

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The management of osteoradionecrosis in palliative head and neck cancer patients

AlHakim,

Jawad,

Sproat

et al. 2024

Oral Surgery

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ObjectiveOsteoradionecrosis (ORN) is a well‐recognised complication of radiotherapy in the cured head and neck cancer (HNC) patients. More recently with improved survivorship in the palliative HNC group, there is an increasing population that is also burdened by radiation late effects such as ORN. Currently, there is no proven approach to manage ORN in this cohort of patients. This study reports the management and outcome of a case series of palliative care HNC patients with established ORN.Materials and MethodsThe clinical records of 20 palliative care HNC patients with an established ORN diagnosis were identified and reviewed retrospectively.ResultsAll 20 patients were managed via a conservative approach. Medical management via PENTO (n = 4, 20%) or PENTOCLO (n = 8, 40%) was the most popular approach. All but two patients had ORN that healed (4/20, 20%), or was stabilised (14/20, 70%). The two patients with progressive ORN had a tumour diagnosis adjacent to the necrotic site.ConclusionMedical management via PENTO/CLO provided promising results in this small cohort of palliative patients with ORN. The overall combined healing and stability of ORN status are comparable to those in the literature, though most cases are stabilised as opposed to cured.

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Section: Discussionmentioning

confidence: 99%

“…Finally, one patient received intravenous bisphosphonates which is routinely used to manage bone metastases. 17 This medicine is well recognised to cause ONJ and provides yet another complexity to the management of ORN in this palliative group. It is not restricted to just bone metastases and more commonly used in osteoporosis patients.…”

Section: Discussionmentioning

confidence: 99%

The management of osteoradionecrosis in palliative head and neck cancer patients

AlHakim,

Jawad,

Sproat

et al. 2024

Oral Surgery

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“…10,18 Metastatic cancer patients with longer survival times will accumulate more anti-resorptive agents which can lead to increasing risk of medicationrelated osteonecrosis of the jaw. 25 Additionally, research has shown that a substantial proportion of cancer patients with bone metastasis suffer from signi cant physical and psychological challenges, leading to a decline in their overall health-related quality of life. 26 In line with these ndings, our results also demonstrated that patients with bone metastasis had elevated scores in various domains of the OHIP-14 questionnaire.…”

Section: Discussionmentioning

confidence: 99%

Oral Hygiene, Dental Status, and Quality of Life in cancer patients with Medication related osteonecrosis of the jaws- A cross sectional study: Part 2.

Gurav,

Dholam,

Singh

et al. 2024

Preprint

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Purpose. Oral health has been considered a critical component of MRONJ. However, there remains a gap in research concerning the role of oral health status and burden of dental disease on quality of life in patients with MRONJ. The objective of this article (part 2) is to evaluate the influence of oral hygiene, dental status and oral health related quality of life in cancer patients affected with MRONJ. Methods. A cross-sectional study was conducted from May 2021 to November 2022 in the Department of Dental and Prosthetic Surgery at Tata Memorial Hospital. A total of 30 cancer patients diagnosed with MRONJ who provided written consent were included in the study. The Oral health impact-14 (OHIP-14) questionnaire was employed to assess the patient's oral health related QoL and simplified oral health index scores (OHI-S), Decayed, missing, filled teeth score (DMFT), and pertinent dental history that triggered the necrosis were recorded. Results.The mean age of the patients was 62 years. Our findings demonstrated significant correlation between poor oral health status and MRONJ.The mean total OHIP-14 was 20.7 (± 14). The highest mean was found for the psychological discomfort (4.0 ± 2.3). Higher total OHIP-14 score significantly correlated with a history of surgery for primary disease, presence of comorbidities, and bone metastasis. Poor dental status characterized by dental extractions and decayed teeth contributed to more psychological discomfort, whereas patients with DMFT score in the range of 15-28 had significantly more functional limitations. Conclusion. Our findings underscore the importance of increased awareness of MRONJ risks, maintaining optimal oral hygiene, and adopting an interdisciplinary preventive approach for cancer patients receiving ARD’s and antiangiogenics ultimately contributing to an improved oral health related quality of life.

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“…In a recent series examining the dental status of 492 patients with bone metastases requiring BMAs, mean survival following diagnosis was as high as 34.3 months in metastatic prostate cancer and 28.6 months in metastatic breast cancer. 62 The increased survival in these tumour groups translates to patients receiving increased cumulative doses of BMAs, which ultimately increases a patient’s risk of developing MRONJ. In addition to this the percentage of edentate individuals in the ageing population is declining.…”

Section: Mronjmentioning

confidence: 99%

Osteonecrosis of the jaw in primary dental care: Recognition and referral

Burns

Patel

2022

Prim Dent J

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Osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) are uncommon conditions, however when present they have a significant impact on a patient’s quality of life and are notoriously difficult to treat. With medical advances resulting in improved survival rates and increased life expectancy, it is likely that general dental practitioners (GDPs) will more frequently be involved in the oral health management of patients at risk of both ORN and MRONJ. Though management of both diseases is beyond the scope of primary care dentistry, the GDP still has a key role in the patient’s overall care. It is therefore important to have a good understanding of these conditions and their consequences for dental treatment in order to provide adequate patient support. Management requires a multidisciplinary approach to treatment and as part of this GDPs are integral in prevention, early recognition and maintenance of oral health following diagnosis. This article aims to refresh the reader’s knowledge regarding MRONJ and ORN and support the GDP in managing this patient group.

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The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 1: an overview

Cited by 10 publications

References 15 publications

The management of osteoradionecrosis in palliative head and neck cancer patients

The management of osteoradionecrosis in palliative head and neck cancer patients

Oral Hygiene, Dental Status, and Quality of Life in cancer patients with Medication related osteonecrosis of the jaws- A cross sectional study: Part 2.

Osteonecrosis of the jaw in primary dental care: Recognition and referral

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