Calik Jacek, Calik Katarzyna, Sauer Natalia, Zdzisław Bogucki, Giedziun Piotr, Mackiewicz Jacek, Murawski Marek, Dzięgiel Piotr
Department of Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland.
Old Town Clinic, 50-136 Wrocław, Poland.
Cancers (Basel). 2024 Mar 11;16(6):1124. doi: 10.3390/cancers16061124.
This study investigates the impact of bisphosphonate therapy on the stomatognathic system in 80 patients with cancer of the breast and prostate with bone metastases. Bisphosphonates are integral for managing skeletal complications in these malignancies but are associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ), affecting 0.8-18.5% of patients. BRONJ manifests with pain, neuropathy, tissue swelling, mucosal ulceration, tooth mobility, and abscesses, yet its pathogenesis remains elusive, complicating risk prediction. The research employed comprehensive dental and radiological evaluations. Dental status was assessed using DMFT and OHI-S indices, Eichner's classification, and clinical periodontal measurements like the pocket depth (PD), clinical attachment loss (CAL), and modified Sulcus Bleeding Index (mSBI). A radiological analysis included panoramic X-rays for radiomorphometric measurements and TMJ lateral radiographs. Results indicated a significant decline in oral hygiene in patients with cancer after bisphosphonate therapy, marked by increased DMFT and OHI-S scores. Periodontal health also showed deterioration, with increased PD and CAL readings. The incidence of BRONJ symptoms was noted, although exact figures are not quantified in this abstract. The study also revealed changes in radiomorphometric parameters, suggesting bisphosphonates' impact on bone density and structure. No substantial alterations were observed in TMJ function, indicating a need for extended observation to understand bisphosphonates' long-term effects on the stomatognathic system. These findings highlight the importance of continuous dental monitoring and prophylaxis in patients undergoing bisphosphonate therapy. Implementing meticulous oral care protocols is essential for mitigating BRONJ risk and managing the complex oral health challenges in patients with cancer.
本研究调查了双膦酸盐治疗对80例患有骨转移的乳腺癌和前列腺癌患者口腔颌面部系统的影响。双膦酸盐对于控制这些恶性肿瘤的骨骼并发症不可或缺，但与颌骨双膦酸盐相关骨坏死（BRONJ）有关，影响0.8%-18.5%的患者。BRONJ表现为疼痛、神经病变、组织肿胀、黏膜溃疡、牙齿松动和脓肿，但其发病机制仍不清楚，这使得风险预测变得复杂。该研究采用了全面的牙科和放射学评估。使用DMFT和OHI-S指数、艾希纳分类以及诸如牙周袋深度（PD）、临床附着丧失（CAL）和改良龈沟出血指数（mSBI）等临床牙周测量来评估牙齿状况。放射学分析包括用于放射形态测量的全景X线片和颞下颌关节侧位X线片。结果表明，双膦酸盐治疗后癌症患者的口腔卫生显著下降，表现为DMFT和OHI-S评分增加。牙周健康也显示恶化，PD和CAL读数增加。记录了BRONJ症状的发生率，尽管本摘要中未对确切数字进行量化。该研究还揭示了放射形态测量参数的变化，表明双膦酸盐对骨密度和结构有影响。未观察到颞下颌关节功能有实质性改变，这表明需要进行长期观察以了解双膦酸盐对口腔颌面部系统的长期影响。这些发现凸显了在接受双膦酸盐治疗的患者中持续进行牙科监测和预防的重要性。实施细致的口腔护理方案对于降低BRONJ风险和应对癌症患者复杂的口腔健康挑战至关重要。
