The aim of this paper is to describe the incidence of decayed, missing, and filled teeth (DMFT) and periodontal disease in 32 osteoporotic patients affected by bisphosphonate-related osteonecrosis of the jaw (BRONJ). Moreover, an investigation between the obtained data and 20 patients treated with bisphosphonate drugs and with no evidence of ONJ has been performed. Osteonecrosis of the jaws is a rare complication in a subset of patients receiving bisphosphonate drugs. Based on a growing number of case reports and institutional reviews, this kind of therapy can cause exposed and necrotic bone specifically in the jawbones. From April 2009 to June 2012, 32 osteoporotic patients treated with oral or intravenous (I.V.) bisphosphonates have been recorded. The patients’ oral health has been compared with 20 bisphosphonates patients with no ONJ. The incidence of decayed, missing, and filled teeth (DMFT) and periodontal disease was recorded in all patients and student’s -test was applied for comparing the two investigated groups data. Data demonstrated how the poor dental hygiene and periodontal disease of the BRONJ patients’ are connected with the occurrence of jawbone necrosis. 1. Introduction Osteoporosis is a systemic skeletal disorder characterized by skeletal fragility, microarchitectural variation, and low bone mineral density estimated with a T-score for bone mineral density below ？2.5 (National Institutes of Health Consensus Conference) . Osteoporosis is one of the most common chronic diseases referred in 1/3 postmenopausal women and 1/5, men over the age of 50 years (European Parliament Osteoporosis Interest Group and EU Osteoporosis Consultation Panel 2004) . Although it is widely recognized that low bone mass is not the only determinant of bone fragility, the strength of the skeleton is influenced by other bone tissue properties, collectively named “bone quality” [3, 4]. Change of bone remodelling pattern in osteoporosis patients resulted in perforation of trabecular plates and loss of cancellous trabecular elements with consequent bone mineral density reduction. Bisphosphonates are a new class of drugs indicated for use in patients with osteoporosis, Paget’s disease of bone, hypercalcemia in a malignant disease, osteolytic bone metastases, and osteolytic lesions of multiple myeloma. Despite the benefits of bisphosphonate therapy like increasing bone density and preventing bone pathological fractures, osteonecrosis of the jaw is a rare complication in a subset of patients receiving these drugs. This complication often occurs after simple
D. Felsenberg and S. Boonen, “The bone quality framework: determinants of bone strength and their interrelationships, and implications for osteoporosis management,” Clinical Therapeutics, vol. 27, no. 1, pp. 1–11, 2005.
S. L. Ruggiero, B. Mehrotra, T. J. Rosenberg, and S. L. Engroff, “Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases,” Journal of Oral and Maxillofacial Surgery, vol. 62, no. 5, pp. 527–534, 2004.
S. L. Ruggiero, T. B. Dodson, L. A. Assael, R. Landesberg, R. E. Marx, and B. Mehrotra, “American association of oral and Maxillofacial surgeons position paper on bisphosphonate-related osteonecrosis of the jaws-2009 update,” Journal of Oral and Maxillofacial Surgery, vol. 67, no. 5, pp. 2–12, 2009.
S. Otto, M. H. Abu-Id, S. Fedele et al., “Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence-a multi-centre study,” Journal of Cranio-Maxillofacial Surgery, vol. 39, no. 4, pp. 272–277, 2011.
J. G. Neely, J. M. Hartman, J. W. Forsen Jr., and M. S. Wallace, “Tutorials in clinical research: VII. Understanding comparative statistics (contrast)-part B: application of t-test, Mann-Whitney U, and chi-square,” Laryngoscope, vol. 113, no. 10, pp. 1719–1725, 2003.
D. L. Brunello and M. N. Mandikos, “Construction faults, age, gender, and relative medical health: factors associated with complaints in complete denture patients,” Journal of Prosthetic Dentistry, vol. 79, no. 5, pp. 545–554, 1998.
M. E. Sarasquete, R. García-Sanz, L. Marín et al., “Bisphosphonate-related osteonecrosis of the jaw is associated with polymorphisms of the cytoehrome P450 CYP2C8 in multiple myeloma: a genome-wide single nucleotide polymorphism analysis,” Blood, vol. 112, no. 7, pp. 2709–2712, 2008.
P. Sambrook, I. Olver, and A. N. Goss, “Bisphosphonates and osteonecrosis of the jaw. Position statement on behalf of the Australian and New Zealand Bone Mineral Society, Osteoporosis Australia, Medical Oncology Group of Australia and the Australian Dental Society,” Australian Family Physician, vol. 35, pp. 801–803, 2006.
E. Vairaktaris, S. Vassiliou, D. Avgoustidis, P. Stathopoulos, T. Toyoshima, and C. Yapijakis, “Bisphosphonate-induced avascular osteonecrosis of the Mandible associated with a common thrombophilic mutation in the prothrombin gene,” Journal of Oral and Maxillofacial Surgery, vol. 67, no. 9, pp. 2009–2012, 2009.
M. Manfredi, E. Merigo, R. Guidotti, M. Meleti, and P. Vescovi, “Bisphosphonate-related osteonecrosis of the jaws: a case series of 25 patients affected by osteoporosis,” International Journal of Oral and Maxillofacial Surgery, vol. 40, no. 3, pp. 277–284, 2011.
G. Favia, G. P. Pilolli, and E. Maiorano, “Osteonecrosis of the jaw correlated to bisphosphonate therapy in non-oncologic patients: clinicopathological features of 24 patients,” Journal of Rheumatology, vol. 36, no. 12, pp. 2780–2787, 2009.
G. Gasparini, G. Saponaro, F. Di Nardo et al., “Clinical experience with spiramycin in bisphosphonate-associated osteonecrosis of the jaw,” International Journal of Immunopathology and Pharmacology, vol. 23, no. 2, pp. 619–626, 2010.
D. Carmagnola, S. Celestino, and S. Abati, “Dental and periodontal history of oncologic patients on parenteral bisphosphonates with or without osteonecrosis of the jaws: a pilot study,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 106, no. 6, pp. e10–e15, 2008.
P. G. Arduino, E. Menegatti, M. Scoletta et al., “Vascular endothelial growth factor genetic polymorphisms and haplotypes in female patients with bisphosphonate-related osteonecrosis of the jaws,” Journal of Oral Pathology and Medicine, vol. 40, no. 6, pp. 510–515, 2011.
S. E. Pichardo and J. P. van Merkesteyn, “Bisphosphonate related osteonecrosis of the jaws: spontaneous or dental origin?” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, vol. 116, no. 3, pp. 287–292, 2013.
D. Black, D. Bauer, A. Schwartz, S. Cummings, and C. Rosen, “Continuing bisphosphonate treatment for osteoporosis—for whom and for how long?” The New England Journal of Medicine, vol. 366, no. 22, pp. 2051–2053, 2012.
M. Cicciù, A. S. Herford, G. Juod？balys, and E. Stoffella, “Recombinant human bone morphogenetic protein type 2 application for a possible treatment of bisphosphonates-related osteonecrosis of the jaw,” Journal of Craniofacial Surgery, vol. 23, no. 3, pp. 784–788, 2012.