Awareness of Complications of Dental Treatment in Patients Treated with Drugs Affecting the Immune System : A Nationwide Questionnaire Survey of Dental Practitioners in Japan.

Published on Apr 1, 2021in Acta Medica Okayama0.642
· DOI :10.18926/AMO/61877
Nishizaki Hitomi (Kanagawa Dental College), Morimoto Yoshinari (Kanagawa Dental College)+ 7 AuthorsYutaka Imai1
Estimated H-index: 1
(Dokkyo Medical University)
The aim of this study was to investigate the awareness and experience, among dental practitioners, of adverse events resulting from dental treatment of patients undergoing therapy with drugs that affect the immune system [angiogenesis inhibitors, biological agents, immunosuppressants, and disease-modifying anti-rheumatic drugs (DMARDs)]. For this purpose, a nationwide questionnaire survey was conducted. Questionnaires were sent to 2,050 dentists, of which 206 (10.1%) were completed and returned. The results showed that most dentists were aware of complications associated with dental treatment of patients treated with drugs that affect the immune system, and about half had actually experienced such complications. Delayed wound healing, osteonecrosis of the jaw (ONJ), and postoperative infections were reported. Whereas approximately 50% of dentists did not discontinue the drugs during dental treatment, about 18% did. During temporary drug discontinuation, some patients experienced aggravation of the primary disease, such as worsening of rheumatism, growth of tumors, and rejection reactions of transplanted organs. As for medical cooperation, only less than half of the dentists were asked for oral hygiene management by a physician prior to starting the drug treatment. Prospective studies are needed because evidence for dental treatments in patients treated with these drugs remains limited.
Abstract Background Medication-related osteonecrosis of the jaws (MRONJ) is a prominent complication and growing problem related to the oral and maxillofacial region due to antiresorptive and antiangiogenic agents. Awareness about MRONJ is crucial for all dental practitioners identify ‘at risk’ patients for appropriate advice and management. This cross-sectional survey aimed to appraise MRONJ awareness and knowledge among dentists. Materials and methods A questionnaire-based survey was carried o...
5 CitationsSource
#1Mikio KamimuraH-Index: 23
#2Akira Taguchi (Matsumoto Dental University)H-Index: 34
Last. Hiroyuki Kato (Shinshu University)H-Index: 70
view all 9 authors...
Summary In osteoporosis patients receiving antiresorptive medications, stopping the drug and delaying tooth extraction has been suggested to reduce the risk of osteonecrosis of the jaw (ONJ). However, postponing tooth extraction for ≥ 2 months was associated with an increased risk of delayed wound healing beyond 8 weeks after extraction, a risk factor for developing ONJ.
4 CitationsSource
#1Akira Taguchi (Matsumoto Dental University)H-Index: 34
#2Yukari Uemura (UTokyo: University of Tokyo)H-Index: 16
Last. Masataka ShirakiH-Index: 61
view all 10 authors...
Osteonecrosis of the jaw (ONJ) associated with bisphosphonate therapy is a rare but severe side effect in osteoporosis patients. Recently, the number of osteoporosis patients with ONJ has dramatically increased in Japan. This has contributed to an increase in the number of patients avoiding extractions. However, there has been no prospective study providing definitive incidence data for ONJ in Japanese patients. The purpose of this study was to elucidate the true as well as suspected incidence o...
6 CitationsSource
: Bisphosphonates (BPs) have been used as antiresorptive agents to treat patients with osteoporosis or metastatic bone cancer, each of which is characterized by bone loss due to the increased bone resorption. However, BPs could cause osteonecrosis of the jaw (ONJ), known as bisphosphonate-related osteonecrosis of the jaw (BRONJ). ONJ is associated with severe pain and deteriorated quality of life. ONJ is also caused by administration of denosumab, a monoclonal antibody against receptor activator...
14 CitationsSource
#1Megumi Hayashi (Kanagawa Dental College)H-Index: 2
#1Megumi Hayashi (Kyushu University)H-Index: 3
Last. Shuntaro SugiyamaH-Index: 1
view all 5 authors...
: Bone-modifying or antiresorptive agents that target osteoclasts, such as bisphosphonates, are known to cause delayed wound healing and osteonecrosis of the jaw (ONJ) following tooth extraction. However, there are no data on whether such adverse events are also caused by drugs that may suppress the immune system, including corticosteroids, immunosuppressants, biological agents, and disease-modifying anti-rheumatic drugs (DMARDs). The aim of this retrospective study was to examine the incidence ...
5 CitationsSource
#1Kununya Pimolbutr (MU: Mahidol University)H-Index: 1
#2Stephen Porter (UCL Eastman Dental Institute)H-Index: 69
Last. Stefano Fedele (UCL: University College London)H-Index: 38
view all 3 authors...
Objectives. To review the available literature on medication-related osteonecrosis of the jaw (MRONJ) associated with antiangiogenics in antiresorptive-naive individuals. Methods. A literature search was performed using MEDLINE via PubMed, EMBASE, and Web of Science in December 2017. Results. We identified reports describing a total of 35 antiresorptive drugs-naive patients who developed antiangiogenic-related MRONJ. The mean age of these patients was 59.06 years and the F : M ratio was 4 : 5. T...
30 CitationsSource
#1Takefumi FuruyaH-Index: 22
#2Shigeru Maeda (Okayama University)H-Index: 2
Last. Hisashi YamanakaH-Index: 76
view all 5 authors...
This study aimed to evaluate dental treatments, tooth extractions, and osteonecrosis of the jaw (ONJ) in Japanese patients with rheumatoid arthritis (RA). Patients with RA enrolled in our cohort completed self-administered questionnaires, which included questions regarding their dental treatments, tooth extractions by dentists during the past 6 months, and past history of ONJ. The history of ONJ was validated with the patients’ medical records. Logistic regression was used to determine the assoc...
11 CitationsSource
#1N. Tanna (UCLH: University College Hospital)H-Index: 1
#2C. Steel (UCLH: University College Hospital)H-Index: 1
Last. Edmund Bailey (UCLH: University College Hospital)H-Index: 9
view all 4 authors...
Background Recent evidence suggests that medication-related osteonecrosis of the jaw (MRONJ) can be caused by a number of anti-resorptive and anti-angiongenic agents not limited to bisphosphonates. A working knowledge of these medications is important for dental practitioners. Methods A total of 129 general dental practitioners (GDPs) were surveyed regarding their awareness of MRONJ and its causes. Results More than 90% of the GDPs sampled were unaware of anti-resorptive and anti-angiogenic medi...
27 CitationsSource
#2Toshiyuki Yoneda (IU: Indiana University)H-Index: 85
#3Hiroshi Hagino (Tottori University)H-Index: 34
Last. Satoru Toyosawa (Osaka University)H-Index: 28
view all 11 authors...
Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an intractable, though rare, complication in cancer patients with bone metastases and patients with osteoporosis who are treated with antiresorptive agents, including bisphosphonates and denosumab. Despite the more than 10 years that have passed since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were reported, our understanding of the epidemiology and pathophysiology of ARONJ remains limited, and data ...
112 CitationsSource
#1Lida Radfar (University of Oklahoma Health Sciences Center)H-Index: 21
#2Roshanak E. Ahmadabadi (University of Oklahoma Health Sciences Center)H-Index: 1
Last. R. Hal Scofield (OMRF: Oklahoma Medical Research Foundation)H-Index: 60
view all 4 authors...
In recent years, a new class of drugs has revolutionized the treatment of autoimmune, allergic, infectious, and many more diseases. This new class of drugs is made of 3 groups—cytokines, monoclonal antibodies, and fusion proteins—that may target special damaged cells but not all the cells. These drugs may have side effects such as infection, hypersensitivity, hematologic disorders, cancer, hepatotoxicity, and neurologic disorders. However, there is not enough evidence or long-term studies of the...
6 CitationsSource
Cited By0