The importance of an up-to-date medical history

PD Dr. Kristina Bertl, PhD MSc MBA

It is important to fully update our patients’ general medical history and medication at regular intervals (at least once per year) – even for patients we have known ‘for years’. Numerous medication groups are important in the field of dentistry and its possible treatments. Antiresorptive medications are one such group. Antiresorptives include all bisphosphonate preparations and some other medications, and they can be prescribed as tablets or in injection form. These medications affect bone metabolism and can lead to severe necrosis of the jawbone, particularly after tooth extractions and surgical interventions. These antiresorptive medications are widely used because they have numerous areas of application, such as osteoporosis and primary bone cancer. They are also used for bone metastases, which often occur in breast and prostate carcinoma.

So why is it now so important to know this in prophylaxis?

1. Prophylaxis dental assistants and dental hygienists see their patients frequently, which means they can take a fully up-to-date history at regular intervals. If a patient reports a newly diagnosed disease, such as osteoporosis or a tumour, they should be explicitly asked about their medications, and the dentist should be informed.
2. Jawbone necrosis caused by antiresorptive medications usually happens after tooth extractions or surgical procedures. Nonetheless, it can also occur without a preceding surgical intervention, around both the natural dentition and implants (see Figure). Consequently, patients who notice any abnormalities (e.g. fistula, minimally exposed bony tissue, non-healing ulcers) should not wait until their next appointment and ‘see whether it gets better’, but should instead immediately visit their dentist.
3. Recently, the first case report (Diniz-Freitas et al., 2018) was published in which non-surgical periodontal treatment was suspected as having triggered the onset of jawbone necrosis. However, this should in no way discourage us from promoting prophylaxis measures to patients on antiresorptive medications. Chronic and acute inflammation should be avoided as far as possible, and periodontitis patients should definitely continue to have regular periodontal treatment.

Reference

1. Diniz-Freitas M, Fernández-Feijoo J, Diz Dios P, Pousa X, Limeres J. Denosumab-related osteonecrosis of the jaw following non-surgical periodontal therapy: A case report. J Clin Periodontol. 2018 May;45(5):570-577. doi: 10.1111/jcpe.12882. Epub 2018 Apr 16. Stavropoulos A, Bertl K, Pietschmann P, Pandis N, Schiødt M, Klinge B. The effect of antiresorptive drugs on implant therapy: Systematic review and meta-analysis. Clin Oral Implants Res. 2018 Oct;29 Suppl 18:54-92. doi: 10.1111/clr.13282.