Comparative Evaluation of DMF Scores in Patients Using Bisphosphonates: A Retrospective Study

Abstract

Objectives This study aimed to evaluate the association between bisphosphonate use and the prevalence of dental caries in comparison with systemically healthy controls. Material and Methods This retrospective study included 100 patients: 50 were on bisphosphonate medication and 50 were healthy controls who were matched for age and gender. Between 2013 and 2023, each participant was recorded in the database of Akdeniz University's Faculty of Dentistry. Dental health markers, such as the number of undamaged teeth, restorations, and the prevalence of caries, were evaluated using panoramic radiography. The analysis did not include third molars. Following established standards, two skilled dentists independently assessed the radiographs. Patients between the ages of 18 and 70 were included in the inclusion criteria, however those with major radiographic artifacts, crowns, implants, or tooth loss were excluded. The end measures included the DMF index, the number of caries-affected teeth, the number of teeth that were treated, and the number of teeth that were fully intact. To use the independent samples t-test for statistical analysis, these parameters were compared between the bisphosphonate and control groups (P < 0.05). Results There was no statistically significant difference between the groups (p = 0.26), with the mean DMF index for healthy people being 8.42 and for bisphosphonate users being 9.32. The number of restored teeth (3.0 vs. 2.4, respectively; p = 0.08), carious teeth (2.08 vs. 2.34, respectively; p = 0.52), and sound teeth (20.12 vs. 20.32, respectively; p = 0.59) did not differ significantly either. Conclusion The DMF index, the number of sound teeth, restored teeth, and carious teeth did not differ statistically significantly between bisphosphonate users and healthy people. The DMF index did not significantly rise among bisphosphonate users. It is advised that bigger sample sizes be used in future research to validate these results.

Keywords

• Bisphosphonates
• Dental caries
• DMF index
• Panoramic x-ray

Bifosfonat Kullanan hastalarda DMF Skorlarının Karşılaştırmalı Değerlendirmesi: Bir Retrospektif Çalışma

Öz

Amaç Bu çalışmanın amacı, sistemik olarak sağlıklı bireylerle karşılaştırıldığında hastalarda çürük görülme sıklığı ile bifosfonat kullanımı arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler Bu retrospektif çalışmada 100 hasta yer aldı: 50'si bisfosfonat tedavisi gören hastalar, 50'si ise yaş ve cinsiyet açısından eşleştirilmiş sağlıklı kontrol grubu hastalarıdır. 2013 ile 2023 yılları arasında, her katılımcı Akdeniz Üniversitesi Diş Hekimliği Fakültesi'ne bir giriş yapmıştır. Sağlam diş sayısı, restorasyonlar ve çürük prevalansı gibi diş sağlığı bulguları panoramik radyografiler kullanılarak değerlendirildi. Analiz üçüncü molarları kapsamadı. Yerleşik standartlara göre, iki uzman diş hekimi radyografileri bağımsız değerlendirdi. Çalışmaya 18–70 yaş aralığındaki hastalar dahil edildi, ancak radyografik artefaktları bulunanlar, kronu, implantı olanlar ya da diş kaybı bulunanlar ise dışlandı. Son ölçümler arasında DMF indeksi, çürükten etkilenen diş sayısı, tedavi edilen diş sayısı ve tamamen sağlam diş sayısı yer aldı. İstatistiksel analiz için bağımsız örnekler t-testi kullanmak üzere, bu parametreler bisfosfonat ve kontrol grupları arasında karşılaştırıldı (P < 0,05). Bulgular Gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (p = 0.26), sağlıklı kişilerde ortalama DMF indeksi 8.42, bifosfonat kullanıcılarında ise 9.32 idi. Restore edilmiş diş sayısı (sırasıyla 3.0 ve 2.4; p = 0.08), çürük diş sayısı (sırasıyla 2.08 ve 2.34; p = 0.52) ve sağlam diş sayısı (sırasıyla 20.12 ve 20.32; p = 0.59) arasında da istatistiksel olarak anlamlı bir fark görülmedi. Sonuç DMF indeksi, sağlam diş sayısı, restore edilmiş diş sayısı ve çürük diş sayısı, bifosfonat kullanıcıları ile sağlıklı kişiler arasında istatistiksel olarak anlamlı bir fark göstermemiştir. DMF indeksi, bifosfonat kullanıcıları arasında anlamlı bir artış göstermemiştir. Bu sonuçları doğrulamak için gelecekteki araştırmalarda daha büyük örneklemlerin kullanılması tavsiye edilir.

Anahtar Kelimeler

• Bisfosfonatlar
• Diş çürükleri
• DMF indeksi
• Panoramik röntgen

References

1. Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008; 83: 1032-45.
2. Pazianas M, Miller P, Blumentals WA, et al. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007; 29: 1548-58.
3. Medscape. Bisphosphonate-related osteonecrosis of the jaw: practice essentials, history of the procedure, epidemiology [Internet]. 2025 Mar 28 [cited 2025 Oct 28]. Available from: https://emedicine.medscape.com/article/1447355-overview
4. Lo JC, O’Ryan FS, Gordon NP, et al. Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg. 2010; 68: 243-53.
5. Yoo JJ, Kim J, Kang MJ, et al. Risk of bisphosphonate-related osteonecrosis of the jaw in implants vs. extractions: a nationwide population-based study. Clin Oral Investig. 2025; 29: 368.
6. Yamazaki T, Yamori M, Ishizaki T, et al. Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg. 2012; 41: 1397-1403.
7. Lo JC, O’Ryan FS, Gordon NP, et al. Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg. 2010; 68: 243-53.
8. Mavrokokki T, Cheng A, Stein B, et al. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Aust J Oral Maxillofac Surg. 2007; 65: 415-23.

9. Maciel AP, Quispe RA, Martins LJO, et al. Clinical profile of individuals with bisphosphonate-related osteonecrosis of the jaw: an integrative review. Sao Paulo Med J. 2020; 138: 326-35.
10. Hess LM, Jeter JM, Benham-Hutchins M, et al. Factors associated with osteonecrosis of the jaw among bisphosphonate users. Am J Med. 2008; 121: 475-83.
11. Lima-Souza RAD, Leonel ACLDS, Duarte ALBP, et al. Awareness of patients receiving bisphosphonates: a cross-sectional study. Braz Oral Res. 2022; 36: E0126.
12. Kunchur R, Goss AN. The oral health status of patients on oral bisphosphonates for osteoporosis. Aust Dent J. 2008; 53: 354-7.
13. Russell RGG. Bisphosphonates: the first 40 years. Bone. 2011; 49: 2-19.
14. Ruggiero SL, Dodson TB, Aghaloo T, et al. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws - 2022 update. J Oral Maxillofac Surg. 2022; 80: 920-43.
15. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61: 1115-7.
16. Oubbaih A, Remch S, Reggab M, et al. Prevalence and risk factors of osteonecrosis of the jaw in patients with bisphosphonate exposure in Casablanca, Morocco: an observational study. Open J Epidemiol. 2024; 14: 533-45.
17. Kalra S, Jain V. Dental complications and management of patients on bisphosphonate therapy: a review article. J Oral Biol Craniofac Res. 2013; 3: 25-30.
18. Shani M, Schonmann Y, Comaneshter D, et al. The relationship between patient medication adherence and following preventive medicine recommendations. J Am Board Fam Med. 2021; 34: 1157-62.
19. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007; 22: 1479-91.
20. Khan AA, Morrison A, Hanley DA, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015; 30: 3-23.
21. Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw -2014 update. J Oral Maxillofac Surg. 2014; 72: 1938-56.
22. Migliorati CA, Casiglia J, Epstein J, et al. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc. 2005; 136: 1658-68.