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Observational Study
. 2021 Aug 26;11(1):17226.
doi: 10.1038/s41598-021-96480-8.

Relationship between tooth extraction and development of medication-related osteonecrosis of the jaw in cancer patients

Sakiko Soutome  1 , Mitsunobu Otsuru  2 , Saki Hayashida  2 , Maho Murata  2 , Souichi Yanamoto  2 , Shunsuke Sawada  3 , Yuka Kojima  3 , Madoka Funahara  4 , Hiroshi Iwai  5 , Masahiro Umeda  2 , Toshiyuki Saito  6
Affiliations
Observational Study

Relationship between tooth extraction and development of medication-related osteonecrosis of the jaw in cancer patients

Sakiko Soutome et al. Sci Rep. .

Abstract

Tooth extraction has been avoided since it has been considered a major risk factor for medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may also develop from tooth that is an infection source. This study aimed to clarify whether tooth extraction is a risk factor for the development of MRONJ in cancer patients receiving bone-modifying agents (BMAs). This retrospective observational study included 189 patients (361 jaws) from two hospitals. The risk factors of MRONJ were identified by comparing patient characteristics between those who did and did not develop MRONJ. Furthermore, the effect of tooth extraction during BMA therapy was analyzed after adjusting for confounding factors using the propensity score matching method. MRONJ occurred in 33 patients jaws. A longer duration of BMA administration, fewer number of teeth, presence of symptoms of local infection, and infected teeth were independent risk factors of MRONJ. However, tooth extraction during BMA therapy did not increase the risk. Propensity score matching analysis showed that tooth extraction significantly lowered the risk of MRONJ development. Teeth that can be an infection source increases the risk of MRONJ, and thus, they need to be extracted even during BMA administration.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Cumulative occurrence rate of MRONJ. The incidence of MRONJ increases over time, and the 1-, 2-, 3-, 4-, and 5-year cumulative occurrence rates are 8.1%, 14.7%, 18.2%, 18.2%, and 23.3%, respectively.
Figure 2
Figure 2
Relationship between tooth extraction and development of MRONJ. (A): Overall, MRONJ occurs earlier when tooth extraction is performed, although there is no significant difference in MRONJ incidence between the extraction and no-extraction groups. (B). After propensity score matching, the incidence of MRONJ is higher in the no-extraction group, indicating that tooth extraction significantly lowers the risk of MRONJ.
Figure 3
Figure 3
Schema for dental intervention in patients receiving high-dose BMA.
See this image and copyright information in PMC

References

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