Prevalence of Bisphosphonate Associated Osteonecrosis of the Jaws in Breast Cancer Patients

Svrha rada: Zadatak je bio ocijeniti tijekom sistematičnih oralnih pregleda prevalenciju nekroze kostiju povezanu s bisfosfanatima (BP-ONJ) i zaštitnim čimbenicima od razvoja BP-ONJ-a kod pacijentica s rakom dojke i koštanim metastazama pod terapijom bisfosfanatima. Ispitanici i metode: Na Odjelu ginekologije klinike u Mainzu (Njemačka) bila je provedena retrospektivna studija. Sudjelovale su sve pacijentice s rakom dojke (n=51) pod terapijom bisfosfanatima u razdoblju od srpnja 2006. do rujna 2007. Primarni kriterij bio je razvoj BP-ONJ-a i traženje mogućih dodatnih “okidača” za njegov razvoj te eventualni čimbenici za izbjegavanje. Rezultati: Samo kod jedne od 51 pacijentice razvio se BP-ONJ (2,0%). Pretpostavlja se da bi se kao dodatni “okidač” mogla identificirati ekstrakcija zuba. Stupanj oralne higijene tih pacijentica bio je iznad prosjeka. Zaključak: U usporedbi s ostalim malignim bolestima, BP-ONJ se kod pacijentica s rakom dojke ne javlja često. Primarna bolest mogla bi utjecati na njegov razvoj. Vjeruje se da bi dobra oralna higijena mogla biti zaštitni čimbenik.Objective: To evaluate the prevalence of Bisphosphonate-associated-osteonecrosis-of-the-jaws (BP-ONJ) and protective factors of BP-ONJ-development in breast cancer patients with osseous metastasis and bisphosphonate therapy using systematical dental oral examinations. Material and Methods: A cross-sectional-study was conducted in the Department for Gynecology in Mainz, Germany. All breast cancer patients (n=51) treated with bisphosphonate in the time span from 07/2006 to 09/2007 were recruited. Primary outcome was the development of BP-ONJ and the detection of possible additional trigger factors for the development of BP-ONJ, as well as possible factors for avoiding BP-ONJ. Results: Only 1 out of 51 patients developed BP-ONJ (2.0%). A tooth extraction could be identified as an additional trigger factor. The overall dental hygiene of this patient clientele was above average. Conclusion: Compared to other alignant diseases, BP-ONJ in breast cancer patients does not appear as often. The underlying disease might be of importance in the development of BP-ONJ. A good dental hygiene might be a protective factor

Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients

<p>Abstract</p> <p>Background</p> <p>Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates.</p> <p>Methods</p> <p>In two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from Jan. 2000 - Feb. 2006 were contacted by letter. In the CSS, all patients treated from Oct. 2006 - Mar. 2008 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalence. PubMed search terms were: bisphosphonat, diphosphonate, osteonecrosis, prevalence and incidence.</p> <p>Results</p> <p>In the RS, data from 81 of 161 patients could be obtained; four patients (4.9%) developed BP-ONJ. In the CSS, 16 of 78 patients (20.5%) developed BP-ONJ. All patients with BP-ONJ had received zoledronate; 12 of these had had additional bisphosphonates. All except one had an additional trigger factor (tooth extraction [n = 14], dental surgical procedure [n = 2], sharp mylohyoid ridge [n = 3]).</p> <p>Conclusion</p> <p>The prevalence of BP-ONJ may have been underestimated to date. The oral examination of all patients in this CSS might explain the higher prevalence, since even early asymptomatic stages of BP-ONJ and previously unnoticed symptomatic BP-ONJ were recorded. Since nearly all patients with BP-ONJ had an additional trigger factor, oral hygiene and dental care might help to reduce BP-ONJ incidence.</p

Oral cavity infections – why should cardiologists care about them?

Periodontal examination should be included in a routine medical proceeding in case of patients admitted to the cardiological wards and clinics. In case of any doubts concerning oral health or suspicion of any diseases described above, the cardiologist should always remember about a necessity of periodontal consultation. Our own observations point to a specific importance of such a consultation in patients with acute coronary syndrome, and maybe also in patients with chronic heart failure. Infection within the oral cavity can be a source of a chronic systemic inflammatory burden as well as infective endocarditis. Both the factors limiting patient's contact with the periodontologist (fear of pain on the dental chair, poor previous dental experience, lack of awareness of potential risks, treatment restricted to pain relief) and those related to medical professionals of other specialties (lack of knowledge related to oral pathologies and diagnostics, considering other organs more relevant than the oral cavity, lack of dental consultants in the hospitals) should be eliminated. It seems appropriate to postulate the initiation of interdisciplinary, cardiological-periodontal treatment. The patients presenting to the cardiologists require very often periodontal consultation, but also the periodontal patients should be frequently subjected to a thorough internal medical diagnostics