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Dental risk factors for osteonecrosis of the jaws: a CONDOR case–control study

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Abstract

Background

Reports of osteonecrosis of the jaw (ONJ) have associated this lesion to treatment with bisphosphonates (BPs) and dental procedures. In this study, we investigated the association of specific dental diagnoses and procedures with ONJ among patients with past BP use.

Methods

Dentists from three practice-based research networks provided ONJ cases and controls (1:3). Data gathered from patients and dental offices with two respective standard questionnaires included demographic, medical, pharmaceutical, and dental information. Diagnoses and procedures up to 3 years prior to ONJ (prior to interview for controls) were analyzed within risk strata, defined by BP use and cancer status, using interaction terms within conditional logistic regression models.

Results

We enrolled 191 ONJ cases and 573 controls from 119 dental offices. Among participants who had used only oral BP, extraction was the only dental risk factor for ONJ (odds ratio (OR) = 12, p = 0.01). Suppuration was also more prevalent in cases (18 %) than in controls (9 %), but not statistically significant (OR = 9, p = 0.06). Among participants who had not used either oral or IV BP (a majority of whom received radiation therapy to the head and neck), suppuration was the only dental risk factor for ONJ (prevalence = 34 % for cases and 8 % for controls; OR = 7, p = 0.01). The prevalence of extractions in this group was also higher, but not statistically significant (44 vs 10 %; OR = 3). Limited power precludes definitive findings among participants exposed to IV BP.

Conclusions

Among patients taking oral BP, extraction was the only dental procedure associated with subsequent ONJ development

Clinical relevance

Results of this study suggest that routine dental procedures are not associated with development of ONJ in patients exposed to BPs.

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Acknowledgments

Supported by NIH–NIDCR grant nos. U01DE016747, U01DE016755, U01DE016750, U01DE016746, U01DE016754, U01DE016752, and U19-DE-22516.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Dental Medicine, Winthrop University Hospital, 222 Station Plaza N, Suite 408, Mineola, NY, 11501, USA

    A. Barasch

  2. School of Dentistry, University of Washington, Seattle, WA, USA

    J. Cunha-Cruz, T. DeRouen & P. Hujoel

  3. College of Dentistry, New York University, New York, NY, USA

    F. Curro

  4. Department of General Dental Sciences, University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA

    G. H. Gilbert & A. E. Voinea-Griffin

  5. The EMMES Corporation, Rockville, MA, USA

    P. Hujoel, D. A. Vena & H. Wu

  6. Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    M. M. Safford

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  1. A. Barasch
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  2. J. Cunha-Cruz
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  3. F. Curro
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  4. T. DeRouen
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  5. G. H. Gilbert
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  6. P. Hujoel
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  7. M. M. Safford
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  8. D. A. Vena
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  9. A. E. Voinea-Griffin
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  10. H. Wu
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for the CONDOR Collaborative Group

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Correspondence to A. Barasch.

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Barasch, A., Cunha-Cruz, J., Curro, F. et al. Dental risk factors for osteonecrosis of the jaws: a CONDOR case–control study. Clin Oral Invest 17, 1839–1845 (2013). https://doi.org/10.1007/s00784-012-0880-4

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  • DOI: https://doi.org/10.1007/s00784-012-0880-4

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