Radoi Loredana, Kadri Mohamed, Gosset Marjolaine
Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Louis Mourier, 92700, Colombes, France.
Université Paris Cité, 1 Rue Maurice Arnoux, 92120, Montrouge, France.
BMC Oral Health. 2025 Mar 27;25(1):442. doi: 10.1186/s12903-024-05414-z.
By a scoping review, to evaluate whether patients with immune-mediated inflammatory disorders (IMIDs) treated with biological and conventional disease-modifying antirheumatic drugs (b/cDMARDs) and/or glucocorticoids (GCs) experience complications after invasive oral procedures.
Primary search was conducted on PubMed/MEDLINE database, Google Scholar, Embase and Web of Science up to December 31, 2023. The PICO question was "Does a patient with IMIDs and treated with b/cDMARDs in mono/bi or combination therapies have delayed oral wound healing or infectious complications after an invasive oral procedure?". To be included, references had to be primary studies written in English or French. Qualitative assessment was performed.
From 1,494 initial articles, 59 full-text articles were selected, including 47 case reports and case series, 7 comparative non-randomized studies, 1 randomized clinical trial, 2 case-case studies, 1 case-control study, and 1 prospective cohort study. Most reports involved patients with rheumatoid arthritis on methotrexate and/or anti-TNF. Complications (medication-related osteonecrosis of the jaw, delayed healing, local infection) occurred predominantly after tooth extractions, particularly affecting women, patients over 50 with bisphosphonate use, unhealthy lifestyle habits, or diabetes. They were generally managed with prolonged antibiotic and antiseptic courses, and surgical interventions.
Local infectious complication or jaw osteonecrosis could occur post-invasive procedures, especially tooth extractions, in IMIDs patients on b/cDMARDs and/or GCs, often in patients with comorbidities and/or concurrent medications such as bone-modifying drugs.
It is essential for dentists to be alert to the existence of local or focal infectious complications after tooth extraction in patients with IMIDs on immunosuppressive therapy.
通过范围综述，评估接受生物和传统改善病情抗风湿药物（b/cDMARDs）和/或糖皮质激素（GCs）治疗的免疫介导性炎症疾病（IMIDs）患者在侵入性口腔手术后是否会出现并发症。
截至2023年12月31日，在PubMed/MEDLINE数据库、谷歌学术、Embase和科学网进行了初步检索。PICO问题是“接受b/cDMARDs单药/双联或联合治疗的IMIDs患者在侵入性口腔手术后是否存在口腔伤口愈合延迟或感染并发症？”。纳入的参考文献必须是用英语或法语撰写的原始研究。进行了定性评估。
从1494篇初始文章中，筛选出59篇全文文章，包括47篇病例报告和病例系列、7篇比较性非随机研究、1项随机临床试验、2篇病例-病例研究、1篇病例对照研究和1项前瞻性队列研究。大多数报告涉及使用甲氨蝶呤和/或抗TNF的类风湿关节炎患者。并发症（药物相关颌骨坏死、愈合延迟、局部感染）主要发生在拔牙后，尤其影响女性、50岁以上使用双膦酸盐的患者、生活方式不健康或患有糖尿病的患者。这些并发症通常通过延长抗生素和防腐剂疗程以及手术干预来处理。
在接受b/cDMARDs和/或GCs治疗的IMIDs患者中，侵入性手术后，尤其是拔牙后，可能会发生局部感染并发症或颌骨坏死，这类并发症常发生在患有合并症和/或同时使用如骨改良药物等并发药物的患者中。
对于牙医来说，警惕接受免疫抑制治疗的IMIDs患者拔牙后局部或局灶性感染并发症的存在至关重要。
