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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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Massaad J, Magremanne M. Is medication related osteonecrosis of the jaw around implants a rare entity? A case series with a focus on etiopathophysiology. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e743-e748. [PMID: 34922047 DOI: 10.1016/j.jormas.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Medication Related Osteonecrosis of the Jaw (MRONJ) around dental implants is a rare complication of antiresorptive drug (ARD) treatment. MRONJ has been described in patients with implants placed before, during or after ARD treatment. The aim of this study was to review our cases and to discuss a preventive approach to avoid the risk of MRONJ around implants. MATERIALS AND METHODS In a retrospective analysis of the 168 MRONJ seen in our department from 2005 to 2021, we searched for cases of patients with MRONJ around dental implants. RESULTS Six patients (4 females, 2 males) presented with MRONJ around 17 implants. Median age was 64 (50-83) years. Four patients received ARD treatment for osteoporosis and 2 for cancer. The maxilla was more affected than the mandible. Six implants were placed after the initiation of ARD treatment and eleven were placed before initiation of ARD treatments. Eight implants were managed surgically while 9 implants were managed conservatively. CONCLUSION In this series, implants were placed before or after starting ARD treatment. Despite initial successful osseointegration, MRONJ occurred months or years after initiation of ARD treatment. The role of periimplantitis should be discussed as well as the role of microcracks in the bone following implant loading. Less is known over the effect of ARD treatment after implant osseointegration. Implants could be a risk factor for MRONJ and must be checked regularly (every 3 months). It is important to check the healthy and biomechanical harmony of the implant system during the pre-treatment assessment.
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Affiliation(s)
- Jean Massaad
- Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - Michèle Magremanne
- Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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McMillan SS, Hu J, El-Den S, O'Reilly CL, Wheeler AJ. Pharmacy participation in dental and oral health care: a scoping review protocol. JBI Evid Synth 2021; 19:1651-1658. [PMID: 33394620 DOI: 10.11124/jbies-20-00209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of the review is to identify and describe the characteristics and associated outcomes of dental and oral health advice and support provided by members of the pharmacy profession. Research exploring the role, attitudes, and knowledge of pharmacists, pharmacy students, and support staff relating to dental and oral health care, as well as stakeholder perceptions, will also be examined. INTRODUCTION With the increasing prevalence of dental and oral health disorders and resource constraints within health care systems, other avenues for oral health promotion and care provision are warranted. Pharmacists, as primary care professionals working across various practice settings, could play a significant role in promoting good oral health. Yet, there is limited insight about the role, attitudes, and knowledge of members of the pharmacy profession towards dental and oral health care, as well as what stakeholders, such as consumers and other health care professionals, think about their role in this context. INCLUSION CRITERIA Any full-text publication that describes outcomes related to pharmacist, pharmacy assistant, or student involvement, knowledge, or attitudes towards dental or oral health care in any setting, and stakeholder perspectives of this role, will be included. Reviews, protocols, and commentaries will be excluded, as will studies specifically focused on smoking cessation or that do not describe the related health promotion activity. METHODS Articles published in English will be sought from health and educational databases with no date restrictions, with additional references identified via snowballing using citations and reference lists. Data searching and screening processes will follow JBI methodology, involving two independent reviewers, and data extraction presented in a narrative form.
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Affiliation(s)
- Sara S McMillan
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.,School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD, Australia
| | - Jie Hu
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Sarira El-Den
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.,Faculty of Medical and Health Sciences, Auckland University, Auckland, New Zealand
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Almeida MVDC, Moura AC, Santos L, Gominho L, Cavalcanti UDNT, Romeiro K. Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report. J Lasers Med Sci 2021; 12:e12. [PMID: 34084738 DOI: 10.34172/jlms.2021.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) corresponds to an adverse effect of the use of drugs such as bisphosphonates and denosumab. This condition is often associated with pain, infection, purulent secretion, paraesthesia, tooth mobility and halitosis, decreasing the patient's quality of life. The management of MRONJ tends to be conservative, through the guidance of oral hygiene, antibiotic therapy and mouthwashes. However, the use of antimicrobial photodynamic therapy (aPDT) has shown promise in the treatment of these injuries. The purpose of this article is to report a case of MRONJ treatment associated with aPDT. Case Report: A 75-year-old patient, with a history of breast cancer and use of intravenous Zoledronic Acid, presented with bilateral MRONJ lesions in tuberosity on the right and left sides. Treatment was conservatively instituted with the use of aPDT as an adjuvant. After 12 aPDT sessions, complete regression of the lesion was observed. However, after two weeks, the presence of a new lesion was noted, this time in the anterior region of the maxilla. The same protocol previously established was followed and after two aPDT sessions, the patient returned with complete lesion regression. Conclusion: The use of aPDT may represent an important adjuvant within a set of clinical protocols in the treatment of MRONJ.
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Affiliation(s)
- Marcelo Vieira da Costa Almeida
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
| | - Antonio C Moura
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
| | - Lúcia Santos
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
| | - Luciana Gominho
- Department of Restorative Dentistry, Universidade Federal da Paraíba - UFPB, s/n, Cidade Universitária - João Pessoa, 58051-900, PB, Brazil
| | | | - Kaline Romeiro
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760 - Paissandu, 52010-075, Recife - PE, Brazil
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Noritz G, Naprawa J, Apkon SD, Kinnett K, Racca F, Vroom E, Birnkrant DJ. Primary Care and Emergency Department Management of the Patient With Duchenne Muscular Dystrophy. Pediatrics 2018; 142:S90-S98. [PMID: 30275253 DOI: 10.1542/peds.2018-0333k] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/26/2022] Open
Abstract
Primary care providers (PCPs) are usually the first point of contact with the health care system for patients with Duchenne muscular dystrophy (DMD), and patients often present to emergency departments in which providers have little experience in dealing with this condition. With this article, we give primary care and emergency medicine providers a background in the common issues that affect people with DMD. By acquiring some specialized knowledge about the multisystem medical complications of DMD and by applying general principles of primary care, such as timely immunization, anticipatory safety counseling, behavioral screening, and routine nutritional and developmental assessments, the PCP can be a valued and effective medical provider to patients with DMD. The PCP can provide access to and effective coordination among the patient's specialty caregivers. Moreover, the PCP can become a trusted advisor to the patient and his family about important medical decisions, as well as issues in the psychosocial, behavioral, and educational domains. This article also contains a "pocket guide" used to assess and manage common urgent medical problems that cause patients with DMD to seek care in the emergency department. With the background information discussed in this article, both PCPs and emergency medicine physicians can skillfully care for patients with DMD in their respective settings, optimizing patient outcomes.
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Affiliation(s)
| | - James Naprawa
- Department of Emergency Medicine, UCSF Benioff Children's Hospital, University of California, San Francisco, Oakland, California
| | | | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | | | - Elizabeth Vroom
- Duchenne Parent Project Netherlands, Amsterdam, Netherlands; and
| | - David J Birnkrant
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Di Fede O, Panzarella V, Mauceri R, Fusco V, Bedogni A, Lo Muzio L, SIPMO ONJ Board, Campisi G. The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2684924. [PMID: 30306086 PMCID: PMC6164200 DOI: 10.1155/2018/2684924] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/26/2018] [Indexed: 01/13/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of this paper is to describe the new paradigm by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of MRONJ, prior to and during/after the administration of the aforementioned ONJ-related drugs. In reducing the risk of MRONJ, dentists and oral hygienists are key figures in applying a correct protocol of primary prevention for pre-treatment and in-treatment patients. However, the necessity of a multidisciplinary standardized approach, with a sustained dialogue among specialists involved, should be always adopted in order to improve the efficacy of preventive strategies and to ameliorate the patient's quality of life.
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Affiliation(s)
- Olga Di Fede
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Vittorio Fusco
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Alberto Bedogni
- Unit of Maxillofacial Surgery, Department of Neurosciences (DNS), University of Padua, Padua, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - SIPMO ONJ Board
- Italian Society of Oral Pathology and Medicine (SIPMO), Foggia, Italy
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Karna H, Gonzalez J, Radia HS, Sedghizadeh PP, Enciso R. Risk-reductive dental strategies for medication related osteonecrosis of the jaw among cancer patients: A systematic review with meta-analyses. Oral Oncol 2018; 85:15-23. [PMID: 30220314 DOI: 10.1016/j.oraloncology.2018.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/01/2018] [Accepted: 08/05/2018] [Indexed: 12/25/2022]
Abstract
The purpose of this systematic review with meta-analysis was to assess the effectiveness of dental interventions in preventing or reducing the incidence of medication-related osteonecrosis of the jaw (MRONJ) in cancer patients receiving antiresorptive therapy, compared to similar control groups receiving no intervention. Randomized controlled trials (RCT), case-controls and cohorts on cancer patients with primary outcome being the prevalence of MRONJ were included. Four electronic databases were searched (Cochrane Library, PubMed, EMBASE and Web of Science) up to February 12, 2018. A total of 409 abstracts were assessed and one case-control, one RCT and four cohort studies with 2332 cancer patients met our inclusion criteria. Risk of bias analysis followed Cochrane's handbook. Risk of bias was unclear for the case-control study and high risk for the RCT and all cohort studies. Five studies utilized preventive measures consisting of an initial examination and performing all necessary dental treatment before patients initiated antiresorptive therapy; one study used specialized post-extraction protocols utilizing plasma-rich in growth factors (PRGF) on cancer patients receiving antiresorptive therapy. Though dental preventive measures decreased MRONJ incidence by 77.3% in six studies with 2332 cancer patients (95% CI = 47.4-90.2%; p = .001) compared to control groups, quality of the evidence was low due to high or unclear risk of bias and the observational nature of five of the included studies. In conclusion, high-quality long-term prospective large sample size studies are needed to confirm these results due to high risk of bias and heterogeneous interventions. No funding.
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Affiliation(s)
- Harry Karna
- Master of Science in Orofacial Pain and Oral Medicine Program, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Jaime Gonzalez
- Master of Science in Orofacial Pain and Oral Medicine Program, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Harveen S Radia
- Master of Science in Orofacial Pain and Oral Medicine Program, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Parish P Sedghizadeh
- Division of Periodontology, Diagnostic Sciences & Dental Hygiene, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA.
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Coello-Suanzes JA, Rollon-Ugalde V, Castaño-Seiquer A, Lledo-Villar E, Herce-Lopez J, Infante-Cossio P, Rollon-Mayordomo A. Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment. Oral Dis 2018; 24:1029-1036. [DOI: 10.1111/odi.12842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/14/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- JA Coello-Suanzes
- Department of Oral and Maxillofacial Surgery; Virgen Macarena University Hospital; Seville Spain
| | - V Rollon-Ugalde
- Department of Oral and Maxillofacial Surgery; Virgen Macarena University Hospital; Seville Spain
| | - A Castaño-Seiquer
- Department of Preventive and Community Dentistry; Faculty of Dentistry; University of Seville; Seville Spain
| | - E Lledo-Villar
- Department of Oral and Maxillofacial Surgery; Virgen Macarena University Hospital; Seville Spain
| | - J Herce-Lopez
- Department of Oral and Maxillofacial Surgery; Virgen Macarena University Hospital; Seville Spain
| | - P Infante-Cossio
- Department of Surgery; School of Medicine; University of Seville; Seville Spain
| | - A Rollon-Mayordomo
- Department of Oral and Maxillofacial Surgery; Virgen Macarena University Hospital; Seville Spain
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Mathai PC, Andrade NN, Aggarwal N, Nerurkar S, Kapoor P. Low-dose methotrexate in rheumatoid arthritis: a potential risk factor for bisphosphonate-induced osteonecrosis of the jaw. Oral Maxillofac Surg 2018; 22:235-240. [PMID: 29508096 DOI: 10.1007/s10006-018-0688-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
Bisphosphonate-induced osteonecrosis of the jaw [BIONJ] is a relatively new pathological condition which was first described in the year 2003. The prevalence of BIONJ in patients on oral formulations is around 0.05% within the first 3 years and increases up to 0.2% after 4 years of consumption. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases [e.g., high doses of methotrexate up to 30 mg daily] significantly increase the chances of acquiring BIONJ. We present three patients with osteoporosis and rheumatoid arthritis [RA] who consumed oral bisphosphonates [alendronate] for less than 1 year and developed BIONJ within 2 to 5 months of undergoing a traumatic dental procedure. The patients also gave a history of consuming low doses of methotrexate [disease-modifying anti-rheumatic drugs] up to 20 mg weekly for 4 to 10 years. No history of steroid consumption was given by any of the patients. This case series highlights the possibility of rheumatoid arthritis and low-dose methotrexate being potential risk factors for BIONJ. This may be on account of the synergistic effect of methotrexate and bisphosphonates and the pro-inflammatory state created by RA which increased the risk of acquiring BIONJ.
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Affiliation(s)
- Paul C Mathai
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
| | - Neelam N Andrade
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India.
| | - Neha Aggarwal
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
| | - Shibani Nerurkar
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
| | - Prathmesh Kapoor
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
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Egloff-Juras C, Gallois A, Salleron J, Massard V, Dolivet G, Guillet J, Phulpin B. Denosumab-related osteonecrosis of the jaw: A retrospective study. J Oral Pathol Med 2017; 47:66-70. [DOI: 10.1111/jop.12646] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Claire Egloff-Juras
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
| | - Aurélie Gallois
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
| | - Julia Salleron
- Cellule Data-biostatistiques; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
| | - Vincent Massard
- Department of Oncology; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
| | - Gilles Dolivet
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
| | - Julie Guillet
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
| | - Bérengère Phulpin
- Department of Head and Neck and Dental Surgery; Institut de Cancérologie de Lorraine; Vandoeuvre-lès-Nancy France
- Dental Faculty of Nancy; Université de Lorraine; Nancy France
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Oral mucosal changes induced by anticancer targeted therapies and immune checkpoint inhibitors. Support Care Cancer 2017; 25:1713-1739. [PMID: 28224235 DOI: 10.1007/s00520-017-3629-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022]
Abstract
Development of biological targeted therapies and immune checkpoint inhibitors has redefined the treatment for many cancers; however, the increasing use of new protocols has led to physicians observing a new spectrum of toxicities. To date, oral adverse events induced by these new anticancer therapies have been mainly reported using nonspecific terminology ("stomatitis," "mucosal inflammation," "mucositis") and remain poorly characterized, with the exception of mammalian target of rapamycin (mTOR) inhibitor-associated stomatitis. Oral toxicities of targeted therapies often display very characteristic features which clearly differ from classic oral injuries observed with cytotoxic chemotherapy and/or radiotherapy. In addition, they frequently affect more than 20% of treated patients and can lead to a significant morbidity or permanent treatment discontinuation. Oral mucosal toxicities described in this review include mTOR inhibitor-associated stomatitis (mIAS); stomatitis, benign migratory glossitis, and osteonecrosis of the jaw associated with multi-targeted kinase inhibitors of the VEGF and PDGF receptors; mucositis induced by EGFR inhibitors (in monotherapy or in combination with head and neck radiotherapy and/or chemotherapy); hyperkeratotic lesions with BRAF inhibitors; pigmentary changes and lichenoid reactions secondary to imatinib; and more recent data on the "Osler-Weber-Rendu-like syndrome" described with the antibody-drug conjugate, TDM-1. Finally, we provide, to our knowledge, the first available structured data on oral toxicities induced by the new recently FDA- and EMA-approved monoclonal antibodies targeting PD-1. Clinical management of these targeted therapy-related oral changes is also discussed.
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Clinical features of peri-implant medication-related osteonecrosis of the jaw: Is there an association to peri-implantitis? J Craniomaxillofac Surg 2016; 44:1945-1951. [DOI: 10.1016/j.jcms.2016.09.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/19/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022] Open
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Metwally T, Burke A, Tsai JY, Collins MT, Boyce AM. Fibrous Dysplasia and Medication-Related Osteonecrosis of the Jaw. J Oral Maxillofac Surg 2016; 74:1983-99. [PMID: 27137436 DOI: 10.1016/j.joms.2016.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Osteonecrosis of the jaw (ONJ) is an established side effect of intravenous bisphosphonates and other antiresorptive medications. Although bisphosphonates are frequently prescribed for patients with the skeletal disorder fibrous dysplasia (FD), there are no reports of ONJ in this population. This has led some to conclude that patients with FD are at low risk for the development of bisphosphonate-related ONJ. PATIENTS AND METHODS Patients were evaluated as part of a longstanding FD natural history study at the National Institutes of Health. RESULTS Of 76 patients with FD who were treated with bisphosphonates, 4 developed ONJ (5.4%). Three patients developed ONJ in areas of FD-affected bone and 1 in an area of normal bone. All 4 patients had features known to be associated with ONJ in the general population, including long-term high-dose intravenous bisphosphonate treatment, periodontal and endodontic infections, and dentoalveolar surgical procedures. CONCLUSIONS These cases establish ONJ as a potential complication of bisphosphonate treatment in patients with FD. The presence of established risk factors for ONJ in this group of patients with FD suggests that high-risk patients could be identified before the development of ONJ. Clinicians should use caution in prescribing bisphosphonates to patients with FD and should do so only for established indications.
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Affiliation(s)
- Tarek Metwally
- Medical Research Scholar, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Dental Student, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Andrea Burke
- Clinical Research Fellow, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Jeffrey Y Tsai
- Resident, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY
| | - Michael T Collins
- Chief, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Alison M Boyce
- Attending Physician, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Adjunct Assistant Professor, Division of Endocrinology and Diabetes, and Attending Physician, Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Health System, Washington, DC.
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