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Calabria E, Antonelli A, Barone S, Adamo D, Salviati M, Cerra MG, Bennardo F, Giudice A. Oral Health-Related Quality of Life and Mental Health Impairment in Patients Affected by Medication-Related Osteonecrosis of the Jaws: A Case-Control Pilot Study. Dent J (Basel) 2023; 11:147. [PMID: 37366670 DOI: 10.3390/dj11060147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
In the present case-control study, the impact of medication-related osteonecrosis of the jaws (MRONJ) on patients' oral health-related quality of life (OHRQoL), overall quality of life (QoL), and psychological status was evaluated using a set of questionnaires. These questionnaires included the Oral Health Impact Profile-14 (OHIP-14), the Short Form 36 Health Survey Questionnaire (SF-36), and the hospital anxiety and depression scale (HADS). A total of 25 MRONJ patients and 25 controls were included in the study. The results showed that MRONJ patients had a significantly poorer OHRQoL (OHIP-14 score p-value: 0.003) and lower general QoL, particularly in the domains of "physical functioning", "physical role", "body pain", "general health", and "vitality" in the SF-36 questionnaire (p-values: 0.001, 0.001, 0.013, 0.001, and 0.020). Although there were no significant differences between the groups in the SF-36 domains of "social functioning", "emotional role", and "mental health", the mean sub-scores of the HADS, specifically the depression and anxiety scores (HADS-D and HADS-A), were significantly higher in MRONJ patients (p-values: 0.002 and 0.009). However, the "mental health" domain of the SF-36 questionnaire showed a correlation with both HADS-A and HADS-D scores (p-values: 0.003 and 0.031). Therefore, a comprehensive clinical examination of MRONJ patients should include the assessment of OHRQoL, overall QoL, and psychological profile using different questionnaires. This approach aims to gather detailed information about patients' physical and psychological well-being, enabling the development of tailored treatments.
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Affiliation(s)
- Elena Calabria
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Alessandro Antonelli
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Daniela Adamo
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples "Federico II", 80131 Naples, Italy
| | - Marianna Salviati
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Maria Giulia Cerra
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Francesco Bennardo
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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Coropciuc R, Coopman R, Garip M, Gielen E, Politis C, Van den Wyngaert T, Beuselinck B. Risk of medication-related osteonecrosis of the jaw after dental extractions in patients receiving antiresorptive agents - A retrospective study of 240 patients. Bone 2023; 170:116722. [PMID: 36858337 DOI: 10.1016/j.bone.2023.116722] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
This study investigated the incidence, risk factors, and outcome of medication-related osteonecrosis of the jaw after dental extractions in patients receiving antiresorptive agents for osteoporosis or bone metastases. 240 patients with a median drug exposure of 43 months were retrospectively studied. The incidence of MRONJ after dental extraction in the osteoporosis cohort was 2.7 % per person-year (95 % CI 1.6-4.6 %) (n = 13/126), and for the bone metastases cohort 26.4 % per person-year (95 % CI 20.4-34.2 %) (n = 58/114). 92 % of MRONJ cases were stage 1. Dental infection as the reason for extraction increased the osteonecrosis risk in the osteoporosis (OR 22.77; 95 % CI 2.85-181.62; p = 0.003) and bone metastases cohorts (OR 2.72; 95 % CI 1.28-5.81; p = 0.010). Using leukocyte and platelet-rich fibrin reduced this risk by 84 % (p = 0.003), as did antibiotics use by 86-93 % (p = 0.013). Within the bone metastases cohort, an interval since last administration of at least 3 months reduced risk of MRONJ (OR 0.83; 95 % CI 0.72-0.97; p = 0.018). Mucosal healing occurred in 11/13 patients (84.6 %; 95 % CI 54.5-98.1 %) with osteoporosis and 31/58 patients (53.4 %; 95 % CI 40.0-66.7 %) with bone metastases. In conclusion, though the MRONJ risk in this selected population taking antiresorptive agents and presenting to the Oral Maxillofacial Surgery clinic for a dental extraction is considerable and higher in those with dental infections, preventive measures such as antibiotics and use of LRPF membranes may significantly reduce that risk.
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Affiliation(s)
- Ruxandra Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Belgium.
| | - Renaat Coopman
- Department of Oral and Maxillofacial and Plastic Surgery, University Hospital of Ghent, Belgium
| | - Melisa Garip
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Belgium
| | - Evelien Gielen
- Department of Geriatrics, University Hospital of Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Belgium
| | | | - Benoit Beuselinck
- Department of Medical Oncology, University Hospital of Leuven, Belgium
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Mauceri R, Coppini M, Attanasio M, Bedogni A, Bettini G, Fusco V, Giudice A, Graziani F, Marcianò A, Nisi M, Isola G, Leonardi RM, Oteri G, Toro C, Campisi G. MRONJ in breast cancer patients under bone modifying agents for cancer treatment-induced bone loss (CTIBL): a multi-hospital-based case series. BMC Oral Health 2023; 23:71. [PMID: 36739399 PMCID: PMC9899375 DOI: 10.1186/s12903-023-02732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/10/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer treatment-induced bone loss (CTIBL) is the most common adverse event experienced by patients affected by breast cancer (BC) patients, without bone metastases. Bone modifying agents (BMAs) therapy is prescribed for the prevention of CTIBL, but it exposes patients to the risk of MRONJ. METHODS This multicentre hospital-based retrospective study included consecutive non-metastatic BC patients affected by MRONJ related to exposure to low-dose BMAs for CTIBL prevention. Patients' data were retrospectively collected from the clinical charts of seven recruiting Italian centres. RESULTS MRONJ lesions were found in fifteen females (mean age 67.5 years), mainly in the mandible (73.3%). The mean duration of BMAs therapy at MRONJ presentation was 34.9 months. The more frequent BMAs was denosumab (53.3%). Ten patients (66.7%) showed the following local risk factors associated to MRONJ development: periodontal disease (PD) in three cases (20%) and the remaining six (40%) have undergone PD-related tooth extractions. One patient presented an implant presence-triggered MRONJ (6.7%). In five patients (33.3%) no local risk factors were observed. CONCLUSIONS This is the first case series that investigated BC patients under BMAs for CTIBL prevention suffering from MRONJ. These patients seem to have similar probabilities of developing MRONJ as osteo-metabolic ones. Breast cancer patients under BMAs for CTIBL prevention need a regular prevention program for MRONJ, since they may develop bone metastases and be treated with higher doses of BMAs, potentially leading to a high-risk of MRONJ.
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Affiliation(s)
- Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127, Palermo, PA, Italy.
| | - Martina Coppini
- grid.10776.370000 0004 1762 5517Present Address: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, PA Italy
| | - Massimo Attanasio
- grid.10776.370000 0004 1762 5517Department of Economics, Business and Statistics, University of Palermo, 90128 Palermo, Italy
| | - Alberto Bedogni
- grid.5608.b0000 0004 1757 3470Regional Center for Prevention, Diagnosis, and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
| | - Giordana Bettini
- grid.5608.b0000 0004 1757 3470Regional Center for Prevention, Diagnosis, and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
| | - Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera Di Alessandria SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Amerigo Giudice
- grid.411489.10000 0001 2168 2547School of Dentistry, Department of Health Sciences, Unit of Oral and Maxillofacial Surgery, “Magna Grecia” University of Catanzaro, 88100 Catanzaro, Italy
| | - Filippo Graziani
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Antonia Marcianò
- grid.10438.3e0000 0001 2178 8421Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy
| | - Marco Nisi
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gaetano Isola
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical Surgery Specialties, School of Dentistry, University of Catania, 95123 Catania, Italy
| | - Rosalia Maria Leonardi
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical Surgery Specialties, School of Dentistry, University of Catania, 95123 Catania, Italy
| | - Giacomo Oteri
- grid.10438.3e0000 0001 2178 8421Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy
| | - Corrado Toro
- Maxillofacial Surgery Unit, Clinica del Mediterraneo di Ragusa, 97100 Ragusa, Italy
| | - Giuseppina Campisi
- grid.10776.370000 0004 1762 5517Present Address: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, PA Italy ,University Hospital Policlinico “Paolo Giaccone” of Palermo, 90127, Palermo, Italy
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Comparing the Influence of Surgical and Conservative Therapy on Quality of Life in Patients with Early-Stage Medication-Related Osteonecrosis of the Jaw-A Prospective Longitudinal Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020277. [PMID: 36837478 PMCID: PMC9966476 DOI: 10.3390/medicina59020277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
Background and Objectives: The purpose of this study was to evaluate the impact of surgical and conservative, non-surgical treatment on general health-related (QoL) and oral health-related quality of life (OHRQoL) in patients suffering from AAOMS stage I MRONJ. Materials and Methods: In the course of this prospective clinical study, QoL and OHRQoL using QLQ-C30 and QHIP G14 questionnaire were longitudinally assessed in N = 174 prospectively enrolled patients with indication of treatment of MRONJ stage I over a period of 12 months. Patients received conservative or surgical treatment. The measurement time points were preoperatively (T0), 12 weeks (T1), 6 months (T2) and 1 year after operation (T3). Results: For OHRQoL, no significant (p > 0.05) differences were found between both treatment groups for all timepoints (T0-T3). In the surgical treatment group, OHIP scores of T1, T2 and T3 were significantly lower than baseline measures (T0) (T0-T1 (2.99, p = 0.024), T0-T2 (5.20, p < 0.001), T0-T3 (7.44, p < 0.001)). For conservative treatment group OHIP, scores of T2 and T3 were significantly lower than baseline measures (T0) (T0-T2 (9.09, p = 0.013), T0-T3 (12.79, p < 0.001)). There was no statistically significant effect of time on QLQ-C30 scores in both groups (surgical treatment: F(3, 174) = 1.542, p < 0.205, partial η2 = 0.026; conservative treatment: F(3, 30) = 0.528, p = 0.667, partial η2 = 0.050). QLQ-C30 scores turned out to be significantly lower in the non-surgical group at T1 (p = 0.036) and T3 (p = 0.047) compared to the surgical treatment group. Conclusions: Surgical and conservative treatment of MRONJ stage I significantly improves patients' OHRQoL. Surgical treatment is superior to conservative treatment of MRONJ stage I regarding general QoL. Therefore, surgical treatment of MRONJ stage I should not be omitted for QoL reasons.
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Winter A, Schulz SM, Schmitter M, Brands RC, Straub A, Kübler A, Borgmann A, Hartmann S. Oral-Health-Related Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw: A Prospective Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811709. [PMID: 36141982 PMCID: PMC9517310 DOI: 10.3390/ijerph191811709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 05/13/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) represents an adverse side effect of antiresorptive and antiangiogenic medications. It is associated with impaired quality of life, oral health, and oral function and can be classified into various stages. The purpose of this prospective clinical study is to evaluate the impact of stages I and II MRONJ on oral-health-related quality of life (OHRQoL) and related parameters. Patients' OHRQoL, satisfaction with life, oral discomfort, and oral health were assessed using the German version of the Oral Health Impact Profile (OHIP-G49), visual analog scales (VAS), and Satisfaction with Life Scale (SWLS) at baseline (T0), 10 days (T1), and 3 months after treatment (T2) in 36 patients. Data were analyzed using Kolmogorov-Smirnov test, two-way mixed ANOVAs, and follow-up Mann-Whitney U tests. The impact of treatment effects on the original seven OHIP domain structures and the recently introduced four-dimensional OHIP structure were evaluated using linear regression analysis. Thirty-six patients received surgical MRONJ treatment. Before treatment, patients' perceived OHRQoL, oral discomfort, oral health, and satisfaction with life were negatively affected by MRONJ. Surgical treatment significantly improved OHRQoL and related parameters (all p ≤ 0.012). This improvement was greater in patients with higher impairment at T0. OHRQoL and oral restrictions were still impaired after treatment in patients who needed prosthetic treatment. The four-dimensional structure revealed valuable information beyond the standard seven OHIP domains. Increased awareness of MRONJ risks and an interdisciplinary treatment approach for MRONJ patients are needed.
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Affiliation(s)
- Anna Winter
- Department of Prosthodontics, Julius Maximilian University Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
- Correspondence: ; Tel.: +49-(0)-931-201-73100
| | - Stefan M. Schulz
- Department of Behavioural Medicine and Principles of Human Biology for the Health Sciences, Trier University, Universitätsring 15, 54296 Trier, Germany
| | - Marc Schmitter
- Department of Prosthodontics, Julius Maximilian University Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Roman C. Brands
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Alexander Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Anna Borgmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
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Anastasilakis AD, Pepe J, Napoli N, Palermo A, Magopoulos C, Khan AA, Zillikens MC, Body JJ. Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS. J Clin Endocrinol Metab 2022; 107:1441-1460. [PMID: 34922381 PMCID: PMC9016445 DOI: 10.1210/clinem/dgab888] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Antiresorptive therapy significantly reduces fracture risk in patients with benign bone disease and skeletal-related events (SREs) in patients with bone metastases (BM). Osteonecrosis of the jaw (ONJ) is a rare but severe condition manifested as necrotic bone lesion or lesions of the jaws. ONJ has been linked to the use of potent antiresorptive agents, termed medication-related ONJ (MRONJ). OBJECTIVE We aimed to identify the differences various aspects of MRONJ among distinct patient categories and provide recommendations on how to mitigate the risk and optimally manage MRONJ in each of them. METHODS A working group of the European Calcified Tissue Society (ECTS) and 2 experts performed an updated detailed review of existing literature on MRONJ incidence, characteristics, and treatment applied in bone diseases with variable severity of skeletal insult, ranging from osteoporosis to prevention of cancer treatment-induced bone loss and SREs in cancer patients with BM. RESULTS The risk for MRONJ is much higher in patients with advanced malignancies compared to those with benign bone diseases because of the higher doses and more frequent administration of antiresorptive agents in individuals with compromised general health, along with coadministration of other medications that predispose to MRONJ. The overall risk for MRONJ is considerably lower than the benefits in all categories of patients. CONCLUSION The risk for MRONJ largely depends on the underlying bone disease and the relevant antiresorptive regimen applied. Physicians and dentists should keep in mind that the benefits of antiresorptive therapy far outweigh the risk for MRONJ development.
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Affiliation(s)
- Athanasios D Anastasilakis
- Department of Endocrinology, 424 General Military Hospital, 564 29 N Efkarpia Thessaloniki, Greece
- Correspondence: Athanasios D. Anastasilakis, PhD, Department of Endocrinology, 424 General Military Hospital, Ring Rd, 564 29 N Efkarpia, Thessaloniki, Greece.
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Christos Magopoulos
- Department of Oral and Maxillofacial Surgery, 424 General Military Hospital, 56429 Thessaloniki, Greece
| | - Aliya A Khan
- Division of Endocrinology and Metabolism and Geriatrics, McMaster University, L8N3Z5 Hamilton, Ontario, Canada
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, 2040 Rotterdam, the Netherlands
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium
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Influence of Preventive Tooth Extractions on Quality of Life in Patients with Antiresorptive Intake-A Prospective Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111650. [PMID: 34770164 PMCID: PMC8583437 DOI: 10.3390/ijerph182111650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022]
Abstract
Background: To find out whether preventive tooth extractions in patients on antiresorptive therapy have a direct impact on the patients’ overall quality of life (QoL); Methods: QoL using the five-level version of the EuroQol Group’s EQ-5D instrument (EQ-5D-5L) was longitudinally assessed in N = 114 prospectively enrolled patients with indication of preventive tooth extraction over a period of 12 months. Patients were stratified as high-risk (malignant disease with bone metastasis or multiple myeloma, with monthly high-dose antiresorptive therapy delivered intravenously [bisphosphonate] or subcutaneously [denosumab]) and low-risk/osteoporosis patients (weekly low-dose antiresorptive therapy administered orally [bisphosphonate] or half-yearly subcutaneously [denosumab]). The measurement time points were 4 weeks preoperatively (T0), 2 months (T1) and 1 year postoperatively (T2), respectively. Results: EQ-5D-5L index scores fell in a range from −0.21 to 1.00 in the low-risk group to 0.15 to 1.00 in the high-risk group. The t-test comparing the baseline index scores of both groups showed EQ-5D-5L index score in the low-risk group (0.708 ± 0.292) to be significantly smaller (p = 0.037) than in the high-risk group (0.807 ± 0.19). ANCOVA showed no significant differences in EQ-5D-5L index scores between the groups at T1 and T2. Conclusions: Preventive tooth extractions in patients undergoing antiresorptive treatment have no negative effect on QoL. Therefore, if indicated, preventive tooth extraction should not be omitted. Patient-oriented outcome measures are important to obtain a good risk–benefit balance for patient-specific treatment.
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Marcianò A, Ieni A, Mauceri R, Oteri G. CD34 and CD105 Microvessels in Resected Bone Specimen May Implicate Wound Healing in MRONJ. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111362. [PMID: 34769880 PMCID: PMC8582901 DOI: 10.3390/ijerph182111362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/16/2021] [Accepted: 10/23/2021] [Indexed: 01/18/2023]
Abstract
Clinical treatment outcome of MRONJ (medication-related osteonecrosis of the jaw) surgery despite radical osseous removal and primary closure healing still shows differences in terms of outcome and disease recurrence. The study aims to assess the rate of angiogenesis of MRONJ lesions in order to understand the impact of angiogenesis and neoangiogenesis status on MRONJ surgical treatment outcome. This is the first study correlating microvessel density with prognosis in MRONJ surgically-treated patients. The immunohistochemical expression of CD34 and CD105 in MRONJ specimens obtained from surgically-treated patients was evaluated. The most vascularized areas detected by CD34 and CD105 were selected and the microvessel density value of the samples was registered. Samples were retrospectively divided according to the clinical outcome of MRONJ surgical treatment, dividing patients into two groups, “healed” and “not healed”. Statistical analysis was performed to assess if neovessels could influence treatment outcome in patients undergoing radical surgery. In the examined cohort, this value was highly predictive of better treatment outcome after radical surgery of MRONJ. Understanding of angiogenesis-dependent factors deserves further attention as a future target for MRONJ prevention and therapies.
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Affiliation(s)
- Antonia Marcianò
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
- Correspondence:
| | - Antonio Ieni
- Department of Human Pathology of Adults and Developmental Age, Gaetano Barresi, University of Messina, 98124 Messina, Italy;
| | - Rodolfo Mauceri
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
- Department of Biomedical, Postgraduate School of Oral Surgery, Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy;
| | - Giacomo Oteri
- Department of Biomedical, Postgraduate School of Oral Surgery, Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy;
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Quality of life in patients affected by medication-related osteonecrosis of the jaws: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:182-189. [PMID: 33934955 DOI: 10.1016/j.oooo.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this systematic review was to describe the quality of life and oral health-related quality of life of patients affected by medication-related osteonecrosis of the jaw. STUDY DESIGN The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A combination of keywords and MeSH terms was used in PubMed, Scopus, Cochrane Library, Web of Science, and EBSCO up to December 13, 2020. RESULTS A total of 1066 results were obtained after duplicate exclusion and 11 articles were included in the final qualitative analysis. Most of the articles described the quality of life in patients with osteonecrosis of the jaw secondary to cancer treatment. The main drugs associated with the disease were bisphosphonates. Surgical treatment of the osteonecrosis improves the quality of life of these patients. CONCLUSIONS The present systematic review suggested the negative influence of osteonecrosis of the jaw on the quality of life and oral health-related quality of life among oncologic and osteoporotic patients. The use of quality of life questionnaires in daily practice could be an important tool to better diagnose and manage patients affected by osteonecrosis of the jaws who have received or are receiving drugs associated with this complication.
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Murphy J, Mannion C. Medication-related osteonecrosis of the jaws and quality of life: review and structured analysis. Br J Oral Maxillofac Surg 2020; 58:619-624. [DOI: 10.1016/j.bjoms.2020.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
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Marcianò A, Rubino E, Peditto M, Mauceri R, Oteri G. Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree. Life (Basel) 2020; 10:life10070099. [PMID: 32610675 PMCID: PMC7399969 DOI: 10.3390/life10070099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to standardize clinical decision making and maximize the success of oral surgical treatment of MRONJ. Methods: Different surgical approaches were categorized taking into consideration two variables (a) hard tissue management (defined as debridement, saucerization or marginal resective surgery of maxillary necrotic bone) and (b) soft tissue management (defined as type of flap design and related modality of wound-healing). Results: For the retrospective cohort study, 103 MRONJ patients were enrolled and a total of 128 surgical procedures were performed. The role of radical-intended surgery using local flaps in MRONJ treatment was investigated, as well as palliative treatments. All stage I–II patients completely healed when a combination of radical necrotic bone surgery associated with a first intention healing of soft tissues was obtained. In stage III, when a patient was not eligible for maxillo-facial surgery, the use of palliative surgical strategies was effective in symptom relief in order to maintain a better quality of life for the duration of the patient’s life. Conclusions: Oral surgery with radical intent associated with a flap design able to ensure first intention healing might represent a valid option for the majority of MRONJ patients. The designed decision tree allows clinicians to assess individual surgical approaches for MRONJ treatment in accordance with patient-centered outcomes and surgical skills.
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Affiliation(s)
- Antonia Marcianò
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy;
| | - Erasmo Rubino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (E.R.); (G.O.)
| | - Matteo Peditto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (E.R.); (G.O.)
- Correspondence:
| | - Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (E.R.); (G.O.)
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A Retrospective Observational Study of Risk Factors for Denosumab-Related Osteonecrosis of the Jaw in Patients with Bone Metastases from Solid Cancers. Cancers (Basel) 2020; 12:cancers12051209. [PMID: 32408510 PMCID: PMC7281320 DOI: 10.3390/cancers12051209] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/22/2022] Open
Abstract
This single-center retrospective observational study aimed to identify risk factors for developing denosumab-related osteonecrosis of the jaw (DRONJ) in stage IV solid cancer patients with bone metastases. In total, 123 consecutive patients who had received 120 mg of denosumab every 4 weeks at least twice between July 2014 and October 2018 were included. We surveyed their demographics, medical history, blood test, underlying disease, and intraoral findings. Fourteen patients (11.4%) developed DRONJ within a mean denosumab administration period of 4 months (range: 2-52 months). Univariate analyses showed a statistically significant correlation between DRONJ and hormone therapy, chemotherapy/molecular target drug, apical periodontitis, periodontal disease, sex and body mass index. Multivariate analysis showed a statistically significant correlation between DRONJ and hormone therapy (odds ratio [OR], 22.07; 95% confidence interval [CI], 2.86-170.24), chemotherapy and/or molecular targeted therapy (OR, 18.61; 95% CI, 2.54-136.27), and apical periodontitis (OR, 22.75; 95% CI, 3.20-161.73). These findings imply that collaborative oral examinations by oral specialists may reduce the risk of development of DRONJ in patients treated with denosumab for bone metastases from solid cancers.
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13
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Wan JT, Sheeley DM, Somerman MJ, Lee JS. Mitigating osteonecrosis of the jaw (ONJ) through preventive dental care and understanding of risk factors. Bone Res 2020; 8:14. [PMID: 32195012 PMCID: PMC7064532 DOI: 10.1038/s41413-020-0088-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
It is well established that alterations in phosphate metabolism have a profound effect on hard and soft tissues of the oral cavity. The present-day clinical form of osteonecrosis of the jaw (ONJ) was preceded by phosphorus necrosis of the jaw, ca. 1860. The subsequent removal of yellow phosphorus from matches in the early 20th century saw a parallel decline in "phossy jaw" until the early 2000s, when similar reports of unusual jaw bone necrosis began to appear in the literature describing jaw necrosis in patients undergoing chemotherapy and concomitant steroid and bisphosphonate treatment. Today, the potential side effect of ONJ associated with medications that block osteoclast activity (antiresorptive) is well known, though the mechanism remains unclear and the management and outcomes are often unsatisfactory. Much of the existing literature has focused on the continuing concerns of appropriate use of bisphosphonates and other antiresorptive medications, the incomplete or underdeveloped research on ONJ, and the use of drugs with anabolic potential for treatment of osteoporosis. While recognizing that ONJ is a rare occurrence and ONJ-associated medications play an important role in fracture risk reduction in osteoporotic patients, evidence to date suggests that health care providers can lower the risk further by dental evaluations and care prior to initiating antiresorptive therapies and by monitoring dental health during and after treatment. This review describes the current clinical management guidelines for ONJ, the critical role of dental-medical management in mitigating risks, and the current understanding of the effects of predominantly osteoclast-modulating drugs on bone homeostasis.
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Affiliation(s)
- Jason T. Wan
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
| | - Douglas M. Sheeley
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
| | - Martha J. Somerman
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
- Laboratory for Oral Connective Tissue Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Janice S. Lee
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
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High Cervical Intrathecal Targeted Drug Delivery: A Case Report of Refractory Oropharyngeal Cancer Pain. Case Rep Oncol Med 2019; 2019:2098921. [PMID: 31583144 PMCID: PMC6754888 DOI: 10.1155/2019/2098921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/31/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Some patients with head and neck cancers have pain refractory to aggressive multimodal therapies. Herein, we report the use of an intrathecal targeted drug delivery (TDD) system catheter tip placed at C1 for the treatment of recalcitrant oropharyngeal cancer pain. Case Report A patient with recurrent metastatic squamous cell tongue cancer reported severe pain not controlled despite high-dose opioids and nonopioid adjuvants. It was elected to proceed with an intrathecal TDD system with the catheter tip placed at the C1 level. After pump placement, we were able to decrease her daily oral morphine equivalents (OME) from nearly 1000 mg to 300 mg over the course of two months while titrating her TDD from 0.3 mg/day to 0.7 mg/day of intrathecal hydromorphone. Unfortunately, her improvement was limited secondary to aggressive cancer-directed treatments likely contributing to device infection and explant. Conclusions In this patient, high cervical placement of an intrathecal TDD catheter was associated with a decrease in OME. While used in clinical practice on occasion, the use of high cervical TDD placement such as this implantable C1 intrathecal TDD system for cancer-associated pain is underreported in the literature. Further studies on this intervention within this challenging population are warranted.
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Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8345309. [PMID: 31011580 PMCID: PMC6442486 DOI: 10.1155/2019/8345309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/17/2019] [Indexed: 12/15/2022]
Abstract
This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.
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Relationship between anxiety/depression and oral health-related quality of life in inpatients of convalescent hospitals. Odontology 2018; 107:254-260. [PMID: 30317463 DOI: 10.1007/s10266-018-0394-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study is to examin the association between anxiety/depressive tendency and oral health-related quality of life in inpatients of convalescent wards. This cross-sectional study included inpatients of convalescent wards (age range 34-100 years). Data on age, sex, functional independence measure, number of teeth, odontotherapy status, and primary disease for which hospitalization was required were collected. The Hospital Anxiety and Depression Scale (HADS) was used to assess emotional distress. The oral health-related quality of life was evaluated by the Geriatric Oral Health Assessment Index (GOHAI). Oral hygiene level was assessed by the Oral Health Assessment Tool (OHAT). We performed a multiple regression analysis to assess relationships among HADS, GOHAI, and OHAT. Following the analysis, causal connections of these factors were evaluated with structural equations modeling. The scores of GOHAI and OHAT in the caseness cohort (HADS score > 11) were significantly worse than those in the non-caseness cohort (HADS score < 7). Multiple regression analysis revealed that GOHAI was a statistically significant predictor of HADS score (p = 0.012), and that HADS and OHAT scores were predictors of GOHAI (p = 0.012 and < 0.001, respectively), adjusted by sex and age. We found that a model connected from OHAT to HADS through GOHAI was a good fit for the data of inpatients. Oral health-related quality of life, affected by oral hygiene status, was strongly associated with emotional distress in inpatients of convalescent wards. Daily oral care and assessment by healthcare professionals can reduce the emotional distress of inpatients in convalescent wards.
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Herlofson BB, Kjølle GK, Westgaard KL, Løndalen AM, Bruland ØS. Osteonecrosis of the Jaw in a Patient With Bone Metastatic Prostate Cancer After Long-term Bisphosphonate Treatment With Severe Deterioration Following Radium-223. Clin Genitourin Cancer 2018; 16:328-331. [DOI: 10.1016/j.clgc.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 01/26/2023]
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18
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Giudice A, Barone S, Giudice C, Bennardo F, Fortunato L. Can platelet-rich fibrin improve healing after surgical treatment of medication-related osteonecrosis of the jaw? A pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:390-403. [PMID: 30108028 DOI: 10.1016/j.oooo.2018.06.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/10/2018] [Accepted: 06/14/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of platelet-rich fibrin (PRF) after bone surgery compared to surgery alone in the treatment of medication-related osteonecrosis of the jaw (MRONJ). STUDY DESIGN A total of 47 patients with diagnosis of stage II or III of MRONJ were recruited at the Academic Hospital of Magna Graecia University of Catanzaro and allocated to 2 groups: In the first, patients were treated with PRF in addition to surgery (PRF group), in the other, only bone surgery was performed (non-PRF group). Fisher's exact and Student t tests were used to evaluate differences between the 2 surgical protocols in terms of mucosal integrity, absence of infection, and pain evaluation at scheduled follow-ups of 1 month (T1), 6 months (T2), and 1 year (T3). RESULTS Analysis of mucosal integrity, absence of infection, and pain evaluation showed a significant difference between the 2 groups in favor of PRF only at T1 (P < .05), whereas no differences were determined at T2 and T3 (P > .05). CONCLUSIONS Our results suggested that local application of PRF after bone surgery may improve the quality of life limited to the short-term follow-up and reduce pain and postoperative infections.
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Affiliation(s)
- Amerigo Giudice
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Francesco Bennardo
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Leonzio Fortunato
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Could the Combined Administration of Bone Antiresorptive Drug, Taxanes, and Corticosteroids Worsen Medication Related Osteonecrosis of the Jaws in Cancer Patients? BIOMED RESEARCH INTERNATIONAL 2018; 2018:4021952. [PMID: 30003097 PMCID: PMC5996467 DOI: 10.1155/2018/4021952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/25/2018] [Accepted: 04/16/2018] [Indexed: 01/20/2023]
Abstract
The study presents a report of 58 metastatic cancer patients who developed osteonecrosis of the jaws after being treated with zoledronic acid and taxanes, plus corticosteroids. A retrospective analysis of data registered in the archives of two Italian osteonecrosis of the jaws treatment centers, who are based at the University of Messina and at the University of Palermo, was performed in order to study, in these patients, demographic data and characteristics such as frequency of cancer location, lines of therapy, frequency of cancer drugs, presence/absence of oral trigger, number, location, and stage of jaw osteonecrosis. It was found that the majority of patients developed advanced stages of osteonecrosis, frequently complicated with infection. It was hypothesized that the concurrent administration of chemotherapeutic agents could be eventually considered as a factor able to allow a faster worsening of the clinical manifestation through the exacerbation of soft tissue defects, due to chemotherapy drugs.
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