Sjögren’s Patients at Higher Risk for Bone Death in Jaw After Tooth Extraction

Those with Sjögren’s syndrome appear to be at higher risk for osteonecrosis of the jaw (ONJ), a condition where, after undergoing tooth extraction, a person’s jawbone is cut off from its blood supply and starts to starve, a study found.

The study, “Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study,” was published in BMJ Open.

ONJ usually happens after a tooth extraction. Although it can be managed relatively easily, ONJ can be a problem because it’s not very well-known and doesn’t always cause symptoms, so it’s not always diagnosed.

In order to help identify ONJ so it can be treated before it does real damage, it’s useful to know which patients are at higher risk. For example, patients taking bisphosphonates, a group of drugs used to treat some cancers and osteoporosis, are at higher risk for ONJ.

The researchers behind the new study noted that the molecular pathways that characterize ONJ are similar to those that characterize the autoimmune disease Sjögren’s syndrome. They hypothesized that patients with this disease might be at greater risk of developing ONJ.

To test this, the researchers analyzed patient data from The National Health Insurance program in Taiwan, which provides care for 99% of the Taiwanese population. Analyzing patient records, they identified 13,398 patients with Sjögren’s syndrome, as well as 53,592 patients without Sjögren’s syndrome but similar in terms of age and sex whose data were used as controls.

The investigators found that patients with Sjögren’s syndrome were at a much higher risk (7.6 times more likely) of developing ONJ after a tooth extraction. It is worth noting, however, that there were only 20 cases of ONJ in the entire study population.

Patients with Sjögren’s syndrome were more likely to be taking bisphosphonates, and the incidence of ONJ in patients with Sjögren’s syndrome who were also taking bisphosphonates was much higher than the incidence in any other group — about 19 times that of healthy patients who weren’t taking bisphosphonates.

The researchers found that males were more likely than females to develop ONJ, although the study included relatively few males, as Sjögren’s syndrome is more common in females.

The use of steroids or chemotherapy weren’t significant risk factors for ONJ in this analysis, which contradicts some previous results. The investigators called for further research to clarify these contradictions.

“We found that patients with [Sjögren’s syndrome] were more susceptible to ONJ than patients without SS,” the researchers concluded. They further suggested that bisphosphonate should be used with caution in patients with Sjögren’s syndrome.