Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort-based study

Background: We investigated whether periodontal diseases contribute to the development of medication-related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence. Methods: This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data. Results: Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74–3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86–3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41–4.64). Conclusions: The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates.