Oral-Health-Related Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw: A Prospective Clinical Study

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) represents an adverse side effect of antiresorptive and antiangiogenic medications. It is associated with impaired quality of life, oral health, and oral function and can be classified into various stages. The purpose of this prospective clinical study is to evaluate the impact of stages I and II MRONJ on oral-health-related quality of life (OHRQoL) and related parameters. Patients’ OHRQoL, satisfaction with life, oral discomfort, and oral health were assessed using the German version of the Oral Health Impact Profile (OHIP-G49), visual analog scales (VAS), and Satisfaction with Life Scale (SWLS) at baseline (T0), 10 days (T1), and 3 months after treatment (T2) in 36 patients. Data were analyzed using Kolmogorov–Smirnov test, two-way mixed ANOVAs, and follow-up Mann–Whitney U tests. The impact of treatment effects on the original seven OHIP domain structures and the recently introduced four-dimensional OHIP structure were evaluated using linear regression analysis. Thirty-six patients received surgical MRONJ treatment. Before treatment, patients’ perceived OHRQoL, oral discomfort, oral health, and satisfaction with life were negatively affected by MRONJ. Surgical treatment significantly improved OHRQoL and related parameters (all p ≤ 0.012). This improvement was greater in patients with higher impairment at T0. OHRQoL and oral restrictions were still impaired after treatment in patients who needed prosthetic treatment. The four-dimensional structure revealed valuable information beyond the standard seven OHIP domains. Increased awareness of MRONJ risks and an interdisciplinary treatment approach for MRONJ patients are needed.

Comparing the Influence of Surgical and Conservative Therapy on Quality of Life in Patients with Early-Stage Medication-Related Osteonecrosis of the Jaw—A Prospective Longitudinal Study

“…Two recent systematic reviews [ 29 , 30 ] on this topic identified a total of 12 studies that examined quality of life in MRONJ patients [ 10 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Another literature search by our research group identified six more papers [ 42 , 43 , 44 , 45 , 46 , 47 ]. Ten of the studies assess OHRQoL (using the questionnaires OHIP 14, OHIP 49, QLQ-OH 15, QLQ-HN35) [ 10 , 32 , 33 , 36 , 37 , 39 , 41 , 42 , 43 , 44 ], while twelve looked at general health-related QoL, pain or psychological outcome measures (using the questionnaires: EORTC QLQ-C30, SF 12, UWQoL, EQ-5D, Duke health profile, VAS, QLQ-ELD14, SWLS) [ 31 , 32 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 44 , 47 ].…”

“…Another literature search by our research group identified six more papers [ 42 , 43 , 44 , 45 , 46 , 47 ]. Ten of the studies assess OHRQoL (using the questionnaires OHIP 14, OHIP 49, QLQ-OH 15, QLQ-HN35) [ 10 , 32 , 33 , 36 , 37 , 39 , 41 , 42 , 43 , 44 ], while twelve looked at general health-related QoL, pain or psychological outcome measures (using the questionnaires: EORTC QLQ-C30, SF 12, UWQoL, EQ-5D, Duke health profile, VAS, QLQ-ELD14, SWLS) [ 31 , 32 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 44 , 47 ]. One working group developed and validated a separate QLQ questionnaire specifically for patients with MRONJ [ 45 ].…”

“…The most noticeable change was between stages one and two [ 41 ]. In a prospective clinical trial in 36 patients with MRONJ, Winter et al showed that MRONJ defect size has a significant effect on satisfaction with life [ 42 ]. Patients with larger defects were significantly less satisfied with life.…”

“…Patients with larger defects were significantly less satisfied with life. Interestingly, Winter et al did not find significant differences between MRONJ stages [ 42 ]. It is certainly debatable whether the current AAOMS staging [ 12 ] correctly reflects the defect size.…”

Bone Concentration of Ampicillin/Sulbactam: A Pilot Study in Patients with Osteonecrosis of the Jaw

“…Furthermore, it is an important treatment option when surgery is not possible (for example comorbidities) [ 1 , 11 ]. Nevertheless, most patients undergo surgery because of the lower success rate, prolonged therapy, and the progression of ONJ when only conservative therapy is performed [ 12 , 13 ]. Surgical treatment involves complete necrosectomy of the bone and mucosal closure or other reconstructive surgery, such as microvascular transplants.…”