(71) Is Dental Clearance Necessary Before Antiresorptive Treatment in Pediatric Patients?

Abstract:

Background: In the adult population, dental clearance before starting antiresorptive treatment has been shown to reduce the incidence of medication-related osteonecrosis of the jaws (MRONJ).¹ With few studies investigating the risk of MRONJ in the pediatric population, the role of dental clearance is unclear.²

Purpose: The purpose of this study was to determine if there was a difference in the frequency of MRONJ between pediatric patients who obtained dental clearance and those who didn't obtain dental clearance before the start of antiresorptive therapy. We hypothesized there would be no difference in the frequency of MRONJ. The specific aim was to enroll a sample of pediatric patients who received antiresorptive treatment and determine the effect of dental clearance on the frequency of MRONJ. The secondary aim was to assess the effect of dental clearance on future dental follow-up after the start of antiresorptive treatment.
Study

Design: A retrospective cohort study was designed and implemented. The study population was composed of patients less than 18 years of age who received antiresorptive treatment from 2010 to 2024 at Children’s Medical Center Dallas.
Predictor Variable: The primary predictor variable was dental clearance.
Outcome Variable: The primary outcome variable was MRONJ. The secondary outcome variable was dental follow-up after the start of antiresorptive treatment.
Covariates: There were 9 covariate variables, including age at the start of antiresorptive treatment, sex, type of antiresorptive received, reason for antiresorptive treatment, dose/duration, immunosuppressant/chemotherapy exposure, dental extractions after starting antiresorptive, longest follow-up after starting antiresorptive, and mean dental visits per year after starting antiresorptive.
Analyses: Chi-squared analyses and t-tests were used to evaluate the effect of the covariates on the primary predictor variable. To evaluate the effect of the primary predictor on the secondary outcome variable, t-test was used. A P value of < .05 was considered statistically significant.

Results: The total study population consisted of 136 subjects. After the start of antiresorptive treatment, 34 subjects underwent dental extraction of 108 teeth. There were 88 subjects in the clearance group and 48 in the no-clearance group. There were statistically significant differences between the two groups in the covariates age, reason for antiresorptive, antiresorptive received, and cumulative pamidronate dose. No cases of MRONJ were observed in either group. The clearance group mean dental visits per year after the start of antiresorptive therapy was 1.21 (SD 0.96), and 0.55 (0.65) for the no-clearance group. There was a statistically significant difference between the two groups in mean dental visits per year after the start of antiresorptive treatment (P = .0002).

Conclusions: There were no cases of MRONJ observed in the present study. In pediatric patients who receive dental clearance prior to the start of antiresorptive medications, there is an association with continued routine dental follow-up.

1. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 80.5:920-943, 2022
2. Brown JJ, Ramalingam L, Zacharin MR. Bisphosphonate-associated osteonecrosis of the jaw: does it occur in children? Clin Endocrinol (Oxf) 68:863–7, 2008. doi: 10.1111/j.1365-2265.2008.03189.x