Bisphosphonate-related osteonecrosis of the jaws: a case-control study of risk factors in breast cancer patients.
OBJECTIVE
Osteonecrosis of the jaws (ONJ) was initially described in 2001 in patients receiving intravenous bisphosphonate (BP) treatment. The objective of the present study was to determine whether routine dental procedures can be considered as possible risk factors for the development of ONJ in breast cancer patients receiving BP.


METHODS
Twenty breast cancer patients who developed ONJ receiving BP treatment were included in group A, whereas group B consisted of 40 matched controls (breast cancer patients who did not progress to ONJ receiving BP treatment). Routine dental care, smoking habits, history of tooth extraction, use of dentures, and root canal therapy were recorded.


RESULTS
Our results indicate that history of tooth extraction during zoledronic acid treatment (adjusted odds ratio [OR] = 16.4; 95% CI, 3.4 to 79.6) and the use of dentures (adjusted OR = 4.9; 95% CI, 1.2 to 20.1) increase the risk of developing ONJ.


CONCLUSIONS
The outcome of the present study suggests early referral by oncologists for dental evaluation for every patient to be treated with BP. These results raise the current American Society of Clinical Oncology Level of Evidence linking certain dental procedures with ONJ from V to III. Further studies are needed to assess other possible risk factors and also to highlight the etiopathogenesis mechanism of ONJ.
Department of Oral Maxillofacial Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece. akyrgidi@dent.auth.gr
Athanassios
A
Kyrgidis
Konstantinos
K
Vahtsevanos
Georgios
G
Koloutsos
Charalampos
C
Andreadis
Ioannis
I
Boukovinas
Zisis
Z
Teleioudis
Anna
A
Patrikidou
Stefanos
S
Triaridis
D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017742:Dental Care for Chronically Ill; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D007571:Jaw Diseases / Q000139:chemically induced*; D016015:Logistic Models; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid