The role of systemic antibiotics in tooth extractions with patients on antiresorptive therapy
DOI:
https://doi.org/10.6016/ZdravVestn.3106Keywords:
tooth extraction, systemic antibiotics, medication-related osteonecrosis of the jaw, antiresorptive therapyAbstract
Basis: Antiresorptive drugs (ARZ) are used to treat osteoporosis and bone manifestations of certain malignancies. The drugs inhibit bone breakdown and consequently proper bone remodelling. During oral surgery in the oral cavity, such as tooth extraction, drug-induced osteonecrosis of the jaw may develop. The pathogenesis itself has not yet been fully elucidated, and an important factor in its development is inflammation. This could be treated with systemic antibiotics after the procedure. The main purpose of the study is to establish whether the use of antibiotics after tooth extraction in patients on ARZ treatment affects the incidence of osteonecrosis of the jaws.
Methods: We retroactively reviewed the documentation of 94 patients (83 women and 11 men) who had their teeth extracted between 2006 and 2015 at the Clinical Department for Maxillofacial and Oral Surgery and were treated with antiresorptive drugs. Extractions were performed according to a uniform protocol to prevent the development of jaw necrosis. A systemic antibiotic was administered to 22 patients after the procedure. Patients were monitored regularly. The results were statistically analyzed.
Results: Osteonecrosis of the jaws developed in a total of 14 patients (14.9%). Five of 22 patients receiving systemic antibiotics developed jaw necrosis (22.7%), while the latter was observed in 9 of 72 patients (12.5%) who did not receive a systemic antibiotic. The overall incidence of osteonecrosis of the jaw when receiving a systemic antibiotic was 5.32%. The use of antibiotic protection and morbidity for MRONJ are not statistically significantly related (p > 0.05).
Conclusion: Additional systematic research is needed to definitively confirm the pathogenesis of MRONJ development and the role of bacterial inflammation in it, so that the feasibility of systemic antibiotics use during oral surgery, especially in dental extractions in patients treated with ARZ, may be definitively confirmed or refuted.
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