ABSTRACT
Aims To determine the incidence of medication-related osteonecrosis of the jaw in patients prescribed oral bisphosphonate medication following dental extraction in a dedicated clinic within the Department of Oral Surgery of King's College Hospital. The effect of factors such as sex, duration of therapy, medical comorbidities and site of extraction, which have previously been reported to significantly affect the risk of developing osteonecrosis of the jaw, was also examined.Materials and methods Data were gathered from the dental records of patients who had extractions over an eight-year period and were included in this retrospective study. Patients with previous or current exposure to intravenous bisphosphonates, denosumab, novel-targeted chemotherapies used in the oncology setting or radiotherapy to the head and neck were excluded from this study.Results The incidence of medication-related osteonecrosis of the jaw following tooth extraction in this group of 652 was 0.8%. A significantly increased risk of developing medication-related osteonecrosis of the jaw was evident in patients prescribed oral bisphosphonates for four years or more (p = 0.02), with an incidence in this group of 1.6%.Conclusion This study demonstrates that, following dental extraction, patients who are prescribed oral bisphosphonates are at risk of developing medication-related osteonecrosis of the jaw and that this risk increases significantly when the patient has been taking the bisphosphonate for four years or more.
ABSTRACT
This report provides important background information on osteoporosis (OP) and bone complications of cancer for the dental team, and discusses why bisphosphonate (BP) therapy is vital for patients with the two conditions. It also addresses several questions, including in particular: 'Is withholding BP therapy the best way to prevent osteonecrosis of the jaw (ONJ) occurrence?' Also,'Of the two, which is more important: ONJ or OP fracture prevention?' CPD/Clinical Relevance: BP therapy offers OP patients the promise of a fracture-free life and the prevention of fracture-related pain, disability, loss of qualify of life (QOL) and the shortening of life. Without BP therapy, the lifetime risk of fracture occurrence in OP patients is as high as 1 in 2 women and 1 in 5 men; whilst using it, the relative risk of ONJ occurrence is as low as between 1 in 10, 000 and 1 in 100, 000. To cancer patients with bone complications, it offers the much needed pain relief and improvement in QOL. In cancer patients, the risk of ONJ is almost 100 times higher but, despite that, oncologists advocate BP therapy for virtually all the patients. Therefore, when prescribed, BP therapy merits the whole-hearted support of the dental team.
