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18.06.2021 | Original Article

Oral health condition in cancer patients under bisphosphonate therapy

verfasst von: Rogério Jardim Caldas, Héliton Spíndola Antunes, Camila de Oliveira Rodini Pegoraro, Fábio Ribeiro Guedes, Paulo Sérgio da Silva Santos

Erschienen in: Supportive Care in Cancer | Ausgabe 12/2021

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Abstract

Objectives

To investigate the association of oral health condition with the occurrence of medication-related osteonecrosis of the jaw (MRONJ) in a cancer population.

Methods

A multicenter cross-sectional study was conducted with cancer patients exposed to bisphosphonates for at least 7 months. Dental and periodontal conditions were assessed by epidemiological indices.

Results

The sample consisted of 80 patients under bisphosphonate therapy, nine of which were allocated to group 1 (with MRONJ) and 71 to group 2 (without MRONJ). Osteonecrosis cases presented 19 decayed, missing, and filled teeth on average. Moderate gingival inflammation was noted in both groups and together with severe inflammation exceeded 50% of the groups. The presence of dental calculus was detected in about half of the individuals in both groups. Shallow periodontal pockets were detected in about 25% of both groups. Deep periodontal pockets were more prevalent among patients with osteonecrosis. Regular oral hygiene was detected in approximately 25% of individuals in both groups. There was a strong positive correlation between the clinical staging of osteonecrosis and decayed, missing, and filled teeth index (DMFTI).

Conclusions

Patients had a poor oral health condition. All but one osteonecrosis case had no previous history of tooth extraction; oral infections seemed to play a major role in the development of bone necrosis. Advanced osteonecrosis stages were associated with a higher DMFTI.

Wan JT, Sheeley DM, Somerman MJ, Lee JS (2020) Mitigating osteonecrosis of the jaw (ONJ) through preventive dental care and understanding of risk factors. Bone Res 8:1–12. https://doi.org/10.1038/s41413-020-0088-1CrossRef

Nicolatou-Galitis O, Papadopoulou E, Vardas E, Kouri M, Galiti D, Galitis E, Alexiou KE, Tsiklakis K, Ardavanis A, Razis E, Athanasiadis I, Droufakou S, Psyrri A, Karamouzis MV, Linardou H, Daliani D, Tzanninis D, Sachanas S, Laschos K, Kyrtsonis MC, Antoniou F, Laskarakis A, Giassas S, Nikolaidi A, Rigakos G, Ntokou A, Migliorati CA, Ripamonti CI (2020) Alveolar bone histological necrosis observed prior to extractions in patients, who received bone-targeting agents. Oral Dis 26:955–966. https://doi.org/10.1111/odi.13294CrossRefPubMed

Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F (2014) American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014. J Oral and Maxillofac Surg 72:1938–1956. https://doi.org/10.1016/j.joms.2014.04.031CrossRef

Soares MQS, Van Dessel J, Jacobs R, da Silva Santos PS, Cestari TM, Garlet GP, Duarte MAH, Imada TSN, Lambrichts I, Rubira-Bullen IRF (2018) Zoledronic acid induces site-specific structural changes and decreases vascular area in the alveolar bone. J Oral and Maxillofac Surg 76:1893–1901. https://doi.org/10.1016/j.joms.2018.03.007CrossRef

Katsarelis H, Shah NP, Dhariwal DK, Pazianas M (2015) Infection and medication-related osteonecrosis of the jaw. J Dental Res 94:534–539. https://doi.org/10.1177/0022034515572021CrossRef

[WHO] WORLD HEALTH ORGANIZATION (2013) Oral health surveys: basic methods. WHO, Monts

Löe H, Silness J (1963) Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 21:533–551. https://doi.org/10.3109/00016356309011240CrossRefPubMed

Greene JG, Vermillion JR (1964) The simplified oral hygiene index. J Am Dent Assoc 68:7–13. https://doi.org/10.14219/jada.archive.1964.0034CrossRefPubMed

Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G, Koutsoukou V, Gika D, Anagnostopoulos A, Papadimitriou C, Terpos E, Dimopoulos MA (2005) Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23:8580–8587. https://doi.org/10.1200/jco.2005.02.8670CrossRefPubMed

10.

Durie BGM, Katz M, Crowley J (2005) Osteonecrosis of the jaw and bisphosphonates. N Engl J Med 353:99–102. https://doi.org/10.1056/NEJM200507073530120CrossRefPubMed

11.

Dimopoulos MA, Kastritis E, Anagnostopoulos A, Melakopoulos I, Gika D, Moulopoulos LA, Bamia C, Terpos E, Tsionos K, Bamias A (2006) Osteonecrosis of the jaw in patients with multiple myeloma treated with bisphosphonates: evidence of increased risk after treatment with zoledronic acid. Haematologica 91:968–971. https://doi.org/10.3324/%25xCrossRefPubMed

12.

Wang EP, Kaban LB, Strewler GJ, Raje N, Troulis MJ (2007) Incidence of osteonecrosis of the jaw in patients with multiple myeloma and breast or prostate cancer on intravenous bisphosphonate therapy. J Oral and Maxillofac Surg 65:1328–1331. https://doi.org/10.1016/j.joms.2007.03.006CrossRef

13.

Boonyapakorn T, Schirmer I, Reichart PA, Sturm I, Massenkeil G (2008) Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies. Oral Oncol 44:857–869. https://doi.org/10.1016/j.oraloncology.2007.11.012CrossRefPubMed

14.

Walter C, Al-Nawas B, Grötz KA, Thomas C, Thüroff JW, Zinser V, Gamm H, Beck J, Wagner W (2008) Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate. Eur Urol 54:1066–1072. https://doi.org/10.1016/j.eururo.2008.06.070CrossRefPubMed

15.

Stumpe MR, Chandra RK, Yunus F, Samant S (2009) Incidence and risk factors of bisphosphonate-associated osteonecrosis of the jaws. Head Neck 31:202–206. https://doi.org/10.1002/hed.20941CrossRefPubMed

16.

Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG, Boukovinas I, Koloutsos GE, Teleioudis Z, Kitikidou K, Paraskevopoulos P, Zervas K, Antoniades K (2009) Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin OncoL 27:5356–5362. https://doi.org/10.1200/jco.2009.21.9584CrossRefPubMed

17.

Scagliotti GV, Hirsh V, Siena S, Henry DH, Woll PJ, Manegold C, Solal-Celigny P, Rodriguez G, Krzakowski M, Mehta ND, Lipton L, García-Sáenz JA, Pereira JR, Prabhash K, Ciuleanu TE, Kanarev V, Wang H, Balakumaran A, Jacobs I (2012) Overall survival improvement in patients with lung cancer and bone metastases treated with denosumab versus zoledronic acid: subgroup analysis from a randomized phase 3 study. J Thorac Oncol 7:1823–1829. https://doi.org/10.1097/JTO.0b013e31826aec2bCrossRefPubMed

18.

Kajizono M, Sada H, Sugiura Y, Soga Y, Kitamura Y, Matsuoka J, Sendo T (2015) Incidence and risk factors of osteonecrosis of the jaw in advanced cancer patients after treatment with zoledronic acid or denosumab: a retrospective cohort study. Biol Pharm Bull 38:1850–1855. https://doi.org/10.1248/bpb.b15-00385CrossRefPubMed

19.

Kos M (2015) Incidence and risk predictors for osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. Arch Med Sci 11:319–324. https://doi.org/10.5114/aoms.2015.50964CrossRefPubMedPubMedCentral

20.

Manfredi M, Mergoni G, Goldoni M, Salvagni S, Merigo E, Meleti M, Vescovi P (2017) A 5-year retrospective longitudinal study on the incidence and the risk factors of osteonecrosis of the jaws in patients treated with zoledronic acid for bone metastases from solid tumors. Med Oral Patol Oral Cir Bucal 22:e342–e348. https://doi.org/10.4317/medoral.21728CrossRefPubMed

21.

Loyson T, Van Cann T, Schöffski P, Clement PM, Bechter O, Spriet I, Coropciuc R, Politis C, Vandeweyer RO, Schoenaers J, Dumez H, Berteloot P, Neven P, Nackaerts K, Woei-A-Jin FJSH, Punie K, Wildiers H, Beuselinc B (2018) Incidence of osteonecrosis of the jaw in patients with bone metastases treated sequentially with bisphosphonates and denosumab. Acta Clin Belg 73:100–109. https://doi.org/10.1080/17843286.2017.1348001CrossRefPubMed

22.

Hallmer F, Bjarnadottir O, Götrick B, Malmström P, Andersson G (2020) Incidence of and risk factors for medication-related osteonecrosis of the jaw in women with breast cancer with bone metastasis: a population-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 130:252–257. https://doi.org/10.1016/j.oooo.2020.04.808CrossRefPubMed

23.

Stearns-Reider KM, D’Amore A, Beezhold K, Rothrauff B, Cavalli L, Wagner WR, Vorp DA, Tsamis A, Shinde S, Zhang C, Barchowsky A, Rando TA, Tuan RS, Ambrosio F (2017) Aging of the skeletal muscle extracellular matrix drives a stem cell fibrogenic conversion. Aging Cell 16:518–528. https://doi.org/10.1111/acel.12578CrossRefPubMedPubMedCentral

24.

Rogers MJ, Mönkkönen J, Munoz MA (2020) Molecular mechanisms of action of bisphosphonates and new insights into their effects outside the skeleton. Bone 139:115493. https://doi.org/10.1016/j.bone.2020.115493CrossRefPubMed

25.

Kos M (2014) Association of dental and periodontal status with bisphosphonate-related osteonecrosis of the jaws. A retrospective case-controlled study. Arch Med Sci 10:117–123. https://doi.org/10.5114/aoms.2014.40738CrossRefPubMedPubMedCentral

26.

Niibe K, Ouchi T, Iwasaki R, Nakagawa T, Horie N (2015) Osteonecrosis of the jaw in patients with dental prostheses being treated with bisphosphonates or denosumab. J Prosthodont Res 59:3–5. https://doi.org/10.1016/j.jpor.2014.08.001CrossRefPubMed

27.

Borke JL, McAllister B, Harris T, Neiberg M, Guevarra-Toth C, Fulzele S, Stoianovici C, Guerra C (2015) Correlation of changes in the mandible and retina/choroid vasculature of a rat model of BRONJ. J Craniomaxillofac Surg 43:1144–1150. https://doi.org/10.1016/j.jcms.2015.05.021CrossRefPubMed

28.

Kapitola J, Zak J (1998) Effect of pamidronate on bone blood flow in oophorectomized rats. Physiol Res 47:237–240PubMed

29.

Barasch A, Cunha-Cruz J, Curro FA, Hujoel P, Sung AH, Vena D, Voinea-Griffin AE, Beadnell S, Craig RG, DeRouen T, Desaranayake A, Gilbert A, Gilbert GH, Goldberg K, Hauley R, Hashimoto M, Holmes J, Latzke B, Leroux B, Lindblad A, Richman J, Safford M, Ship J, Thompson VP, Williams OD, Yin W (2011) Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN. J Dent Res 90:439–444. https://doi.org/10.1177/0022034510397196CrossRefPubMedPubMedCentral

30.

Soutome S, Hayashida S, Funahara M, Sakamoto Y, Kojima Y, Yanamoto S, Umeda M (2018) Factors affecting development of medication- related osteonecrosis of the jaw in cancer patients receiving high-dose bisphosphonate or denosumab therapy: Is tooth extraction a risk factor? PLoS ONE 13:e0201343. https://doi.org/10.1371/journal.pone.0201343CrossRefPubMedPubMedCentral

31.

Nisi M, La Ferla F, Karapetsa D, Gennai S, Miccoli M, Baggiani A, Graziani F, Gabriele M (2015) Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: a multivariate analysis. Int J Oral and Maxillofac Surg 44:586–591. https://doi.org/10.1016/j.ijom.2015.01.014CrossRef

32.

Saad F, Brown JE, Van Poznak C, Ibrahim T, Stemmer SM, Stopeck AT, Diel IJ, Takahashi S, Shore N, Henry DH, Barrios CH, Facon T, Senecal F, Fizazi K, Zhou L, Daniels A, Carrière P, Dansey R (2012) Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Ann Oncol 23:1341–1347. https://doi.org/10.1093/annonc/mdr435CrossRefPubMed

33.

Carmagnola D, Celestino S, Abati S (2008) Dental and periodontal history of oncologic patients on parenteral bisphosphonates with or without osteonecrosis of the jaws: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 106:e10–e15. https://doi.org/10.1016/j.tripleo.2008.07.011CrossRef

34.

Watters AL, Hansen HJ, Williams T, Chou JF, Riedel E, Halpern J, Tunick S, Bohle G, Huryn JM, Estilo CL (2013) Intravenous bisphosphonate-related osteonecrosis of the jaw: long-term follow-up of 109 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 115:192–200. https://doi.org/10.1016/j.oooo.2012.05.017CrossRefPubMed

35.

Kastritis E, Melea P, Bagratuni T, Melakopoulos I, Gavriatopoulou M, Roussou M, Migkou M, Eleutherakis-Papaiakovou E, Terpos E, Dimopoulos MA (2017) Genetic factors related with early onset of osteonecrosis of the jaw in patients with multiple myeloma under zoledronic acid therapy. Leuk Lymphoma 58:2304–2309. https://doi.org/10.1080/10428194.2017.1300889CrossRefPubMed

36.

Krimmel M, Ripperger J, Hairass M, Hoefert S, Kluba S, Reinert S (2014) Does dental and oral health influence the development and course of bisphosphonate-related osteonecrosis of the jaws (BRONJ)? Oral Maxillofac Surg 18:213–218. https://doi.org/10.1007/s10006-013-0408-3CrossRefPubMed

37.

Otto S, Pautke C, Martin Jurado O, Nehrbass D, Stoddart MJ, Ehrenfeld M, Zeiter S (2017) Further development of the MRONJ minipig large animal model. J Craniomaxillofac Surg 45:1503–1514. https://doi.org/10.1016/j.jcms.2017.07.002CrossRefPubMed

38.

Simpione G, Caldas RJ, Soares MQS, Rubira-Bullen IRF, Santos PSS (2020) Tomographic study of jaw bone changes in patients with bisphosphonate-related osteonecrosis. J Clin Exp Dent 12:e285–e290. https://doi.org/10.4317/jced.56265CrossRefPubMedPubMedCentral

39.

Dimopoulos MA, Kastritis E, Bamia C, Melakopoulos I, Gika D, Roussou M, Migkou M, Eleftherakis-Papaiakovou E, Christoulas D, Terpos E, Bamias A (2009) Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. Ann Oncol 20:117–120. https://doi.org/10.1093/annonc/mdn554CrossRefPubMed

40.

Owosho AA, Liang STY, Sax AZ, Wu K, Yom SK, Huryn JM, Estilo CL (2018) Medication-related osteonecrosis of the jaw: an update on the Memorial Sloan Kettering Cancer Center experience and the role of premedication dental evaluation in prevention. Oral Surg Oral Med Oral Pathol Oral Radiol 125:440–445. https://doi.org/10.1016/j.oooo.2018.02.003CrossRefPubMedPubMedCentral

Titel: Oral health condition in cancer patients under bisphosphonate therapy
verfasst von: Rogério Jardim Caldas
Héliton Spíndola Antunes
Camila de Oliveira Rodini Pegoraro
Fábio Ribeiro Guedes
Paulo Sérgio da Silva Santos
Publikationsdatum: 18.06.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 12/2021
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-021-06362-y

Springer Medizin

Oral health condition in cancer patients under bisphosphonate therapy