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Tsuhako K, Sekido K, Ando T, Okita M, Harada M, Hariya Y. A case of successful treatment of medication-related osteonecrosis of the jaw with conservative treatment for pathological mandibular fracture. Int J Surg Case Rep 2024; 120:109822. [PMID: 38852564 PMCID: PMC11220542 DOI: 10.1016/j.ijscr.2024.109822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION Surgical therapy is effective for medication-related osteonecrosis of the jaw. However, appropriate conservative treatment options are still important for cases in which surgery is contraindicated. We report a case of medication-related osteonecrosis of the jaw successfully treated conservatively for a pathological mandibular fracture. PRESENTATION OF CASE An 84-year-old female patient presented to our department with a chief complaint of inadequate healing of an extraction tooth socket. She had been taking minodronic acid hydrate for approximately five years for osteoporosis. The clinical examination revealed erythema, diffuse swelling of the left mandibular angle, erythema of the buccal gingiva adjacent to the left mandibular first molar, and fistula formation. Although surgery was recommended, the patient declined to proceed. Therefore, a conservative treatment was initiated. A pathological fracture of the inferior mandibular margin was observed one month after the initial visit. Mouth opening was restricted for six months using a bandage. Two months after the pathological fracture, the inferior margin of the fracture was aligned. Five months later, the inferior margin continued. One year later, the bony union of the fracture was observed. DISCUSSION Conservative treatment and restricting mouth opening was effective in our case. Three years and seven months after the pathological fracture, no new sequestrum formation was observed, and the patient was doing well. CONCLUSION Conservative treatment can be effective for medication-related osteonecrosis of the jaw with severe cases.
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Affiliation(s)
- Kota Tsuhako
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan
| | - Katsuhisa Sekido
- Department of Dentistry and Oral Surgery, Toyama Red Cross Hospital, 2-1-58, Ushijimahonnmachi, 930-0859 Toyama, Japan; Department of Oral and Maxillofacial Surgery, and Comprehensive Oral Science, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama city, Toyama 930-0194, Japan.
| | - Takumi Ando
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
| | - Michiko Okita
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
| | - Masashi Harada
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
| | - Yasushi Hariya
- Department of Oral and Maxillofacial Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo city, Hokkaido 006-8555, Japan.
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Konarski W, Poboży T, Konarska K, Śliwczyński A, Kotela I, Krakowiak J. Exploring the Impact of Novel Anti-Cancer Therapies on Jaw Osteonecrosis and Other Bones: A Comprehensive Review. J Clin Med 2024; 13:1889. [PMID: 38610654 PMCID: PMC11012550 DOI: 10.3390/jcm13071889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Osteonecrosis is a debilitating condition characterized by the loss of blood supply to the bones, leading to bone death. This condition can impact various bones, including the jaw, which significantly affects patients' quality of life by causing difficulties in swallowing, feeding, chewing, and speaking, along with swollen, painful mucous membranes and chronic sinusitis. Osteonecrosis can arise due to treatment with antiresorptive drugs. However, there is a growing number of reports of osteonecrosis following novel targeted anti-cancer treatments, such as tyrosine kinase inhibitors (TKIs) and biological therapies. The pathogenesis of osteonecrosis is linked to the side effects of the antiangiogenic mechanisms of these medications, leading to a disrupted blood flow. Our review aims to examine recent insights into osteonecrosis triggered by new anti-cancer drugs. Most reports focus on the osteonecrosis of the jaw (ONJ); however, we discovered that some authors have described cases of osteonecrosis affecting the femoral head or elbow following novel anti-cancer treatments. Prevention is a key component in managing osteonecrosis. Therefore, a comprehensive risk assessment should always be performed before and during anti-cancer therapy.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland;
| | - Andrzej Śliwczyński
- Social Medicine, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Social Medicine, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
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Aljohani MH, Aljohani AS, Aljohani RM, Alsharif WK, Nourwali I, Elsayed SA. Medical and Dental Professions' Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study. J Contemp Dent Pract 2024; 25:62-67. [PMID: 38514433 DOI: 10.5005/jp-journals-10024-3622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIMS This study aimed to assess the awareness of the risk of medication-related osteonecrosis of the jaw (MRONJ) among general dental practitioners (GDPs) and primary care physicians (PCPs), focusing on the clinical implications and coordination of treating or identifying high-risk patients. MATERIALS AND METHODS Two Google Forms electronic questionnaires were distributed to 724 GDPs and 617 PCPs in primary care settings. One for PCPs with eight multiple choice questions and the other for GDPs with 10 multiple choice questions. A clinical case scenario and a section on open-ended comments were included in both questionnaires. The data obtained from each group were statistically analyzed and compared. RESULTS A total of 239 GDPs and 220 PCPs participated in the study, with a response rate of 34.23%. The mean age of participants was 29.5 years and 54.35% were females (51.2% and 57.5% in the GDPs and PCPs group, respectively). Most participants had graduated from Saudi Arabia. Almost all dentists were aware of osteonecrosis of the jaw (95.1%), 68.3% of them were aware of the guidelines regarding bisphosphonate-related osteonecrosis of the jaw (BRONJ) and MRONJ, 60.5% rated their general knowledge about MRONJ as very poor to poor, and 91.8% did not know any guidelines regarding BRONJ or MRONJ. Among the participants, 75.3% did not know how MRONJ was present in the oral cavity. A total of 69.9% of participants were unaware of other factors associated with an increased risk of MRONJ. CONCLUSION MRONJ risk awareness varies greatly between dentists who diagnose and manage patients in dental clinics and physicians who write about medicines and therapies. Counseling sessions and greater coordination between dental and medical specialists are strongly suggested while prescribing antiresorptive drugs to prevent the consequent development of MRONJ. CLINICAL SIGNIFICANCE This study shows a significant lack of knowledge regarding MRONJ among GDPs and PCPs, which may affect the prevention and treatment of patients. Therefore, we urge GDPS and PCPs to take more information from scientific sources on this topic and more cooperation from specialties for the benefit of patients. How to cite this article: Aljohani MH, Aljohani AS, Aljohani RM, et al. Medical and Dental Professions' Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study. J Contemp Dent Pract 2024;25(1):62-67.
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Affiliation(s)
- Marwan Hamed Aljohani
- Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Madinah, Saudi Arabia, Phone: +966569198623, e-mail:
| | | | | | - Wahab Khalifah Alsharif
- Saudi Board of Orthodontics and Maxillofacial Orthopedics, Ohud Specialty Dental Center, MOH, Madinah, Kingdom of Saudi Arabia
| | - Ibrahim Nourwali
- Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Madinah, Saudi Arabia
| | - Shadia A Elsayed
- Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Madinah, Saudi Arabia
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Mu H, Pang Y, Liu L, Liu J, Liu C. Clinical values of serum Semaphorin 4D (Sema4D) in medication‑related osteonecrosis of the jaw. Eur J Med Res 2023; 28:140. [PMID: 36998031 PMCID: PMC10061851 DOI: 10.1186/s40001-023-01095-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/12/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Bisphosphonates (BPs) are widely used in clinical practice to prevent and treat bone metabolism-related diseases. Medication-related osteonecrosis of the jaw (MRONJ) is one of the major sequelae of BPs use. Early prediction and intervention of MRONJ are of great significance. METHODS Ninety-seven patients currently on treatment with BPs or with a history of BPs usage and 45 healthy volunteers undergoing dentoalveolar surgery were included in this study. Participants' serum Semaphorin 4D (Sema4D) levels were measured and analyzed before participants underwent surgery (T0) and after a 12-month follow-up (T1). Kruskal-Wallis test and ROC analysis were used to examine the predictive effect of Sema4D on MRONJ. RESULTS Sema4D levels in serum of patients corresponding to confirmed MRONJ were significantly lower at both T0 and T1 time points compared to non-MRONJ and healthy controls. Sema4D has a statistically predictive effect on the occurrence and diagnosis of MRONJ. Serum Sema4D levels were significantly reduced in MRONJ class 3 patients. MRONJ patients who received intravenous BPs had significantly lower Sema4D levels than those who received oral BPs. CONCLUSION Serum Sema4D level has predictive value for the onset of MRONJ in BPs users within 12 weeks after dentoalveolar surgery.
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Affiliation(s)
- Hong Mu
- Dental Clinic, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China.
| | - Ying Pang
- Dental Clinic, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China
| | - Lili Liu
- Dental Clinic, Cangzhou Central Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China
| | - Jingbo Liu
- General Department, Cangzhou Stomatological Hospital, Xinhua West Road, Cangzhou, 061000, Hebei, China
| | - Chunsheng Liu
- Department of Oral and Maxillofacial Surgery, Cangzhou People's Hospital, Qingchi Avenue, Cangzhou, 061000, Hebei, China
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France K, Yogarajah S, Gueiros LA, Valdez R, Mays JW, Posey R, Payne AS, Setterfield J, Sollecito TP, Woo SB, DeRossi S, Greenberg MS, Carey B. World Workshop on Oral Medicine VII: Oral adverse effects to biologic agents in patients with inflammatory disorders. A scoping review. J Oral Pathol Med 2023; 52:1-8. [PMID: 36455995 DOI: 10.1111/jop.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Biologic agents are rapidly emerging as an effective therapy to treat autoimmune and other chronic diseases. The use of these agents is poorly characterized, resulting in a lack of guidance for dental practitioners. Case reports of oral adverse events have begun to emerge. However, their scope and frequency have not been summarized and analysed to date. The objective of this review was to characterize the literature on oral adverse effects associated with biological therapy when used for autoimmune and inflammatory disorders. METHODS This review was developed in accordance with scoping review recommendations. Search strategies were developed and employed for six databases. Studies were selected using a systematic search process but with broad inclusion of study types given the paucity of information available. Reports of oral adverse events were analysed descriptively according to agent, mechanism of action, underlying disease, and oral adverse effect observed. RESULTS Our search returned 2080 articles and 51 met our inclusion criteria, of which most were case reports. The most frequent adverse effects included angioedema, oral lichenoid lesions, osteonecrosis of the jaw, and oral infections. There were also cases of oral malignancies associated with use of biologic agents. Less common effects such as pigmentation were also described. CONCLUSIONS Oral adverse events have been reported in patients on biologic therapy, albeit in small numbers to date. This limits the generalizability of these results, which should not be used to generate a clinical guideline as they are based primarily on case reports. However, this study presents the first review characterizing the adverse effects observed. Large multi-center studies will be necessary to further define the oral and dental complications caused by biologic agents.
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Affiliation(s)
- Katherine France
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Sangeetha Yogarajah
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luiz Alcino Gueiros
- Oral Medicine Unit, Department of Clinic and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | - Remberto Valdez
- Oral Medicine Unit, Department of Clinic and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | - Jacqueline W Mays
- Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachael Posey
- William Rand Kenan, Jr. Library of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Aimee S Payne
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Setterfield
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Host Microbiome Interactions (CHMI), Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Sook-Bin Woo
- Oral Medicine and Dentistry, Pathology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Scott DeRossi
- High Point University School of Dental Medicine and Oral Health, High Point, North Carolina, USA
| | - Martin S Greenberg
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Barbara Carey
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Dos Santos Ferreira L, Abreu LG, Calderipe CB, Martins MD, Schuch LF, Vasconcelos ACU. Is teriparatide therapy effective for medication-related osteonecrosis of the jaw? A systematic review and meta-analysis. Osteoporos Int 2021; 32:2449-2459. [PMID: 34331067 DOI: 10.1007/s00198-021-06078-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED Considering the lack of studies determining the real TPTD efficacy in individuals who develop MRONJ, our objective was to combine the available data on MRONJ cases treated with TPTD. The findings demonstrated that TPTD in combination with another therapy, especially antibiotic therapy, can be considered an effective protocol for MRONJ. PURPOSE To integrate the data published on the effect of teriparatide (TPTD) therapy on cases of medication-related osteonecrosis of the jaws (MRONJ) into a comprehensive analysis of clinical features. METHODS An electronic search was undertaken in six databases. Descriptive analyses of clinicodemographic data of MRONJ were carried out. Poisson regression was also run to evaluate predictors of total resolution of MRONJ treated with TPTD. RESULTS Twenty-six publications comprising 111 cases were included. Most reported cases affected female individuals (82.0%) with a mean age of 76.54 years. Osteoporosis (76.5%) represented the main reason for using antiresorptive drugs, with bisphosphonates (98.1%) as the most frequently reported. Comorbidities were commonly present. The most related trigger factor of MRONJ was dental extraction (61.7%). Mandible (75.8%) was the most commonly affected site, with a mean evolution time of 5 months. MRONJ stage 2 (61.3%) was the most prevalent. Regarding TPTD treatment, in 45.1% cases, TPTD was used alone, with the total resolution being observed in 59.5% of the individuals. Associated therapy (54.9%) included surgery, antibiotic therapy, and laser therapy. Mean follow-up was 8.7 months. Poisson regression demonstrated that individuals with MRONJ stage 1 were 1.21 times more likely to present total resolution of osteonecrosis than individuals with MRONJ stage 3 (CI = 1.02-1.43; p < 0.023). Individuals who had undergone treatment with TPTD in association with another therapeutic modality were 1.21 times more likely to present total resolution of osteonecrosis than those who had undergone treatment with TPTD alone (CI = 1.40-1.39; p < 0.010). CONCLUSION TPTD in combination with another therapy, especially antibiotic therapy, should be considered an effective therapeutic modality for MRONJ.
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Affiliation(s)
- L Dos Santos Ferreira
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - L G Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - C B Calderipe
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - M D Martins
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas - UNICAMP, 901, Av. Limeira, Areão, Piracicaba, SP, Brazil
- Department of Oral Pathology, School of Dentistry, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - L F Schuch
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas - UNICAMP, 901, Av. Limeira, Areão, Piracicaba, SP, Brazil.
| | - A C U Vasconcelos
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review. J Clin Med 2021; 10:jcm10194367. [PMID: 34640383 PMCID: PMC8509366 DOI: 10.3390/jcm10194367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.
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Matys T. Medication-related Osteonecrosis of the Jaw. Radiology 2021; 301:548. [PMID: 34546132 DOI: 10.1148/radiol.2021211142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tomasz Matys
- From the Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, England
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