Survey of the association between tooth extraction and development of medication-related osteonecrosis of the jaw in patients undergoing cancer treatment with bone-modifying agents

Mai Nozawa-Kobayashi; Hidenobu Sakuma; Hiroko Kanemaru; Akira Kurokawa; Marie Soga; Moe Yamashita; Kanae Niimi; Tadaharu Kobayashi

doi:10.1007/s10006-024-01221-6

Survey of the association between tooth extraction and development of medication-related osteonecrosis of the jaw in patients undergoing cancer treatment with bone-modifying agents

Oral Maxillofac Surg. 2024 Feb 1. doi: 10.1007/s10006-024-01221-6. Online ahead of print.

Authors

Mai Nozawa-Kobayashi^{1

2}, Hidenobu Sakuma³, Hiroko Kanemaru⁴, Akira Kurokawa⁴, Marie Soga⁴, Moe Yamashita⁴, Kanae Niimi⁵, Tadaharu Kobayashi¹

Affiliations

¹ Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
² Minamiuonuma City Yukiguni Yamato Hospital Dentistry/ Pediatric Dentistry, Minamiuonuma, Japan.
³ Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. h-sakuma@dent.niigata-u.ac.jp.
⁴ Oral Management Clinic for Medical Cooperation, Niigata University Medical and Dental Hospital, Niigata, Japan.
⁵ Patient Support Center, Niigata University Medical and Dental Hospital, Niigata, Japan.

PMID: 38296902
DOI: 10.1007/s10006-024-01221-6

Abstract

Objective: This study aimed to verify whether tooth extraction before the administration of bone-modifying agents (BMA) was effective in preventing the onset of medication-related osteonecrosis of the jaw (MRONJ).

Materials and methods: This retrospective study included patients with a history of receiving BMA for cancer treatment. The patients were classified into three groups based on the timing of tooth extraction: no tooth extraction before the onset of MRONJ, tooth extraction before the administration of BMA, and tooth extraction after the administration of BMA. The incidence of MRONJ was compared between the groups. Fisher's exact test and Bonferroni correction were used to test for differences in proportions between the three groups.

Results: The total number of subjects was 123. Twenty-four patients (19.5%) developed MRONJ. The incidence rates were 12.3% (10/81), 17.9% (5/28), and 64.3% (9/14) in the non-extraction group, the extraction before BMA administration group, and the extraction after BMA administration group, respectively, showing statistically significant differences between the extraction after BMA administration group and the non-extraction groups and between the extraction after BMA administration group and the extraction before BMA administration group (p < 0.001, p = 0.0049). On the other hand, there was no statistically significant difference in incidence between the non-extraction and the extraction before BMA administration group (p = 0.5274).

Conclusions: Tooth extraction before the administration of BMA is effective in preventing the onset of MRONJ in patients receiving BMA for cancer treatment. Prevention of MRONJ development in patients receiving BMA for cancer treatment contributes to the maintenance of patients' quality of life.

Keywords: Bone-modifying agents; Extraction; Medication-related osteonecrosis of the jaw; Quality of life.