A large case-control study reveals a positive association between bisphosphonate use and delayed dental healing and osteonecrosis of the jaw

Gelsomina Lucia Borromeo, Caroline Anne Brand, John Clement, Michael McCullough, Lisa Crighton, Graham Hepworth, John D Wark

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Abstract

This study sought to investigate, using a case-control study design, the association between bisphosphonate therapy and delayed dental healing and osteonecrosis of the jaw. Identification of potential cases of delayed dental healing was by consecutive screening of Specialist Oral and Maxillofacial and Special Needs Dentist clinic records for patients aged older than 50 years, during a 6-month window, in Victoria, Australia. Cases were confirmed by a case adjudication panel blinded to bisphosphonate status. Cases associated with malignancy or local radiotherapy were excluded. Controls were matched for age, sex, and source of dental referral (1:4, n= 160 controls). Variables of interest were dental precipitants, dental clinic type, smoking history, and medical comorbidities. A total of 4212 of 22,358 patients met inclusion criteria, of which 69 were potential cases with 40 (0.95 ) confirmed cases. The odds ratio (OR) for developing delayed dental healing when taking an oral bisphosphonate was 13.1 (95 confidence interval [CI] 4.4 to 39.3; p<0.001). There were no cases associated with intravenous bisphosphonate use. There was some evidence of an interaction with age, sex, and clinic type. When adjusted for smoking, the estimated odds ratio was 11.6 (95 CI 1.9 to 69.4; p= 0.01). There was an association between having another illness and delayed dental healing (OR= 2.3; 95 CI 1.0 to 5.2). A dental precipitant was present in 39 of 40 (97.5 ) delayed dental healing cases. An important association between bisphosphonate use and delayed dental healing in the setting of benign bone disease, predominately in individuals with a dental precipitant, has been demonstrated.
Original languageEnglish
Pages (from-to)1363 - 1368
Number of pages6
JournalJournal of Bone and Mineral Research
Volume29
Issue number6
DOIs
Publication statusPublished - 2014

Cite this

Borromeo, Gelsomina Lucia ; Brand, Caroline Anne ; Clement, John ; McCullough, Michael ; Crighton, Lisa ; Hepworth, Graham ; Wark, John D. / A large case-control study reveals a positive association between bisphosphonate use and delayed dental healing and osteonecrosis of the jaw. In: Journal of Bone and Mineral Research. 2014 ; Vol. 29, No. 6. pp. 1363 - 1368.
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abstract = "This study sought to investigate, using a case-control study design, the association between bisphosphonate therapy and delayed dental healing and osteonecrosis of the jaw. Identification of potential cases of delayed dental healing was by consecutive screening of Specialist Oral and Maxillofacial and Special Needs Dentist clinic records for patients aged older than 50 years, during a 6-month window, in Victoria, Australia. Cases were confirmed by a case adjudication panel blinded to bisphosphonate status. Cases associated with malignancy or local radiotherapy were excluded. Controls were matched for age, sex, and source of dental referral (1:4, n= 160 controls). Variables of interest were dental precipitants, dental clinic type, smoking history, and medical comorbidities. A total of 4212 of 22,358 patients met inclusion criteria, of which 69 were potential cases with 40 (0.95 ) confirmed cases. The odds ratio (OR) for developing delayed dental healing when taking an oral bisphosphonate was 13.1 (95 confidence interval [CI] 4.4 to 39.3; p<0.001). There were no cases associated with intravenous bisphosphonate use. There was some evidence of an interaction with age, sex, and clinic type. When adjusted for smoking, the estimated odds ratio was 11.6 (95 CI 1.9 to 69.4; p= 0.01). There was an association between having another illness and delayed dental healing (OR= 2.3; 95 CI 1.0 to 5.2). A dental precipitant was present in 39 of 40 (97.5 ) delayed dental healing cases. An important association between bisphosphonate use and delayed dental healing in the setting of benign bone disease, predominately in individuals with a dental precipitant, has been demonstrated.",
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A large case-control study reveals a positive association between bisphosphonate use and delayed dental healing and osteonecrosis of the jaw. / Borromeo, Gelsomina Lucia; Brand, Caroline Anne; Clement, John; McCullough, Michael; Crighton, Lisa; Hepworth, Graham; Wark, John D.

In: Journal of Bone and Mineral Research, Vol. 29, No. 6, 2014, p. 1363 - 1368.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - A large case-control study reveals a positive association between bisphosphonate use and delayed dental healing and osteonecrosis of the jaw

AU - Borromeo, Gelsomina Lucia

AU - Brand, Caroline Anne

AU - Clement, John

AU - McCullough, Michael

AU - Crighton, Lisa

AU - Hepworth, Graham

AU - Wark, John D

PY - 2014

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AB - This study sought to investigate, using a case-control study design, the association between bisphosphonate therapy and delayed dental healing and osteonecrosis of the jaw. Identification of potential cases of delayed dental healing was by consecutive screening of Specialist Oral and Maxillofacial and Special Needs Dentist clinic records for patients aged older than 50 years, during a 6-month window, in Victoria, Australia. Cases were confirmed by a case adjudication panel blinded to bisphosphonate status. Cases associated with malignancy or local radiotherapy were excluded. Controls were matched for age, sex, and source of dental referral (1:4, n= 160 controls). Variables of interest were dental precipitants, dental clinic type, smoking history, and medical comorbidities. A total of 4212 of 22,358 patients met inclusion criteria, of which 69 were potential cases with 40 (0.95 ) confirmed cases. The odds ratio (OR) for developing delayed dental healing when taking an oral bisphosphonate was 13.1 (95 confidence interval [CI] 4.4 to 39.3; p<0.001). There were no cases associated with intravenous bisphosphonate use. There was some evidence of an interaction with age, sex, and clinic type. When adjusted for smoking, the estimated odds ratio was 11.6 (95 CI 1.9 to 69.4; p= 0.01). There was an association between having another illness and delayed dental healing (OR= 2.3; 95 CI 1.0 to 5.2). A dental precipitant was present in 39 of 40 (97.5 ) delayed dental healing cases. An important association between bisphosphonate use and delayed dental healing in the setting of benign bone disease, predominately in individuals with a dental precipitant, has been demonstrated.

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