Oralno zdravlje onkoloških pacijenata u kojih se planira liječenje antiresorptivnim i/ii antiangiogenim lijekovima

master's thesis

• Title (english): Oral health of oncological patients intended for the treatment of antiresoptive and / or antiangiogenic medicines
• Author: Lucija Majhen
• Mentor: Vlaho Brailo (mentor)
• Committee member: Vlaho Brailo (predsjednik povjerenstva)
• Committee member: Božana Lončar Brzak (član povjerenstva)
• Committee member: Marko Granić (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Department of Oral Medicine); Zagreb
• Defense date and country: 2019-09-26, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Oral Medicine

Abstract

Osteonekroza čeljusti uzrokovana lijekovima (MRONJ) je komplikacija terapije antiresoptivnim i antiangiogenim lijekovima. Glavna klinička značajka MRONJ je eksponirana kost u usnoj šupljini koja ne cijeli. Osim navedenog, u kliničkoj slici može biti prisutna oteklina mekog tkiva, fistula ili ograničena gnojna upala. Glavni faktor rizika za nastanak MRONJ je ekstrakcija zuba. Da bi se rizik za nastanak MRONJ minimalizirao, pacijente je potrebno stomatološki obraditi prije uvođenja terapije. Prema literaturi, invazivni stomatološki zahvat se preporučuje obaviti mjesec dana prije početka terapije.
Svrha ovog rada je bila utvrditi stanje oralnog zdravlja i potrebu za stomatološkim liječenjem u onkoloških pacijenata prije uvođenja antiresoptivne/antiangiogene terapije.
Napravljena je retrospektivna analiza kartona onkoloških bolesnika upućenih na stomatološku obradu prije uvođenja antiresoptivne i/ili antiangiogene terapije. Podaci koji su se prikupljali bili su: dob, spol, dijagnoza, lijek koji se planira uvesti, KEP indeks, broj zuba za ekstrakciju, tip ekstrakcije, primjena antibiotika, pojava komplikacija, broj dolazaka i vrijeme potrebno za dobivanje suglasnosti stomatologa za uvođenje terapije.
U istraživanju je sudjelovalo 22 ispitanika prosječne dobi 64 godine. Prosječan KEP indeks je iznosio 18,5. Prosječan broj zuba iznosio je 3 ± 3 po pacijentu.
Mali broj onkoloških bolesnika s metastatskom onkološkom bolešću prolazi stomatološku obradu prije uvođenja antiresoptivne terapije. U većine pacijenata potrebna je ekstrakcija jednog ili više zuba. Stomatološka obrada većine zuba može se završiti unutar 14 dana što ne dovodi do značajne odgode početka liječenja, a višestruko smanjuje rizik za nastanak MRONJ.

Abstract (english)

Medication - related osteonecrosis of the jaw (MRONJ) is an adverse side-effect of antiresoptive and antiangiogenic agents. The main clinical sign is exposed necrotic bone in maxillofacial region. Other clinical signs include soft tissue swelling, fistula or purulent inflammation. Tooth extraction is considered a major risk factor for the development of MRONJ. To minimize the risk of MRONJ, patients need to undergo dental treatment before initiating therapy. According to the literature, an invasive dental procedures are recommended to be peformed one month before beginning of the treatment.
The purpose of this study was to determine the oral health status and the need for dental treatment in oncological patients prior to the introduction of antiresoptive/antiangiogenic therapy.
A retrospective chart analysis of oncologic patients referred for dental treatment prior to the introduction of antiresoptive and / or antiangiogenic therapy was done. Registered data were: age, gender, diagnosis, medication to be introduced, DMFT index, number of teeth to be extracted, type of extraction, antibiotic administration, occurrence of complications, number of arrivals, and time required to obtain the dentist’s consent to initiate therapy.
The study involved 22 subjects with an average age of 64 years. The average DMFT index was 18,5. The average number of teeth that needed to be extracted was 3 ± 3 per patient.
A small number of cancer patients with metastatic malignancy undergoes dental treatment prior to the introduction of antiresoptive therapy. Most patients require the extraction of one or more teeth. In the majority of patients dental treatment can be completed within 14 days which does not represent significant treatment delay but significantly reduces the risk for MRONJ.

• Keywords: Osteonekroza čeljusti uzrokovana lijekovima; bisfosfonati; denosumab; antiresorptivni lijekovi; ekstrakcija; prevencija
• Keywords (english): Medication – related osteonecrosis of the jaw; bisphosphonates; denosumab; antiresoptive drugs; extraction; prevention
• Language: croatian
• URN:NBN: urn:nbn:hr:127:324600
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-01-16 12:17:23