title: Periodontal disease preceding osteonecrosis of the jaw (ONJ) in cancer patients receiving antiresorptives alone or combined with targeted therapies: report of 5 cases and literature review.
abstract: OBJECTIVE
  We present clinical and radiologic data of periodontal tissue involvement preceding the appearance of osteonecrosis of the jaw (ONJ) in 5 patients with solid tumors, who received antiresorptives alone or in combination with targeted therapies.
  
  
  METHODS
  Five patients with osteonecrosis before dental extraction were studied.
  
  
  RESULTS
  Periodontal involvement was evidenced by pain, bleeding, fistula, purulence, swelling, periodontal pocket, and tooth mobility. Combined endoperiodontal lesions were considered in 1 patient. Duration of symptoms before ONJ diagnosis lasted 8 to 24 weeks. Routine therapy was performed in 2 of 5 patients. Widening of the periodontal ligament was observed in 4 patients, and dense alveolar bone was seen in 1 patient. Local complications of ONJ required dental extractions in 4 of 5 patients. Spontaneous tooth exfoliation was observed in 1 patient. Alveolar bone biopsies, after the extraction in 2 patients, confirmed osteonecrosis. Osteonecrosis healed in 2 patients--1 after the dental extraction and 1 after 3 dental extractions and surgical debridement. Postextraction socket healed in 1 patient, and the area with exposed bone remained asymptomatic. Osteonecrosis progressed in 2 patients.
  
  
  CONCLUSIONS
  Clinical and radiologic signs of periodontal tissue involvement, before dental extraction in patients treated with antiresorptives alone or in combination with targeted therapy, may represent developing osteonecrosis.
authors.affiliation: Clinic of Hospital Dentistry, Dental School, University of Athens, Athens, Greece. Electronic address: Nicolatou.galitis@hotmail.com.
authors.forename: Ourania
authors.initials: O
authors.lastname: Nicolatou-Galitis
authors.affiliation: Third Medical Oncology Department, Hygeia Hospital, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Razis
authors.affiliation: Clinic of Hospital Dentistry, Dental School, University of Athens, Athens, Greece.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Galiti
authors.affiliation: Clinic of Orofacial Pain, Dental School, University of Athens, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Galitis
authors.affiliation: Third Medical Oncology Department, Hygeia Hospital, Athens, Greece.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Labropoulos
authors.affiliation: Third Medical Oncology Department, Hygeia Hospital, Athens, Greece.
authors.forename: Antonis
authors.initials: A
authors.lastname: Tsimpidakis
authors.affiliation: Third Department of Medical Oncology, Agioi Anargyroi Cancer Hospital, Nea Kifissia, Athens, Greece.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sgouros
authors.affiliation: Medical Oncology Unit, NIMTS Veterans Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Karampeazis
authors.affiliation: Department of Diagnostic Sciences and Oral Medicine, University of Tennessee Health Science Center College of Dentistry, Memphis, Tennessee, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Migliorati
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis* / Q000628:therapy*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010510:Periodontal Diseases / Q000175:diagnosis* / Q000628:therapy*; D011862:Radiography, Panoramic; D012189:Retrospective Studies; D014081:Tooth Extraction; D000077211:Zoledronic Acid
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077557:Ibandronic Acid