2059P - The impact of a dental oncology clinic for patients (pts) prescribed bone-modifying agents (BMA) in a cancer centre

Background

Two decades ago medication related osteonecrosis of the jaw (MRONJ) was first described in oncology pts receiving BMAs. Pre-existing dental disease is the main initiating factor for MRONJ. Dental disease is the commonest global non-communicable disease. We assessed the impact of integrating a dental oncology service for all incident pts prescribed BMAs.

Methods

A dental clinic was established in March 2022 collocated with a cancer centre and all pts receiving BMAs were assessed by an oral surgeon prior to BMA administration and all necessary dental treatment was completed.

Results

120 pts included (66% female), 66 were <65 years, were treated over 1 year. 82 pts had metastatic disease. Early stage breast cancer (N=35), metastatic breast cancer (N=36), prostate cancer (N=24), and other malignancies (N=25) were represented in this cohort. 118 pts were planned for intravenous zoledronate and 2 were planned for denosumab. 117 pts were deemed dentally fit to commence their BMA. 29 pts were current smokers, and 24 pts wore dentures. 45 pts had a current dental complaint on presentation, for which 31 complaints related to pain and infection. Assessment of barriers to dental services; 20 pts live alone, 42 pts were not registered with a dentist, and 51 hadn’t seen their dentist in ≥3 yrs. 8 pts had intraoral smoking related changes, and moderate dysplasia was identified in 1 pt following a biopsy. The Decayed, Missing and Filled Teeth (DMFT) index median score was 18, and mean DMFT score was 19. 88 pts had a periodontal status of ≥Stage 2 Grade B which demonstrated longstanding and active periodontal disease. The mean bleeding on probing score was 35% and 75 pts had a high Caries Risk Assessment score. 65 pts required an operative dental procedure. 33 pts received a dental restoration, of which 16 pts required a median of 2 dental restorations. 58 pts had teeth extracted, of whom 37 had a median of 3 teeth extracted.

Conclusions

This oncology cohort had poor engagement with dentistry and had a high burden of dental disease prior to BMA treatment. The data highlights their dental treatment needs prior to BMA treatment and the requirement for proactive dental integration by the oncology team. Dental care should be an integral part of multidisciplinary cancer care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

CiSA.

Disclosure

All authors have declared no conflicts of interest.