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The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 1: an overview

British Dental Journal (2022)Cite this article

A Correction to this article was published on 07 February 2022

This article has been updated

Abstract

Introduction Dental pre-assessment before bone-targeting agents (BTA) in oncology patients is a well-recognised practice; yet, guidance on this has typically been unable to differentiate between the intricacies of varying oncology groups. This study assesses the presenting dental status of oncology patients with bone metastases (BM) due to commence BTA, to determine whether differences exist with varying tumour groups.

Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic. Statistical analysis and observational data were used to compare patient and tumour demographics as well as to their peers via the Adult Dental Health Survey.

Results A total of 492 patients with a solid tumour diagnosis and BM requiring BTA were included in this retrospective study. Demographics such as sex, age, smoking status and tumour site were all significant for the number of teeth present (p = 0.000). Furthermore, survival data post-BTA identified prostate, breast and thyroid groups surviving over 12 months following dental assessment (p <0.000). In contrast, the remaining groups such as lung, colorectal and gastrointestinal had poorer outcomes (p <0.000).

Conclusion Pre-BTA dental assessment should consider and incorporate additional patient and tumour demographics to allow for a tailored and personalised dental treatment plan. Application of this principle would look to optimise oral function while considering tumour prognosis to avoid over- or under-prescribing pre-BTA dental treatment.

Key points

  • Any cancer can metastasise to the bone; however, the most common are tumours of the prostate, breast, lung, renal and thyroid.

  • Diet, smoking, alcohol and age are recognised risk factors in cancer and are also known to influence the dentition.

  • Metastatic tumour groups with longer survival times will accumulate more bone-targeting agents which can lead to increasing risk of medication-related osteonecrosis of the jaw.

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References

  1. Royal College of Surgeons of England and The British Society for Disability and Oral Health. The Oral Management of Oncology Patients Requiring Radiotherapy, Chemotherapy and/or Bone Marrow Transplantation: Clinical guidelines. 2012. Available at https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines/ (accessed December 2021).

  2. Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw. 2017. Available at https://www.sdcep.org.uk/published-guidance/medicationrelatedosteonecrosisofthe-jaw/ (accessed December 2021).

  3. Ruggiero S L, Dodson T B, Fantasia J et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. J Oral Maxillofac Surg 2014; 72: 1938-1956.

  4. Royal College of Physicians. Medication-related osteonecrosis of the jaw: guidance for the oncology multidisciplinary team. 2019. Available at https://www.rcplondon.ac.uk/guidelines-policy/medication-related-osteonecrosis-jaw-guidance-oncology-multidisciplinary-team (accessed December 2021).

  5. Patel V, Mansi J, Ghosh S et al. MRONJ risk of adjuvant bisphosphonates in early stage breast cancer. Br Dent J 2018; 224: 74-79.

  6. Svensson E, Christiansen C F, Ulrichsen S P, Rørth M R, Sørensen H T. Survival after bone metastasis by primary cancer type: a Danish population-based cohort study. BMJ Open 2017; DOI: 10.1136/bmjopen-2017-016022.

  7. Cancer Research UK. Cancer Statistics for the UK. 2021. Available at https://www.cancerresearchuk.org/health-professional/cancer-statistics-for-the-uk#heading-Zero (accessed December 2021).

  8. King R, Tanna N, Patel V. Medication-related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab - a review. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127: 289-299.

  9. King R, Zebic L, Patel V. Deciphering novel chemotherapy and its impact on dentistry. Br Dent J 2020; 228: 415-421.

  10. Patel V, Patel D, Browning T et al. Presenting pre-radiotherapy dental status of head and neck cancer patients in the novel radiation era. Br Dent J 2020; 228: 435-440.

  11. Patel V, Patel D, Browning T et al. Pre-radiotherapy presenting dental status of the three most common head and neck cancer subsites in a novel radiation era. Faculty Dent J 2020; 11: 52-57.

  12. Patel V, Patel D, Browning T et al. Pre-radiotherapy dental status of oropharyngeal cancer patients based on HPV status in a novel radiation era. Br Dent J 2020; DOI: 10.1038/s41415-020-1922-y.

  13. NHS Digital. Adult Dental Health Survey 2009 - Summary report and thematic series. 2011. Available at https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series (accessed December 2021).

  14. Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202.

  15. Macmillan Cancer Support. Statistics Fact Sheet. 2021. Available at https://www.macmillan.org.uk/_images/cancer-statistics-factsheet_tcm9-260514.pdf (accessed December 2021).

  16. Schiodt M, Vadhan-Raj S, Chambers M S et al. A multicentre case registry study on medication-related osteonecrosis of the jaw in patients with advanced cancer. Support Care Cancer 2018; 26: 1905-1915.

  17. Rad M, Kakoie S, Brojeni F N, Pourdamghan N. Effect of long-term smoking on whole-mouth salivary flow rate and oral health. J Dent Res Dent Clin Dent Prospects 2010; 4: 110-114.

  18. Wang Q, Liu J, Qi S, Liao X, Liu D, Pan J. Clinical analysis of medication related osteonecrosis of the jaws: A growing severe complication in China. J Dent Sci 2018; 13: 190-197.

  19. Coleman R E. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001; 27: 165-176.

  20. Macedo F, Ladeira K, Pinho F et al. Bone metastases: an overview. Oncol Rev 2017; 11: 43-49.

  21. Selvaggi G, Scagliotti G V. Management of bone metastases in cancer: a review. Crit Rev Oncol Hematol 2005; 56: 365-378.

  22. Guise T A. Antitumour effects of bisphosphonates: promising preclinical evidence. Cancer Treat Rev 2008; DOI: 10.1016/j.ctrv.2008.03.006.

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Authors and Affiliations

  1. Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK

    Vinod Patel, Rana Wali, Megan Burns, Sheelen Patel & Marianne Henien

  2. Oral and Maxillofacial Surgery Department, Torbay Hospital, UK

    Sanford Grossman

  3. Computer Science Department, Brunel University, London, Kingston Lane, Uxbridge, UB8 3PH, UK

    Isabel Sassoon

  4. Medical Oncology, Guy´s and St Thomas´ NHS Foundation Trust, London, UK

    Sarah Rudman

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  1. Vinod Patel
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Correspondence to Vinod Patel.

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19/LO/1600 - dental status of oncology patients requiring bone-modulating therapy - a retrospective cohort study. There are no conflicts of interest to declare by any of the authors for this submitted work.

Additional information

The original online version of this article was revised.

Due to a production error, when the article 'The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 1: an overview' written by Vinod Patel, Sanford Grossman, Rana Wali et al. was originally published, the publication date on the publisher's internal portal read 14 January 2022. This has been corrected to 13 January 2022, the date the paper was first published online.

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Patel, V., Grossman, S., Wali, R. et al. The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 1: an overview. Br Dent J (2022). https://doi.org/10.1038/s41415-021-3825-y

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