J Korean Assoc Oral Maxillofac Surg.  2016 Dec;42(6):365-369. 10.5125/jkaoms.2016.42.6.365.

Prevalence of osteonecrosis of the jaw and oral characteristics of oncologic patients treated with bisphosphonates at the General Hospital of Mexico

• Cuevas-González MV
• Díaz-Aguirre CM
• Echevarría-y-Pérez E
• Cuevas-González JC

• KMID: 2364004
• DOI: http://doi.org/10.5125/jkaoms.2016.42.6.365

Abstract

OBJECTIVES
To determine the prevalence and oral characteristics of cancer patients treated with bisphosphonates in the oncology and maxillofacial prosthesis departments of the General Hospital of Mexico between 2011 and 2013.
MATERIALS AND METHODS
This cross-sectional study included patients who received prior treatment with bisphosphonates; an intraoral examination was performed by 2 standardized examiners.
RESULTS
The prevalence of bisphosphonate-related necrosis in 75 patients was 2.6%; the most common malignancy was breast cancer (84.0%), followed by prostate cancer (16.0%). Exostosis was present in 9.3% of patients and the mean Decayed, Missing, Filled Teeth index was 4.64; 44.0% of the study group had a Community Periodontal Index value between 2 and 2.9 (mean, 0.60).
CONCLUSION
A detailed intraoral assessment must be performed before initiating treatment with bisphosphonates to identify risk factors for osteonecrosis.

Keyword

Prevalence; Osteonecrosis; Bisphosphonates

MeSH Terms

Breast Neoplasms
Cross-Sectional Studies
Diphosphonates*
Exostoses
Hospitals, General*
Humans
Jaw*
Maxillofacial Prosthesis
Mexico*
Necrosis
Osteonecrosis*
Periodontal Index
Prevalence*
Prostatic Neoplasms
Risk Factors
Tooth
Diphosphonates

Figure

• 

  Fig. 1 A. Patient treated with zoledronic acid with left lingual bone exposure table and no signs of soft tissue infection. B. Orthopantomography patient. Radiolucent scleral area is observed in the presence of bone sequestration in the right jaw.

Reference

1. Hellstein JW, Marek CL. Bisphosphonate osteochemonecrosis (bisphossy jaw): is this phossy jaw of the 21st century? J Oral Maxillofac Surg. 2005; 63:682–689. PMID: 15883944.

2. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007; 22:1479–1491. PMID: 17663640.

3. Marx RE. Oral & intravenous bisphosphonate-induced osteonecrosis of the jaws: history, etiology, prevention, and treatment. Hanover Park: Quintessence Publishing;2007. p. 1–65.

4. Correia Vde F, Caldeira CL, Marques MM. Cytotoxicity evaluation of sodium alendronate on cultured human periodontal ligament fibroblasts. Dent Traumatol. 2006; 22:312–317. PMID: 17073923.

5. Filleul O, Crompot E, Saussez S. Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol. 2010; 136:1117–1124. PMID: 20508948.

6. Kim KM, Rhee Y, Kwon YD, Kwon TG, Lee JK, Kim DY. Medication related osteonecrosis of the jaw: 2015 position statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons. J Bone Metab. 2015; 22:151–165. PMID: 26713306.

7. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007; 65:369–376. PMID: 17307580.

8. Solomon DH, Mercer E, Woo SB, Avorn J, Schneeweiss S, Treister N. Defining the epidemiology of bisphosphonate-associated osteonecrosis of the jaw: prior work and current challenges. Osteoporos Int. 2013; 24:237–244. PMID: 22707065.

9. Casal C, Someso E, Álvarez AM, Fariña J, Álvarez T. Osteonecrosis de maxilares relacionada con el uso de bifosfonatos [Osteonecrosis of the jaws related with the use of bisphosphonates]. Farmacéuticos de Atención Primaria. 2012; 10:9–14.

10. Varun B, Sivakumar T, Nair BJ, Joseph AP. Bisphosphonate induced osteonecrosis of jaw in breast cancer patients: a systematic review. J Oral Maxillofac Pathol. 2012; 16:210–214. PMID: 22923892.

11. Lee JK, Kim KW, Choi JY, Moon SY, Kim SG, Kim CH, et al. Bisphosphonates-related osteonecrosis of the jaw in Korea: a preliminary report. J Korean Assoc Oral Maxillofac Surg. 2013; 39:9–13. PMID: 24471011.

12. Chang JI, Hazboun RC, Chang TI. Incongruities in the AAOMS position paper: medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014; 72:2381.

13. Kos M. Incidence and risk predictors for osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. Arch Med Sci. 2015; 11:319–324. PMID: 25995747.

14. Arce C, Bargalloó E, Villaseñor Y, Gamboa C, Lara F, Pérez V, et al. Oncoguía: Cáncer de Mama. Mexico City: Instituto Nacional de Cancerología;2011. p. 77–86.

15. Robles-Castillo J, Ruvalcaba-Limón E, Maffuz A, Rodríguez-Cuevas S. Breast cancer in Mexican women under 40. Ginecol Obstet Mex. 2011; 79:482–488. PMID: 21966845.

16. Bonacina R, Mariani U, Villa F, Villa A. Preventive strategies and clinical implications for bisphosphonate-related osteonecrosis of the jaw: a review of 282 patients. J Can Dent Assoc. 2011; 77:b147. PMID: 22129778.

17. Junquera LM, Martin-Granizo R. Diagnóstico, prevención y tratamiento de la osteonecrosis de los maxilares por bisfosfonatos. Recomendaciones de la Sociedad Española de Cirugía Oral y Maxilofacial (SECOM). Rev Esp Cir Oral y Maxilofac. 2008; 30:145–156.

18. Khamaisi M, Regev E, Yarom N, Avni B, Leitersdorf E, Raz I, et al. Possible association between diabetes and bisphosphonate-related jaw osteonecrosis. J Clin Endocrinol Metab. 2007; 92:1172–1175. PMID: 17179196.

19. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg. 2009; 67(5 Suppl):2–12.

20. Fuentes R, Borie E, Sanhueza Campos A, Rebolledo Soto K, Parra Villagran P. Presencia de exostosis orales en pacientes de la ciudad de Temuco, Chile. Av Odontoestomatol. 2012; 28:63–69.

21. de la Fuente-Hernández J, González de Cossío M, Ortega-Maldonado M, Sifuentes-Valenzuela MC. Caries y pérdida dental en estudiantes preuniversitarios mexicanos [Dental decay and tooth loss at the high school level in Mexican students]. Salud Pública Méx. 2008; 50:235–240. PMID: 18516371.