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Patients underwent a structured telephone interview conducted by trained research assistants at each PBRN, assessing ONJ characteristics (mouth location, date of onset, size, pain, duration, healing), oral hygiene, medical history (cancers, radiotherapy, bone diseases), occupational exposures (chemical industry, phosphorus exposure), demographics, education and lifestyle (race/ethnicity, alcohol and smoking history), and medications (oral and/or IV bisphosphonates, chemotherapy, antiretroviral medication, steroids, regular use of other drugs). The primary exposure of interest was bisphosphonate therapy.Secondary exposures included therapeutic radiation to the jaws, diagnosis of cancer or osteoporosis, dental diagnoses and procedures, co-existing chronic diseases, and long-term use of systemic corticosteroids.
We enrolled 191 ONJ cases and 573 controls in 119 dental practices.This article presents our main findings related to demographics, medical conditions, dental procedures, and systemic medications.Further information on specific dental diseases and procedures is presented elsewhere.ONJ was defined as maxillary or mandibular exposed bone of any size that clinically appeared necrotic, without regard to duration or cause.Since we included all osteonecrotic jaw lesions, we neither restricted cases to a minimum duration of 8 wks, nor excluded those with a history of radiation therapy (Khosla ., 2007).Beginning in 2003, case reports, case-series, and cohort studies linked ONJ with bisphosphonate treatment, with prevalence varying from less than 1% to 28% (Wang ., 2003).
Several bisphosphonates are available in the US, including alendronate, etidronate, ibandronate, pamidronate, risedronate, and zoledronic acid.
Alendronate and risedronate alone accounted for ., 2004).
We conducted a case-control study in dental practices to determine the risk associated with bisphosphonates and to identify other risk factors for ONJ, including dental diseases and procedures.
Cases originated from primary, secondary, and tertiary care centers.
Subsequent to identification of a case, practitioners were asked to contact the patient verbally and ask permission for contact by the researchers, who then obtained informed consent. For cases obtained from secondary or tertiary care centers, controls were selected from the general dental practice that referred the case or, if this was not possible, from a practice in the same geographic area. Standardized dentist forms queried dental signs, symptoms, diagnoses, and procedures between 20 that preceded the diagnosis of ONJ by a maximum of 3 yrs.
These factors were selected based on their previous association with osteonecrosis.