Imagine an 80-year-old patient who has just undergone a tooth extraction. They take more than ten medications every day, including bisphosphonates for fragile bones and corticosteroids to control inflammation. Two weeks pass, yet the extraction socket has not closed. A month later, the jawbone begins to become exposed. This is not an isolated scenario, and recent research from KU Leuven has demonstrated the risk in striking numbers.
A study published in the Journal of Stomatology Oral and Maxillofacial Surgery found that patients taking a combination of antiresorptive (AR) and non-antiresorptive (non-AR) medications had up to a 14.68-fold higher likelihood of delayed healing compared with patients who were not taking these medications. The study involved drg. Isti Rahayu Suryani, M.Biotech., Sp.RKG, Subsp. RDP(K), Ph.D., a researcher from the Department of Dental Radiology, Faculty of Dentistry, Universitas Gadjah Mada, who also served as the lead author of this multicenter study.
Thousands of Medical Records, 353 Patients Tell the Story
The research team examined digital medical records from 3,977 patients who underwent tooth extraction at the Department of Oral and Maxillofacial Surgery, UZ Leuven, Belgium, over a six-year period from September 2015 to April 2021. After rigorous screening, 353 male patients aged 40–90 years met the inclusion criteria.
Patients were divided into three groups: those receiving non-AR polypharmacy, those receiving a combination of AR and non-AR medications, and a control group that had not taken any medications during the previous 12 months. Healing outcomes were classified into three categories: normal healing (less than 14 days), delayed healing (14 days to 8 weeks), and medication-related osteonecrosis of the jaw (MRONJ), defined as a condition in which the jawbone becomes necrotic and shows no signs of healing for more than eight weeks.
Polypharmacy itself was assessed using categories ranging from minor (0–2 medications), moderate (3–5), major (6–9), to hyper-polypharmacy (more than 10 medications). This score turned out to be one of the strongest predictors in the study.
Numbers That Cannot Be Ignored
Multivariable analysis revealed a consistent and concerning pattern. Patients aged 80 years and older had nearly a sevenfold higher risk of delayed healing (OR = 6.98) compared with younger patients. Meanwhile, patients with a major polypharmacy score had a 15-fold higher risk of delayed healing (OR = 15.37).
Even more strikingly, patients with hyper-polypharmacy who were taking non-AR medications had an almost 59-fold higher risk of developing MRONJ (OR = 58.86) compared with the control group. This figure is more than just a statistic—it is a strong signal that a high medication burden can transform what appears to be a routine tooth extraction into a serious complication.
“Wound healing in patients taking non-AR polypharmacy or a combination of AR and non-AR medications was significantly impaired after tooth extraction. Other risk factors, such as advanced age and a high polypharmacy score, also contributed to delayed healing and MRONJ.”
Regarding specific medications, bisphosphonates showed the highest likelihood of causing delayed healing (OR = 3.12), while corticosteroids were associated with the highest risk of MRONJ (OR = 2.18). Corticosteroids are known to increase osteoblast and osteocyte apoptosis, thereby directly impairing bone and soft-tissue repair.
One interesting finding was that the extraction site and smoking status did not have a significant effect on impaired healing in the multivariable analysis. This suggests that medication-related factors and age may play a much more dominant role than smoking habits.
Why This Matters for Dentists and Patients
In everyday clinical practice, dentists frequently encounter older patients who arrive with long lists of medications, particularly those who are currently undergoing or have previously undergone cancer treatment. This study emphasizes that a comprehensive assessment of a patient's medication profile is not merely an administrative formality—it is a clinically decisive step.
The implications are clear: before performing dentoalveolar procedures on patients with a high degree of polypharmacy, dentists should consider multidisciplinary consultation, modifications to surgical protocols, and potentially adjustments to medication doses in coordination with the relevant specialist. Post-extraction radiographic monitoring, such as through panoramic radiography, may also be important for detecting early signs of MRONJ before the condition becomes more severe.
The researchers acknowledged several limitations, particularly the retrospective study design and limited information regarding medication dosages. All participants were male, meaning that generalization to female populations requires further research. Nevertheless, the study provides a foundation for more structured prospective research to answer an important unanswered question: can adjustments to medication type or dosage prevent healing complications?
For patients, the message is simple but often overlooked: tell your dentist about every medication you are taking, no matter how insignificant it may seem. A complete medication list could make the difference between an extraction socket that heals within two weeks and a jaw that remains problematic for months.
Source DOI: https://doi.org/10.1016/j.jormas.2023.101645
Authors: Anny Anggraini; drg. Achmad Zam Zam Aghasy, M.Kes.
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