ORAL CAVITY STATUS IN PATIENTS WITH MEDICATION-RELATED OSTEONECROSIS OF THE JAW BEFORE AND AFTER TREATMENT

Introduction. Odontogenic infection acts as a key trigger in the pathogenesis of medication- related osteonecrosis of the jaw. Poor oral hygiene exacerbates the situation – foci of chronic odontogenic infection become decompensated, periodontal diseases progress, leading to tooth loss and the emergence of new sources of osteonecrosis. Chronic oral inflammation makes proper oral hygiene and dental restoration impossible, which is one of the causes of social maladjustment for the patient. Objective: to evaluate the oral cavity condition in patients with drug-associated osteonecrosis of the jaw before and after complex treatment. Materials and Methods. A case-control study. 79 patients with medication-related osteonecrosis of the jaw were examined. All patients were treated according to the proposed protocol, which included intraoperative determination of sequestrectomy margins using laser Doppler flowmetry, treatment of residual granulations with a red diode laser, and injections of autologous plasma into the edges of the postoperative wound. The dental status of patients was assessed using the following indices: the caries intensity index, the Simplified Oral Hygiene Index, and the Papillary-Marginal-Alveolar Index (1960). The indices were calculated according to standard methods. Calculations for statistical analysis were performed using the MS Excel 10 Analysis ToolPak and Statistica 10. Results. Pathology of the hard tissues of all tooth groups was identified in all patients. The prevalence of caries was 100 %. The caries intensity index in the study group was 20.06 ±5.58, with 11.4 % of patients having complete secondary edentulism. The mean Simplified Oral Hygiene Index by Greene-Vermillion was 2.5 ±0.07. The mean Papillary-Marginal-Alveolar Index was 54.67 ±15.65. The dynamics of dental indicators were assessed 2 months after treatment. The caries intensity index increased (22.08 ±5.17), the mean Oral Hygiene Index score was 1.61 ±0.5, and the Papillary-Marginal-Alveolar Index decreased by 15.03 % (39.64 ±16.24). In 50.6 % of patients, the integrity of the dentition was restored using removable orthopedic prostheses. Conclusion. Thus, the proposed method for the intraoperative determination of sequestrectomy boundaries and the algorithm for postoperative management and early rehabilitation of patients with medication-related osteonecrosis of the jaw makes it possible to alleviate pain, eliminate the mucosal defect of the alveolar process, perform a complete oral debridement, and restore the integrity of the dentition with orthopedic prostheses.