MEDIX, God. 25 Br. 139/140  •  Autorski pregled  •  Stomatologija HR ENG

Stomatološka priprema onkoloških bolesnika za uvođenje bisfosfonataDental workup of oncology patients prior to bisphosphonate therapy

Lucija Majhen, Marko Granić, Vlaho Brailo

Osteonekroza čeljusti uzrokovana lijekovima (engl. medication-related osteonecrosis of the jaw, MRONJ) komplikacija je terapije antiresorptivnim i antiangiogenim lijekovima. Glavna klinička značajka MRONJ-a je eksponirana kost u usnoj šupljini, koja ne cijeli. Osim navedenoga, u kliničkoj slici može biti prisutna oteklina mekoga tkiva, fistula ili gnojna upala. Glavni čimbenik rizika za nastanak MRONJ-a jest ekstrakcija zuba. Da bi se rizik za nastanak MRONJ-a minimalizirao, bolesnike je potrebno stomatološki obraditi prije uvođenja terapije. Prema literaturi, invazivni stomatološki zahvat preporučuje se obaviti mjesec dana prije početka terapije. Napravljena je retrospektivna analiza kartona onkoloških bolesnika upućenih na stomatološku obradbu prije uvođenja antiresorptivne i/ili antiangiogene terapije. Podatci koji su prikupljani bili su: dob, spol, dijagnoza, lijek koji se planira uvesti, KEP-indeks, broj zuba za ekstrakciju, tip ekstrakcije, primjena antibiotika, pojava komplikacija, broj dolazaka i vrijeme potrebno za dobivanje suglasnosti stomatologa za uvođenje terapije. U istraživanju je sudjelovalo 22 ispitanika prosječne dobi 64 godine. Prosječan KEP-indeks iznosio je 18,5. Prosječan broj zuba za ekstrakciju iznosio je 3 ± 3 po bolesniku. Mali broj onkoloških bolesnika s metastatskom bolešću prolazi stomatološku obradbu prije uvođenja antiresorptivne terapije. U većine bolesnika potrebna je ekstrakcija jednog ili više zuba. Stomatološka obradba većine bolesnika može se završiti unutar 14 dana, što ne dovodi do znatne odgode početka liječenja, a višestruko smanjuje rizik za nastanak MRONJ-a.

Ključne riječi:
antiresorptivni lijekovi; bisfosfonati; denosumab; ekstrakcija zuba; osteonekroza čeljusti uzrokovana lijekovima; prevencija

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Medication related osteonecrosis of the jaw (MRONJ) is a complication of antiresorptive and/or antiangiogenic therapy. Main clinical feature of MRONJ is an exposed, non-healing bone in the oral cavity. Other clinical signs may include soft tissue swelling, fistula or purulent discharge. Tooth extraction is the main risk factor for MRONJ. In order to minimize a risk of the MRONJ development, prior to the antiresorptive therapy patients need to undergo a dental evaluation. According to the literature, invasive dental procedures should be performed one month before the onset of the antiresorptive therapy. Retrospective review of charts of oncology patients referred to dental evaluation before the onset of antiresorptive/antiangiogenic therapy was performed. The following data were registered: age, gender, diagnosis, medication to be introduced, DMFT index, number of teeth to be extracted, type of extraction, antibiotic treatment, postoperative complications, number of appointments and the time needed to obtain a dentist’s approval for the introduction of antiresorptive/antiangiogenic therapy. Twenty-two participants (mean age 64) were included in the study. Average DMFT index was 18.5. Average number of teeth for extraction per patient was 3 ± 3. A small number of oncology patients with metastatic disease undergo dental treatment before starting the antiresorptive therapy. One or more dental extractions are needed in a majority of patients. In most of the patients, dental treatment can be completed within 14 days. This does not lead to a significant delay in their treatment, while it significantly reduces the risk of MRONJ development.

Key words:
antiresorptive drugs; bisphosphonates; denosumab; dental extraction; medication related osteonecrosis of the jaw; prevention