From the Guidelines
Obtaining CTX levels prior to dental procedures in patients with a history of bisphosphonate use is not explicitly recommended by the most recent and highest quality study, which instead emphasizes the importance of comprehensive dental examination and preventive dentistry before bone-modifying therapy. The study published in 2018 1 highlights the risk of osteonecrosis of the jaw (ONJ) associated with bisphosphonate use, but does not mention CTX testing as a recommended practice. Instead, it suggests that all patients with cancer should receive a comprehensive dental examination and appropriate preventive dentistry before bone-modifying therapy, and that active oral infections should be treated and sites at high risk for infection eliminated.
Some key points to consider when assessing the risk of ONJ in patients with a history of bisphosphonate use include:
- The type and duration of bisphosphonate therapy
- Concurrent medications
- The patient's overall health status
- The risk of ONJ increases with frequency, dose, and duration of bisphosphonate administration, as noted in the 2017 study 1
- A comprehensive dental examination and preventive dentistry before bone-modifying therapy can help reduce the risk of ONJ, as recommended in the 2011 study 1
It is essential to prioritize a comprehensive risk assessment and consider the individual patient's circumstances when determining the best course of action. The most recent and highest quality study does not support the routine use of CTX testing in this context, and instead emphasizes the importance of preventive dentistry and comprehensive dental examination.
From the Research
Assessment of CTX Levels Prior to Dental Procedures
- There is no direct evidence to suggest that obtaining creatine phosphokinase (CTX) levels is recommended prior to dental procedures in patients with a history of bisphosphonate use 2, 3, 4, 5, 6.
- The provided studies focus on the management of patients prescribed bisphosphonates, the assessment of risk factors for medication-related osteonecrosis of the jaw (MRONJ), and the importance of dental health assessments prior to treatment with bisphosphonates 2, 3, 4, 5.
- The studies emphasize the need for dental care providers to recognize the clinical signs and symptoms of MRONJ, to eliminate or mitigate risk factors, and to take precautions when performing dental procedures on patients with a history of bisphosphonate use 2, 3, 4, 5.
- One study suggests that patients taking bisphosphonates may not always report their medication use on health history forms, highlighting the importance of direct questioning and thorough medical history assessment 6.
Risk Assessment and Management
- Patients with a history of bisphosphonate use should be assessed for risk factors for MRONJ, including the type and duration of bisphosphonate therapy, as well as other systemic and local risk factors 3, 4, 5.
- Dental care providers should exercise caution when performing dental procedures on patients with a history of bisphosphonate use, and consider alternative treatments or referral to a specialist when necessary 2, 3, 4, 5.