Oral Health Risk Factors for Bisphosphonate-Associated Jaw Osteonecrosis

Purpose: To investigate the role of oral health, including periodontitis, as a risk factor for bisphosphonate-associated jaw osteonecrosis (ONJ). Materials and Methods: This cross-sectional study compared cases with an ONJ history to controls. All had a history of bisphosphonate treatment for malignancy. Participants underwent oral examination, gingival crevicular fluid (GCF) sampling, and phlebotomy. Serum was analyzed for biochemical parameters, bone markers, and immunoglobulin G titers against 4 periodontitis-associated bacteria. Cytokine levels were determined in GCF using a multiplex assay. Results: Caries development was comparable between groups. Periodontitis was significantly associated with ONJ using the US National Center for Health Statistics periodontitis definition (P = .002), at least 1 site with a probing depth of at least 4mm(P = .003), and the percentage of sites per participant with a probing depth of 4 to 5 mm (P = .044). Immunoglobulin G titer against Porphyromonas gingivalis and GCF interleukin-1 beta level were also significantly associated with ONJ (P = .018 and P = .044, respectively). Conclusion: In participants with a history of bisphosphonate treatment for malignancy, periodontitis was associated with ONJ when measured using clinical parameters, serum immunoglobulin G titers against P gingivalis, and GCF interleukin-1 beta levels, suggesting that periodontitis and associated bacteria are potentially important in ONJ pathophysiology. (C) 2013 American Association of Oral and Maxillofacial Surgeons