J Periodontal Implant Sci.  2024 Apr;54(2):65-74. 10.5051/jpis.2300120006.

Pulp and periapical disease as a risk factor for osteonecrosis of the jaw: a national cohort-based study in Korea

• Baek HJ
• Lee H
• Lee JR
• Park JH
• Kim KS
• Kwoen MJ
• Lee TY
• Kim JW
• Lee HJ

• KMID: 2557153
• DOI: http://doi.org/10.5051/jpis.2300120006

Abstract

Purpose
This longitudinal cohort study aimed to evaluate the relationship between osteonecrosis of the jaw and pulp and periapical disease in patients who were administered bisphosphonates.
Methods
Using data from a nationwide cohort, we examined the association among dental caries, pulp and periapical disease, and osteonecrosis of the jaw in women aged >50 years who received bisphosphonates for more than 1 year between 2002 and 2015. Because of ambiguities in the diagnosis of osteonecrosis of the jaw in population-based data, we operationally defined and categorized the condition into established and potential osteonecrosis of the jaw.
Results
Pulp and periapical disease significantly increased the development of both established and potential osteonecrosis of the jaw (hazard ratio, 2.21; 95% confidence interval, 1.40–3.48; and hazard ratio, 2.22; 95% confidence interval, 1.65–2.98, respectively). Root canal treatment did not have any influence on the development of osteonecrosis of the jaw.
Conclusions
Pulp and periapical disease may be a major risk factor for osteonecrosis of the jaw. The study findings suggest that patients should undergo regular dental examinations to detect pulp and periapical disease before or during the administration of bisphosphonates and that root canal treatment should be considered to decrease the risk of osteonecrosis of the jaw.

Keyword

Bisphosphonates; Bisphosphonate-associated osteonecrosis of the jaw; Inflammation; Periapical disease; Pulpitis; Root canal therapy