From nearly 4,000 medical records of patients at Leuven University Hospital in Belgium, one small number turned out to be potentially decisive: whether a tooth extraction wound would heal normally, take longer than expected, or develop into a much more serious condition. This is the central finding of a study involving drg. Isti Rahayu Suryani, M.Biotech., Sp.RKG, Subsp.RDP(K), PhD, a lecturer in the Department of Dental Radiology, Faculty of Dentistry, Universitas Gadjah Mada, together with an international research team from KU Leuven and Karolinska Institutet.
Published in Health Science Reports in 2024, the study proposes a score-based screening tool that could potentially change how dentists manage medically complex patients.
When Tooth Extraction Is More Than a Routine Procedure
For most people, tooth extraction is a procedure that takes only a few minutes, followed by healing within several days. However, for patients with certain medical conditions, such as prostate cancer, multiple myeloma, osteoporosis, or diabetes, who may also be taking multiple medications simultaneously, the healing process can be considerably more complicated.
One of the most concerning complications is medication-related osteonecrosis of the jaw (MRONJ), a condition in which the jawbone fails to heal and necrotic bone becomes exposed, even more than eight weeks after the procedure. The condition is often associated with antiresorptive medications such as bisphosphonates and denosumab, which are commonly used to treat osteoporosis and cancer.
The problem is that, until now, there has been no sufficiently reliable clinical instrument for predicting which patients are at high risk of developing such complications before a procedure is performed.
A Score That Says More Than Just a Number
The research team adapted an existing scale, the University of Connecticut Osteonecrosis Numerical Scale (UCONNS), into a more comprehensive version known as the Adapted-UCONNS (A-UCONNS). The scale takes four major parameters into account: the patient's underlying pathological condition, the dental procedure performed, comorbidities including smoking habits and medication use, and the use of antiresorptive medications.
Each parameter is assigned a different weight, which is then combined into a total score. Scores below 10 indicate minimal risk, scores of 10–15 indicate moderate risk, and scores of 16 or higher indicate significant risk.
Of the 3,977 medical records reviewed, 353 male patients with a mean age of 67.4 years met the inclusion criteria. The findings were striking: 18.69% of patients developed MRONJ, while 12.46% experienced delayed healing. Only approximately 65% healed normally.
“Each one-unit increase in the A-UCONNS score was associated with a 1.347-fold higher odds of developing MRONJ compared with normal healing.”
Multinomial logistic regression analysis showed that antiresorptive medication use had the strongest association with MRONJ, with an odds ratio of 4.6. In other words, patients taking these medications had nearly five times the odds of developing MRONJ compared with patients who were not taking them. Dental treatment factors, such as the type of procedure and periodontal condition, also contributed significantly.
Survival analysis using Kaplan–Meier curves further strengthened these findings: patients with high-risk scores consistently required longer recovery periods than those in the low-risk category.
Who Is Most Vulnerable, and Why?
Among all patients studied, those with prostate cancer represented the largest group, with 58 cases. Of these, 35 developed MRONJ. Patients who had undergone chemotherapy within the previous 12 months also showed concerning outcomes: 56% developed MRONJ.
This is not merely coincidental. Biologically, chemotherapeutic agents interfere with cell migration to wounds, suppress collagen production, and impair fibroblast proliferation—all processes that are crucial during wound healing. Chemotherapy-related adverse effects such as neutropenia, anemia, and thrombocytopenia can further worsen the condition by reducing oxygen delivery to tissues and increasing the risk of infection.
Corticosteroids also came under scrutiny. These drugs directly inhibit the activity of osteoclasts, osteoblasts, and osteocytes, three types of cells that play central roles in bone remodeling. When these cells do not function optimally, the jawbone loses its ability to regenerate.
From Leuven to Dental Clinics Anywhere
The researchers openly acknowledged several limitations: the retrospective design limits causal interpretation, pharmacological data were not always complete, follow-up periods varied between patients, and the sample consisted exclusively of male patients. Broader longitudinal studies involving more diverse populations will therefore be needed before A-UCONNS can be widely implemented as a clinical standard.
Nevertheless, the contribution of this study should not be overlooked. In everyday clinical practice, dentists frequently encounter older patients with long lists of medications and complex medical histories. Tools such as A-UCONNS provide a common framework for systematically assessing risk rather than relying solely on clinical intuition.
For patients with moderate risk scores, closer monitoring and preventive measures may be sufficient. For those in the high-risk category, more individualized strategies—from postponing procedures to implementing intensive post-extraction care protocols—could make the difference between successful recovery and prolonged complications.
This study serves as a reminder that behind every seemingly simple tooth extraction lies a complex biological ecosystem, and in certain patients, that ecosystem requires much closer attention.
Source DOI: DOI: 10.1002/hsr2.2184
Authors: Anny Anggraini; drg. Achmad Zam Zam Aghasy, M.Kes.
Photo: Pexels