Abstract
Recently, numerous articles have been published describing atypical lesions of the jaw bones related to treatment with medications based on phosphorus or analogs of its compounds, particularly bisphosphonates. Goal: To conduct a comparative analysis of the quality of life after radical surgery of the jaw in patients with medication-related osteonecrosis. A total of 82 patients were interviewed, of which 39 (47.6%) patients were in the control group (conservative treatment) and 43 (52.4%) patients in the main group had radical surgical treatment. The mean age of patients in both groups was 66.8 ± 10.03 years. Treatment of patients in the control group in terms of conventional conservative protocol included the local application of 0.05% chlorhexidine solution 1–2 times a day, antibacterial therapy (clindamycin—150 mg 4 times daily for 7 days) and NSAIDs (nimesulide). Patients in the main group (n = 43) underwent segmental resection of the jaw. Thirty days and then 6 months after the treatment, all patients were asked to assess the intensity of pain using a numerical scale, where 0 = no pain, 5 = moderate pain and 10 = the most severe pain imaginable, and to fill in the SF-36 Quality of Life Questionnaire. Results: An analysis of the results obtained with the Numeric Pain Rating Scale demonstrated that the mean pain intensity before treatment was 8.9 points in the control group, and 9.7 in the main group. These values were indicative of “unbearable pain”. After treatment (30 days), the pain score in the control group decreased and amounted to 4.1, which is evidence of the persistence of “moderate pain” in patients. In patients who underwent segmental jaw resection, the mean pain intensity was 0.5. There was no relationship with gender, but there was a direct relationship between the intensity of the pain and the stage of the process (CI = 95%). The SF-36 quality of life questionnaire showed that in the control group, who were treated conservatively, bodily pain (BoP) decreased from a score of 91.2 to 34.3, and the mental health score increased from 34.2 before treatment to 36.3 after treatment, which indicates the persistence of discomfort. The remaining parameters improved after treatment, but no complete recovery was achieved. Before radical surgery, the main group of patients also had a high level of bodily pain (95.2), but after surgery this decreased to 12.4. The remaining parameters also showed a significant difference before and after radical surgery, indicating a positive trend. Radical surgery allows us to improve the quality of life of patients, thereby confirming that surgical volume is a secondary aspect if there is no relapse after the treatment.
Highlights
Numerous articles have recently been published in different countries describing atypical lesions of the jaw bones related to treatment with medications based on phosphorus or analogs of its compounds, bisphosphonates (BP) [1,2,3,4,5,6].According to various authors, the number of medication-related osteonecrosis cases has increased from single clinical cases to a 27% occurrence in the practice of dentistry when using so-called bisphosphonate therapy [7,8].It has been found that, in addition to bisphosphonates, some other classes of drugs are able to induce specific changes in the bones of the jaw, which often manifest clinically as osteonecrosis
Medication-related osteonecrosis of the jaw is characterized by pathognomonic symptoms that distinguish it from other inflammatory, dystrophic, and iatrogenic diseases of the orofacial area; it is reasonable to separate it as an independent nosology that requires comprehensive study
The pathophysiology of the osteonecrotic process in bone tissue is associated with patterns of metabolism and the effects of bisphosphonate drugs prescribed for osteoporosis or bone metastasis
Summary
Numerous articles have recently been published in different countries describing atypical lesions of the jaw bones related to treatment with medications based on phosphorus or analogs of its compounds, bisphosphonates (BP) [1,2,3,4,5,6]. It has been found that, in addition to bisphosphonates, some other classes of drugs (cytostatics, hormones, etc.) are able to induce specific changes in the bones of the jaw, which often manifest clinically as osteonecrosis. The pathophysiology of the osteonecrotic process in bone tissue is associated with patterns of metabolism and the effects of bisphosphonate drugs prescribed for osteoporosis or bone metastasis. Changes in the jaws can occur due to impaired bone remodeling or increased suppression of bone resorption, inhibition of angiogenesis, persistent microtrauma, and the toxic effects of bisphosphonates on soft tissues. The level of bone remodeling of the jaw tissue is quite high; as a result, there is a greater accumulation of bisphosphonates in jaws, especially in the tissues of the lower jaw
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