経口ビスフォスフォネート製剤服用患者の抜歯創治癒経過に関する臨床的検討

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  • Dental extraction wound healing in patients receiving oral bisphosphonate therapy
  • ケイコウ ビスフォスフォネート セイザイ フクヨウ カンジャ ノ バッシソウチユ ケイカ ニ カンスル リンショウテキ ケントウ

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Oral bisphosphonates are the most widely used pharmaceuticals for the prevention and treatment of osteoporosis. Recently, there has been increasing concern about the risks of osteonecrosis of the jaws in patients receiving bisphosphonates. Despite the widespread use of oral bisphosphonates, there has not been a report regarding wound healing after tooth extraction in patients who are receiving oral bisphosphonates. In this study, we surveyed the prevalence of delayed wound healing after extraction in patients receiving oral bisphosphonate therapy. A total of 113 tooth extractions were performed in 44 patients who received oral bisphosphonates from November 2007 to July 2010 in our hospital. Questionnaires were completed by the individual who performed the extraction. The questionnaires included items such as the prognosis, the kind of bisphosphonate, systemic risk factors such as steroid medication, duration of bisphosphonate administration and discontinuation, location of extracted teeth, and the healing period. The prevalence of delayed wound healing was 15 of 113 extractions （13.3 ％）. The prevalence of delayed wound healing with steroid medication was significantly higher than that without steroids. The prevalence of delayed wound healing in accordance with the guidelines proposed by the Japanese Society of Oral and Maxillofacial Surgeons was significantly lower than that not based on the guidelines. There was one case of bisphosphonate-related osteonecrosis and two cases of delayed infection associated with steroid medication. These results indicated that wound healing after extraction in patients who are receiving oral bisphosphonates, especially in the presence of steroids medication, was delayed. Our findings suggested that informed consent and long-term follow up are necessary after extraction in patients given oral bisphosphonates and steroids. Furthermore, tooth extraction in patients receiving oral bisphosphonates should be performed in accordance with the guidelines proposed by the Japanese Society of Oral and Maxillofacial Surgeons.

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