Oral Health Prev Dent 15 (2017), No. 5 13. Oct. 2017
Oral Health Prev Dent 15 (2017), No. 5 (13.10.2017)
Page 447-451, doi:10.3290/j.ohpd.a38777, PubMed:28785748
Preventive Dental Treatment Workload/Costs to Mitigate Antiresorptive Bone Medication-related Osteonecrosis Risk
Chang, Tina I. / Aghazadehsanai, Nona / Hazboun, Renna / Kawakami, Katsumi K. / Friedlander, Arthur H.
Purpose: To determine the extent of dental disease and associated treatment costs designed to mitigate the risk of medication-related osteonecrosis of the jaws (MRONJ) among older, socially disadvantaged veterans prior to physician's administration of antiresorptive medication for osteoporosis or malignant bone disease.
Materials and Methods: This prospective study based on over seven years (2008-2015) of data describes the type and volume of disease, treatment, work-load measures, and costs using Veterans Affairs databases.
Results: One hundred fifty-two outpatients (94% male, mean age 69 ± 12 years) were referred by physicians for clinical/radiographic examination and treatment. Sixteen had a healthy dentition and 17 were completely edentulous with satisfactory prostheses. Three edentulous patients required prosthesis adjustment, 116 dentate individuals required restoration of carious teeth (mean 6.3 ± 5.7) and multiple quadrant (mean 3.1 ± 1.0) scaling/subgingival curettage. In the latter group, 75 required extractions (mean 6.0 teeth, range 1-23). Clinician's (dentist and dental assistant) costs for providing care and preventive education over the 7-year timespan came to almost $132,700.
Conclusion: Older veterans requiring initiation of antiresorptive bone medication harbor extensive, untreated dental disease requiring immediate treatment. An appropriate physician-to-dentist referral network and provision of oral care and patient education prior to initiation of medication can potentially moderate the risk of jaw osteonecrosis.
Keywords: medication-related osteonecrosis of jaw, preventive dentistry, stomatognathic disease