title: Oral health risk factors for bisphosphonate-associated jaw osteonecrosis.
abstract: OBJECTIVE
  To investigate the role of oral health, including periodontitis, as a risk factor for bisphosphonate-associated jaw osteonecrosis (ONJ).
  
  
  METHODS
  This cross-sectional study compared cases with an ONJ history to controls. All had a history of bisphosphonate treatment for malignancy. Participants underwent oral examination, gingival crevicular fluid (GCF) sampling, and phlebotomy. Serum was analyzed for biochemical parameters, bone markers, and immunoglobulin G titers against 4 periodontitis-associated bacteria. Cytokine levels were determined in GCF using a multiplex assay.
  
  
  RESULTS
  Caries development was comparable between groups. Periodontitis was significantly associated with ONJ using the US National Center for Health Statistics periodontitis definition (P = .002), at least 1 site with a probing depth of at least 4 mm (P = .003), and the percentage of sites per participant with a probing depth of 4 to 5 mm (P = .044). Immunoglobulin G titer against Porphyromonas gingivalis and GCF interleukin-1β level were also significantly associated with ONJ (P = .018 and P = .044, respectively).
  
  
  CONCLUSIONS
  In participants with a history of bisphosphonate treatment for malignancy, periodontitis was associated with ONJ when measured using clinical parameters, serum immunoglobulin G titers against P gingivalis, and GCF interleukin-1β levels, suggesting that periodontitis and associated bacteria are potentially important in ONJ pathophysiology.
authors.affiliation: Oral Health CRC and Melbourne Dental School, University of Melbourne, Melbourne, Australia. ctsao@unimelb.edu.au
authors.forename: Claudine
authors.initials: C
authors.lastname: Tsao
authors.forename: Ivan
authors.initials: I
authors.lastname: Darby
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
authors.forename: Katrina
authors.initials: K
authors.lastname: Walsh
authors.forename: Neil
authors.initials: N
authors.lastname: O'Brien-Simpson
authors.forename: Eric
authors.initials: E
authors.lastname: Reynolds
authors.forename: Gelsomina
authors.initials: G
authors.lastname: Borromeo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000097:blood / Q000209:etiology*; D016022:Case-Control Studies; D055113:Chronic Periodontitis / Q000150:complications* / Q000382:microbiology; D024042:Collagen Type I / Q000097:blood*; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000032:analysis; D004164:Diphosphonates / Q000737:chemistry; D005260:Female; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D053583:Interleukin-1beta / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D009584:Nitrogen; D010455:Peptides / Q000097:blood*; D016966:Porphyromonas gingivalis; D012307:Risk Factors
chemical_list: D000907:Antibodies, Bacterial; D024042:Collagen Type I; D016207:Cytokines; D004164:Diphosphonates; D007074:Immunoglobulin G; D053583:Interleukin-1beta; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D009584:Nitrogen