Oral health risk factors for bisphosphonate-associated jaw osteonecrosis

Claudine Tsao, Ivan Darby, Peter R. Ebeling, Katrina Walsh, Neil O'Brien-Simpson, Eric Reynolds, Gelsomina Borromeo

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108 Citations (Scopus)


Purpose: To investigate the role of oral health, including periodontitis, as a risk factor for bisphosphonate-associated jaw osteonecrosis (ONJ). Materials and Methods: This cross-sectional study compared cases with an ONJ history to controls. All had a history of bisphosphonate treatment for malignancy. Participants underwent oral examination, gingival crevicular fluid (GCF) sampling, and phlebotomy. Serum was analyzed for biochemical parameters, bone markers, and immunoglobulin G titers against 4 periodontitis-associated bacteria. Cytokine levels were determined in GCF using a multiplex assay. Results: Caries development was comparable between groups. Periodontitis was significantly associated with ONJ using the US National Center for Health Statistics periodontitis definition (P =.002), at least 1 site with a probing depth of at least 4 mm (P =.003), and the percentage of sites per participant with a probing depth of 4 to 5 mm (P =.044). Immunoglobulin G titer against Porphyromonas gingivalis and GCF interleukin-1β level were also significantly associated with ONJ (P =.018 and P =.044, respectively). Conclusion: In participants with a history of bisphosphonate treatment for malignancy, periodontitis was associated with ONJ when measured using clinical parameters, serum immunoglobulin G titers against P gingivalis, and GCF interleukin-1β levels, suggesting that periodontitis and associated bacteria are potentially important in ONJ pathophysiology.

Original languageEnglish
Pages (from-to)1360-1366
Number of pages7
JournalJournal of Oral and Maxillofacial Surgery
Issue number8
Publication statusPublished - Aug 2013
Externally publishedYes

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