Denosumab, a human monoclonal antibody directed against the receptor activator of nuclear factor-κβ ligand (RANKL), is used for the treatment of patients with metastatic cancer of the bone or osteoporosis. Recent reports have demonstrated that denosumab can induce osteonecrosis of the jaw (ONJ), but reported cases of this are uncommon. The present study reports the case of an 86-year-old male with prostate cancer patient exhibiting bone metastases who developed ONJ whilst receiving denosumab. To elucidate the influence of denosumab on the development of ONJ, the present study also reviewed the literature, including clinical trials and case reports. In the clinical trials, the prevalence of denosumab-related ONJ was higher in patients with cancer compared with those with osteoporosis. The high risk of ONJ in patients with cancer was thought to be associated with the differing dose and frequency of denosumab administration. The prevalence of ONJ was not significantly different between patients receiving denosumab and bisphoshonate (BP). In the reported cases, denosumab-related ONJ had a similar clinical presentation to BP-related ONJ. There was also a tendency for denosumab-related ONJ to develop in the mandible of elderly patients. Previous invasive dental treatment was a commonly shared characteristic of patients with denosumab-related ONJ. A complex medical history was also suspected to affect the prevalence. No clear association between the dose or duration of denosumab treatment and the development of ONJ was observed. Although conservative treatments are given for denosumab-related ONJ, non-improving cases were managed surgically with primarily positive results. Because denosumab may offer superior results compared with BP for the treatment of metastatic cancer of the bone or osteoporosis, the use of denosumab is expected to increase in the near future. Clinicians should also be aware of the risk factors for denosumab-related ONJ, in order to aid in its diagnosis. In addition, patients treated with denosumab should receive prophylactic treatment to maintain their oral health prior to, during and after denosumab treatment.
The aim of this study is to clarify the effect of the change of oral sensory input on brain function and to confirm whether it can be detected electroencephalographically.
Eight healthy dentate dental students were selected as subjects, and asked to wear the experimental occlusal interference on the right second molar for 1 week. Simultaneous recordings were made with electromyograms (EMG) and electroencephalogram (EEG) before and after maximum clenching. Evaluation by visual analogue scale (VAS) questionnaires was also done. Twelve‐session experiments were carried out over a period of 12 days. Daily changes of EMG activity of masticatory muscle, six comfort parameters (VAS), and EEG caused by premature contact were analysed statistically applying repeated measured anova and Tukey–Kramer analysis.
The discomfort which was described by VAS did not disappear during the interference period. Just after applying the interference, EMG activity during clenching was decreased significantly (P < 0·01) compared with control. Significant change in EEGs between before and after clenching were observed, that is, the percentage power fraction of β wave (%β) tends to increase. On the contrary, %α in EEGs after clenching decreased significantly (P < 0·01) compared with before clenching during the interference period, as verified by VAS evaluation.
In conclusion, it is suggested that the decrease of %α in EEGs after clenching may be caused by premature contact influence on the masticatory system, reflected in the presence of discomfort during occlusion, and somatosensor information from the occlusal sensation might be recognized in the higher centre of the brain, and the possibility of detecting change might be indicated electroencephalographically.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.