Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy

2021 ◽  
Author(s):  
Johannes Laimer ◽  
Martin Hechenberger ◽  
Daniela Müller ◽  
Benjamin Walch ◽  
Andreas Kolk ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Oral Surgery ◽  
Osteonecrosis Of The Jaw ◽  
University Hospital ◽  
Antiresorptive Therapy ◽  
Jaw Cysts ◽  
Dental Focus ◽  
Antiresorptive Drugs ◽  
The University ◽  
Tooth Extractions

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a ‘real-world’ setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

scholarly journals Keratocystic odontogenic tumor

2016 ◽  
Vol 43 (6) ◽  
pp. 466-471 ◽  
Author(s):  
BRENDA DE SOUZA MOURA ◽  
MARIA APARECIDA CAVALCANTE ◽  
WAGNER HESPANHOL
Keyword(s):  
Recurrence Rate ◽  
Oral Surgery ◽  
Odontogenic Tumor ◽  
University Hospital ◽  
Keratocystic Odontogenic Tumor ◽  
Negative Group ◽  
Equal Distribution ◽  
Positive Group ◽  
Clinical Records ◽  
The University

ABSTRACT Objective: to evaluate the frequency of keratocystic odontogenic tumor (KOT) in the Oral Surgery Service (OSS) of the University Hospital Clementino Fraga Filho of the Federal University of Rio de Janeiro (HUCFF / UFRJ), with respect to recurrence rate, gender, age of recurrence and location of the injury Methods: clinical records were reviewed and histopathological reports of KOT patients of the HUCFF/UFRJ between 2002 and 2012. Patients diagnosed with KOT were divided into two groups for the occurrence of relapse: positive (n=6) and negative (n=19) Results: regarding the location, there was a predilection for the mandible. In the average age of patients in the positive group was 40.5 and the negative group, 35.53. In the distribution by gender, positive group showed equal distribution, different from that observed in the negative group, which showed a predilection for males Conclusion: KOT was the second most frequent injury in our patients, recurrence was lower among males and had the jaw as most affected location

scholarly journals Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic

2021 ◽  
Vol 18 (18) ◽  
pp. 9924
Author(s):  
Ellen Pick ◽  
Nicolas Leuenberger ◽  
Irina Kuster ◽  
Nicole Selina Stutzmann ◽  
Bernd Stadlinger ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Wound Closure ◽  
Oral Surgery ◽  
Preventive Treatment ◽  
Osteonecrosis Of The Jaw ◽  
Antiresorptive Therapy ◽  
Related Factors ◽  
Treatment Protocols ◽  
Primary Wound Closure ◽  
Mucoperiosteal Flap

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a dreaded complication in patients with compromised bone metabolism. The purpose of the present study was to examine the occurrence of ARONJ and its related factors among patients with a history of antiresorptive therapy undergoing tooth extraction using preventive protocols at a Swiss university clinic. Data were retrospectively pooled from health records of patients having received a surgical tooth extraction between January 2015 and April 2020 in the Clinic of Cranio-Maxillofacial and Oral surgery, University of Zurich. A total of 970 patients received an extraction with flap elevation or wound closure during this period. A total of 104 patients could be included in the study. Furthermore, variables including age, gender, smoking, risk profile, choice, indication and duration of antiresorptive therapy, number of extractions, extraction site, surgical technique, choice and duration of antibiotics as well as the presence of postoperative inflammatory complications were assessed. Overall, 4 patients developed ARONJ (incidence of 3.8%) after tooth extraction at the same location, without previous signs of osteonecrosis. Preventive methods included predominantly primary wound closure using a full thickness mucoperiosteal flap and prolonged perioperative antibiotic prophylaxis. In accordance with current literature, the applied protocol showed a reliable outcome in preventing ARONJ when a tooth extraction is required.

scholarly journals Medication-Related Osteonecrosis of the Jaws and CDK4/6 Inhibitors: A Recent Association

2020 ◽  
Vol 17 (24) ◽  
pp. 9509
Author(s):  
Antonia Marcianò ◽  
Gian Marco Guzzo ◽  
Matteo Peditto ◽  
Antonio Picone ◽  
Giacomo Oteri
Keyword(s):  
Cancer Patients ◽  
Oral Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Similar Distribution ◽  
Close Monitoring ◽  
Breast Cancer Patients ◽  
School Of Dentistry ◽  
The University ◽  
Intravenous Bisphosphonates

The purpose of the present study was to estimate the prevalence of cyclin-dependent kinase (CDK) 4/6 inhibitors use among cancer patients from the medication-related osteonecrosis of the jaw (MRONJ) cohort of the University of Messina. We retrospectively reviewed the records of all patients with either intravenous bisphosphonates or denosumab-related MRONJ reported in the electronic health records of the Unit of Oral Surgery, School of Dentistry, University of Messina between the first quarter of 2018 and the first quarter 2020 to identify eligible patients. We observed six cases of MRONJ associated with CDK4/6 inhibitors concomitantly with intravenous bisphosphonates and/or denosumab in breast cancer patients. The CDK4/6 inhibitors registered were palbociclib (n = 5) and abemaciclib (n = 1). Data of cancer patients diagnosed with MRONJ in the same period (n = 10) were extracted for comparison. The comparative assessment with this group of patients showed a similar distribution of MRONJ stage ranged and clinical course after treatment. The degree of risk for osteonecrosis in patients taking these new classes of drugs is uncertain but warrants awareness and close monitoring. The role of premedication dental evaluation as a prevention strategy has been acknowledged for cancer patients about to initiate intravenous bisphosphonates and/or denosumab for treatment of bone metastasis, but additional attention should be paid to whom are assuming CDK4/6 inhibitors because of their oral adverse events.

scholarly journals Drug-induced osteonecrosis of the jaw: the state of the art

Reumatismo ◽  
2017 ◽  
Vol 69 (1) ◽  
pp. 9 ◽  
Author(s):  
A. Fassio ◽  
F. Bertoldo ◽  
L. Idolazzi ◽  
O. Viapiana ◽  
M. Rossini ◽  
...  
Keyword(s):  
Adverse Event ◽  
Oral Surgery ◽  
Absolute Risk ◽  
Rare Condition ◽  
Osteonecrosis Of The Jaw ◽  
Large Majority ◽  
Drug Induced ◽  
Antiresorptive Agents ◽  
Oncologic Patients ◽  
Antiresorptive Drugs

Osteonecrosis of the jaw (ONJ) is a rare adverse event of antiresorptive drugs such as bisphosphonates (BP) and denosumab (DMAb). The diagnosis of ONJ is considered in cases where exposed bone in the maxillofacial region does not heal within 8 weeks in a patient previously treated with an antiresorptive agent. In patients with osteoporosis, ONJ is reported as a very rare adverse event while in oncologic patients with bone metastases or malignant hypercalcemia the incidence is significantly higher (up to the 1-10% of the patients). The pathophysiology of ONJ is still not completely understood but it is multi-factorial. ONJ is a condition associated with poor oral health, oral surgery, and use of antiresorptive agents. Prevention is of paramount importance especially in cancer patients, in whom the large majority of cases of ONJ (>90%) are reported, but it should also be considered in osteoporotic patients, especially during dental surgical procedure. Some simple prevention procedures are effective in reducing the risk of its appearance. When ONJ unfortunately occurs, the large majority of patients can be managed conservatively. In conclusion, ONJ is a rare condition associated with antiresorptive drugs. Both osteoporotic and oncologic patients should be well informed about its low absolute risk and regarding the fact that the benefits of antiresorptive therapy far outweigh this potential risk of ONJ.

Facial Injuries Due to Criminal Violence: A Retrospective Study of Hospital Attenders

1992 ◽  
Vol 32 (4) ◽  
pp. 345-353 ◽  
Author(s):  
C Ström ◽  
G Johanson ◽  
Å Nordenram
Keyword(s):  
Women Victims ◽  
Oral Surgery ◽  
Nasal Bone ◽  
Fracture Site ◽  
University Hospital ◽  
Patient Records ◽  
Criminal Violence ◽  
Assault Victims ◽  
The University ◽  
Nose And Throat

The material comprised 222 assault victims whose injuries required attention at the Departments of Oral Surgery and Ear, Nose, and Throat diseases, the Central Hospital in Falun or corresponding departments at the Karolinska Institutet, Stockholm or the University Hospital in Huddinge. Information was obtained from patient records. One hundred and thirty-eight patients had fractures and the remainder had flesh-wounds, haematomas or swellings. The most frequent fracture site was the nasal bone followed by the jaws. Forty-one per cent of the patients in Falun and 28 per cent in Stockholm reported the assaults to the police: in Falun the proportion of women victims who reported the assault was significantly higher than those who did not. The willingness to notify the police of the violence was not influenced by the use of drugs or the seriousness of the injuries. The study showed that violence in suburban Stockholm was aggravated: one-third of the patients in the study required hospitalization compared to a quarter in a rural area.

scholarly journals Characteristics and Results of the Treatment of Multiple Myeloma in the Subject under the Age of 65 at the University Hospital of Yopougon in Abidjan, Côte d’Ivoire

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Diebkilé Aïssata Tolo ◽  
Duni Sawadogo ◽  
Danho Clotaire Nanho ◽  
Boidy Kouakou ◽  
N’Dogomo Méité ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Sex Ratio ◽  
Stable Disease ◽  
Bone Pain ◽  
Causes Of Death ◽  
University Hospital ◽  
Professional Activity ◽  
The Subject ◽  
The University ◽  
Ig G

We retrospectively studied 30 cases of multiple myeloma in patients under the age of 65, diagnosed from 1991 to 2005 in the clinical hematology department of the University Hospital of Yopougon that is a hospital incidence of 2.9 cases/year. The age of patients ranged from 34 to 64 years, with a mean age of 49 years and a sex ratio of 1.73. The professional activity was variable with 3% of radiographers and 10% of farmers. Clinically, the dominant sign was bone pain in 83% of cases. Myeloma was secretory in 93% of cases. It was Ig G-type in 86%, kappa-type in 66% of cases. 86% of patients were anemic, 20% had creatinine >20 mg/L, and 10% had serum calcium >120 mg/L. Geodes were found in 80% of cases. 53% were at stage III of DURIE and SALMON. Complications were infectious (33%), renal (20%), and hemorrhagic (7%). Chemotherapy regimens were VAD (10%), VMCP (30%), and VMCP/VBAP (60%) with 47% of partial responses, 33% of stable disease, and 7% of very good quality partial responses. The outcome developed towards death in 37% and causes of death were renal in 46% of cases. The median survival was only 5.1 months.

scholarly journals Clinical and sociodemographic characterization of patients with temporomandibular dysfunction of the University Hospital of Maracaibo.

2018 ◽  
Vol 5 (2) ◽  
pp. 75-79
Author(s):  
Dianiris Rodríguez ◽  
Teresita Rey ◽  
Mariela Ramírez ◽  
Daniela Cabrera
Keyword(s):  
Oral Surgery ◽  
Clinical History ◽  
Clinical Findings ◽  
University Hospital ◽  
Mandibular Movement ◽  
Orthopedic Treatment ◽  
Functional Diagnosis ◽  
History Of ◽  
The University

Abstract: Objective: To describe the clinical and sociodemographic characteristics of patients with temporomandibular joint (TMJ) dysfunction at the University Hospital of Maracaibo. Methods: A retrospective study was conducted by assessing the clinical history of patients with TMJ dysfunction who underwent orthopedic treatment in the Oral Surgery Unit of the Dentistry Service of the University Hospital of Maracaibo. Information was collected on socio-demographic characteristics (age, gender, origin, and occupation) and clinical findings related to the presence, location, area, beginning, frequency, cause, and duration of pain, and signs present during mandibular dynamics; additionally, a structural and functional diagnosis was made. The data were processed and analyzed using SPSS v.9. Results: 221 patients were included, with only 10% of the disorders observed in males. Regarding occupation, 39.1% worked at home and 28.3% were students. 97.2% of patients presented pain, and of these, pain was localized in 75%. During mandibular movement with maximum opening, 47.4% showed some difficulty, which was more significant in males. TMJ noises were noted in 74.9%, more often in females. In addition, the previous partial displacement of a disk with recapture presented an incidence of 66.4%. Conclusion: The prevalence of TMJ dysfunction was higher in female patients and in adulthood. Noises were present with a high frequency, as was limited mandibular movement.

scholarly journals Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Gianfranco Favia ◽  
Angela Tempesta ◽  
Luisa Limongelli ◽  
Vito Crincoli ◽  
Eugenio Maiorano
Keyword(s):  
Staging System ◽  
Osteonecrosis Of The Jaw ◽  
Clinicopathological Features ◽  
Antiresorptive Therapy ◽  
Osteonecrosis Of The Jaws ◽  
Current Series ◽  
Antiresorptive Drugs ◽  
Radiological Healing ◽  
Invasive Surgical Approach

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive therapies for bone neoplastic localizations and osteoporosis. The aim of this study was to evaluate the clinicopathological features of MRONJ in a cohort of patients treated by new antiresorptive drugs (denosumab) and the corresponding outcome after 13-year maximum follow-up. Overall, 244 patients affected by MRONJ were treated from 2003 to 2015. After clinical and radiological examinations, all lesions were staged according to a dimensional staging system and then surgically treated. All the denosumab-related lesions were classified as stage II or III, thus requiring a more or less invasive surgical approach, despite the results of many recent studies, which suggested a conservative medical approach with early resolution for MRONJ in patients on denosumab. In the current series, 86.9% of treated lesions showed complete clinical and radiological healing, while 13.1% recurred; all recurrences were detected in patients who could not interrupt chemotherapy, steroids, and/or antiresorptive drugs administration due to their general conditions. In conclusion, all oral specialists should be aware of the MRONJ risk among patients taking new antiresorptive drugs; moreover, our protocol based on surgical treatment guided by dimensional staging could be considered effective in view of the low recurrence rate.

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