Risk of healing impairment following tooth extraction in patients administered with antiresorptive and non-antiresorptive polypharmacy

Abstract

IntroductionLack of evidence existed related to the essential role by which anticancer medications alone or in combination with other polypharmacy would be accountable for wound healing impairment post-dental extraction. The following study was conducted to assess the influence of antiresorptive (AR) and non-antiresorptive (non-AR) drugs and other patient-related risk factors on wound healing status following tooth extraction. Material and methodsA total of 353 patients (age range: 40–90 years, average age: 67.4 years, clinical and radiological follow-up) were recruited. All the patients were divided into three groups, which included, patients used polypharmacy with non-AR drugs, polypharmacy with a combination of AR + non-AR drugs, and the control group. Based on time of healing, the outcome was defined as, normal healing, delayed healing, and Medication-related osteonecrosis of the jaw (MRONJ). The polypharmacy score was categorized depending on the sum of the number of administered medications. ResultsThe odds of delayed healing were significantly higher in 80+ years old patients (OR=6.98, 95 %CI:2.45–19.88, p = < 0.001) administered with AR+ non-AR drugs (OR=14.68, 95 %CI:4.67–46.14, p = < 0.001), having a major polypharmacy score (OR= 15.37, 95 %CI:4.83–48.91, p = < 0.001). On the contrary, patient administered with non-AR drugs (OR=11.52, 95 %CI: 4.45–29.83, p = < 0.001) with hyper polypharmacy (OR=58.86, 95 %CI:25.03–138.40, p = < 0.001) were significantly more likely to develop MRONJ. Smoking and extraction sites showed no significant impact on wound healing impairment. DiscussionWound healing status in patients administered with both non-AR and AR+ non-AR polypharmacy was significantly impaired following tooth extraction. Other risk factors, such as increased age and high polypharmacy scoring, also significantly contributed towards the occurrence of delayed healing and MRONJ.