Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a 'real-world' setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

Current practice in the management of peripheral ameloblastoma: a structured review

Ameloblastoma is the most common benign, but locally destructive, epithelial odontogenic tumour. Peripheral ameloblastoma may involve soft tissues without invasion or involvement of bone. The aim of this structured review was to evaluate the literature and guide clinical management. Three online databases were searched for relevant studies: Medline, EMBASE, and Ovid Evidence-Based Medicine, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 520 papers were initially identified, and after exclusions were applied, 45 were included. Conservative surgical excision was the treatment of choice. There was no consensus in relation to the extent of the surgical margins required. The management of peripheral ameloblastoma appears to favour conservative excision with narrow margins of normal tissue. Follow up of at least 10 years is recommended to monitor for recurrence.