Long-term oral bisphosphonates delay healing after tooth extraction: a single institutional prospective study

• Published in: Osteoporosis international 2018-10, Vol.29 (10), p.2315-2321
• Main Authors: Shudo, A., Kishimoto, H., Takaoka, K., Noguchi, K.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Antibiotics; Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology; Bisphosphonate-Associated Osteonecrosis of the Jaw - prevention & control; Bisphosphonates; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - pharmacology; Bone Density Conservation Agents - therapeutic use; Cancer therapies; Diabetes mellitus; Diphosphonates - administration & dosage; Diphosphonates - pharmacology; Diphosphonates - therapeutic use; Drug Administration Schedule; Drug dosages; Endocrinology; Female; Follow-Up Studies; Fractures; Glucocorticoids; Humans; Jaw; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Osteonecrosis; Osteoporosis; Patients; Prevention; Prophylaxis; Prospective Studies; Quality of life; Rheumatology; Risk Factors; Teeth; Tooth Extraction - adverse effects; Tooth extractions; Wound healing; Wound Healing - drug effects
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-018-4621-7

Summary Tooth extraction in patients receiving bisphosphonates is thought to be a risk factor for osteonecrosis of the jaw (ONJ); however, ONJ did not develop, even when tooth extraction was performed with continued oral bisphosphonate therapy. A drug holiday from bisphosphonates before tooth extraction may not be necessary. Introduction It is controversial whether bisphosphonate withdrawal is necessary prior to invasive procedures such as tooth extraction in order to prevent bisphosphonate-related osteonecrosis of the jaw (BRONJ). This study aimed to evaluate the clinical safety of continuing oral bisphosphonate therapy in patients undergoing tooth extraction. Methods We prospectively enrolled 132 patients (20 men, 112 women) who were receiving oral bisphosphonates for the prevention or treatment of osteoporosis and required tooth extraction. All patients were managed using an identical protocol, which included preoperative antibiotic prophylaxis and did not necessarily require complete wound closure. The patients were classified into groups according to the duration of bisphosphonate administration:  10 years ( n  = 12). The groups were compared regarding the time taken for the extraction socket to heal, and the occurrence of BRONJ. Follow-up duration was at least 3 months. Results A total of 274 teeth were removed. Long-term oral bisphosphonate therapy for > 5 years significantly delayed the healing of the extraction socket in comparison with administration for