Does inflammatory dental disease affect the development of medication-related osteonecrosis of the jaw in patients using high-dose bone-modifying agents?

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.

Automated summary

In cancer patients with bone metastases, high-dose bone-modifying agents are essential for treatment, but can also increase the risk of medication-related osteonecrosis of the jaw (MRONJ). Inflammatory dental diseases can contribute to MRONJ, and characteristics such as location of teeth, radiographic changes, and tooth extractions after BMA therapy initiation are associated with MRONJ occurrence. Radiographic changes in bone surrounding the tooth roots are important indicators for prophylactic tooth extractions before starting BMA therapy.