Baek Hyeong-Jin, Lee Hyejin, Lee Jae-Ryun, Park Jung-Hyun, Kim Keun-Suh, Kwoen Min-Jeong, Lee Tae-Yeon, Kim Jin-Woo, Lee Hyo-Jung
Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
J Periodontal Implant Sci. 2024 Apr;54(2):65-74. doi: 10.5051/jpis.2300120006. Epub 2023 Jun 16.
This longitudinal cohort study aimed to evaluate the relationship between osteonecrosis of the jaw and pulp and periapical disease in patients who were administered bisphosphonates.
Using data from a nationwide cohort, we examined the association among dental caries, pulp and periapical disease, and osteonecrosis of the jaw in women aged >50 years who received bisphosphonates for more than 1 year between 2002 and 2015. Because of ambiguities in the diagnosis of osteonecrosis of the jaw in population-based data, we operationally defined and categorized the condition into established and potential osteonecrosis of the jaw.
Pulp and periapical disease significantly increased the development of both established and potential osteonecrosis of the jaw (hazard ratio, 2.21; 95% confidence interval, 1.40-3.48; and hazard ratio, 2.22; 95% confidence interval, 1.65-2.98, respectively). Root canal treatment did not have any influence on the development of osteonecrosis of the jaw.
Pulp and periapical disease may be a major risk factor for osteonecrosis of the jaw. The study findings suggest that patients should undergo regular dental examinations to detect pulp and periapical disease before or during the administration of bisphosphonates and that root canal treatment should be considered to decrease the risk of osteonecrosis of the jaw.
这项纵向队列研究旨在评估接受双膦酸盐治疗的患者颌骨坏死与牙髓及根尖周疾病之间的关系。
利用全国性队列的数据，我们研究了2002年至2015年期间年龄大于50岁且接受双膦酸盐治疗超过1年的女性中龋齿、牙髓及根尖周疾病与颌骨坏死之间的关联。由于基于人群的数据中颌骨坏死诊断存在模糊性，我们在操作上对该病症进行定义并分类为确诊颌骨坏死和疑似颌骨坏死。
牙髓及根尖周疾病显著增加了确诊颌骨坏死和疑似颌骨坏死的发生风险（风险比分别为2.21；95%置信区间为1.40 - 3.48；以及风险比为2.22；95%置信区间为1.65 - 2.98）。根管治疗对颌骨坏死的发生没有任何影响。
牙髓及根尖周疾病可能是颌骨坏死的主要危险因素。研究结果表明，患者在接受双膦酸盐治疗之前或期间应定期进行牙科检查以检测牙髓及根尖周疾病，并且应考虑进行根管治疗以降低颌骨坏死的风险。
