Oral health conditions in patients under antiresorptive therapy are comparable to unexposed during supportive periodontal care

Antonio Ciardo; Marlinde M Simon; Sinclair Awounvo; Ti-Sun Kim

doi:10.1007/s00784-023-05257-y

Oral health conditions in patients under antiresorptive therapy are comparable to unexposed during supportive periodontal care

Clin Oral Investig. 2023 Nov;27(11):6523-6536. doi: 10.1007/s00784-023-05257-y. Epub 2023 Sep 15.

Authors

Antonio Ciardo¹, Marlinde M Simon², Sinclair Awounvo³, Ti-Sun Kim²

Affiliations

¹ Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. antonio.ciardo@med.uni-heidelberg.de.
² Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
³ Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.

Abstract

Objectives: To investigate oral health and oral health-related quality of life (OHRQoL) of patients under antiresorptive therapy (ART) during supportive periodontal care (SPC) considering history of medication-related osteonecrosis of the jaw (MRONJ).

Materials and methods: In this cross-sectional study, 100 patients (50 receiving ART (exposed) and 50 without ART (unexposed)) in regular SPC were enrolled for a clinical oral examination and the evaluation of OHRQoL using the OHIP-G14-questionnaire. History of MRONJ was assessed by anamnesis and reviewing patient records.

Results: There were no statistically significant group differences in age (exposed: 70.00 ± 9.07 versus unexposed: 71.02 ± 8.22 years), sex, distribution of systemic diseases and duration of SPC (on average 8.61 ± 5.73 years). Number of teeth (21.02 ± 5.84 versus 21.40 ± 5.42), DMFT (18.38 ± 3.85 versus 17.96 ± 4.08), probing pocket depth (2.31 ± 0.20 versus 2.38 ± 0.26), clinical attachment level (3.25 ± 0.76 versus 3.46 ± 0.58) and bleeding on probing (15.07 ± 11.53 versus 15.77 ± 13.08) were also not significantly different. The OHIP-G14 sum-score was significantly higher in exposed participants (6.10 ± 6.76 versus 3.62 ± 5.22, p = 0.043). History of MRONJ was prevalent in 8% of patients under ART. Periodontal/peri-implant-related MRONJ were reported in three participants with cancer (n = 1 before and n = 2 after active periodontal therapy). History of MRONJ due to endodontic/restorative reasons was reported in one patient with osteoporosis.

Conclusions: Patients under ART in SPC demonstrated similar clinical periodontal and dental status but lower OHRQoL compared to unexposed (not statistically significant). Patient awareness of the MRONJ-risk and appropriate preventive measures should be ensured.

Clinical relevance: SPC in osteoporotic patients under ART appeared safe regarding MRONJ, but further investigations on the MRONJ-risk in patients with different risk-profiles are necessary.

Study registration: clinicaltrials.gov (#NCT04192188).

Keywords: Bisphosphonates; Denosumab; Medication-related osteonecrosis of the jaw; Oral health-related quality of life; Periodontitis; Preventive dentistry.

MeSH terms

Aged
Bisphosphonate-Associated Osteonecrosis of the Jaw* / prevention & control
Bone Density Conservation Agents* / adverse effects
Cross-Sectional Studies
Diphosphonates / adverse effects
Humans
Middle Aged
Oral Health
Quality of Life

Substances

Bone Density Conservation Agents
Diphosphonates

Associated data

ClinicalTrials.gov/NCT04192188