Expert consensus on endodontic therapy for patients with systemic conditions

doi:10.1038/s41368-024-00312-0

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International Journal of Oral Science ›› 2024, Vol. 16 ›› Issue (0) : 45. DOI: 10.1038/s41368-024-00312-0

Expert consensus on endodontic therapy for patients with systemic conditions

Xin Xu¹, Xin Zheng¹, Fei Lin², Qing Yu³, Benxiang Hou⁴, Zhi Chen⁵, Xi Wei⁶, Lihong Qiu⁷, Chen Wenxia⁸, Jiyao Li¹, Lili Chen⁹, Zuomin Wang¹⁰, Hongkun Wu¹¹, Zhiyue Lu¹², Jizhi Zhao¹³, Yuhong Liang¹⁴, Jin Zhao¹⁵, Yihuai Pan¹⁶, Shuang Pan¹⁷, Xiaoyan Wang², Deqin Yang^18,19, Yanfang Ren²⁰, Lin Yue², Xuedong Zhou¹

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1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China;
2. Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China;
3. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi’an, China;
4. Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China;
5. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China;
6. Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China;
7. Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China;
8. College & Hospital of Stomatology, Guangxi Medical University, Nanning, China;
9. Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
10. Department of Stomatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China;
11. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Geriatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China;
12. Beijing Hospital, National Center of Gerontology, Beijing, China;
13. Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China;
14. Department of Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China;
15. Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China;
16. Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China;
17. Department of Endodontics, The First Affiliated Hospital of Harbin Medical University & Department of Endodontics, School of Stomatology, Harbin Medical University, Harbin, China;
18. Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China;
19. Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China;
20. Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

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Abstract

The overall health condition of patients significantly affects the diagnosis, treatment, and prognosis of endodontic diseases. A systemic consideration of the patient’s overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy, as well as selecting appropriate therapeutic approaches. This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence, aiming to provide general guidance on clinical procedures, improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

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Xin Xu, Xin Zheng, Fei Lin, Qing Yu, Benxiang Hou, Zhi Chen, Xi Wei, Lihong Qiu, Chen Wenxia, Jiyao Li, Lili Chen, Zuomin Wang, Hongkun Wu, Zhiyue Lu, Jizhi Zhao, Yuhong Liang, Jin Zhao, Yihuai Pan, Shuang Pan, Xiaoyan Wang, Deqin Yang, Yanfang Ren, Lin Yue, …Xuedong Zhou. Expert consensus on endodontic therapy for patients with systemic conditions. International Journal of Oral Science, 2024, 16(0): 45 https://doi.org/10.1038/s41368-024-00312-0

References

1. Kuzekanani M.Latest concepts in endodontic management of pregnant patients.Int. J. Dent. 2023, 9714515(2023).
2. North B. J.& Sinclair, D. A. The intersection between aging and cardiovascular disease.Circ. Res. 110, 1097-1108 (2012).
3. Zhao D., Liu J., Wang M., Zhang X.& Zhou, M. Epidemiology of cardiovascular disease in China: current features and implications.Nat. Rev. Cardiol. 16, 203-212 (2019).
4. Turk-Adawi, K. et al. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden.Nat. Rev. Cardiol. 15, 106-119 (2018).
5. Kreiner M., Okeson J. P., Michelis V., Lujambio M.& Isberg, A. Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study.J. Am. Dent. Assoc. 138, 74-79 (2007).
6. Yatani, H.et al.Systematic review and recommendations for nonodontogenic toothache.J. Oral Rehabil. 41, 843-852 (2014).
7 7.Zdrojewska-Derwich, M., Derwich, M., Mituś-Kenig, M., Łoboda, M. & Durka-Zając, M. [Coronary artery disease as cause of non-odontogenic toothache. A review of literature].Przegl. Lek. 73, 103-107 (2016).
8. Kreiner M., Falace D., Michelis V., Okeson J. P.& Isberg, A. Quality difference in craniofacial pain of cardiac vs. dental origin.J. Dent. Res. 89, 965-969 (2010).
9. Saitoh, K.et al.Dental management of the medically compromised patient. A study of 162 cases.Meikai Daigaku Shigaku Zasshi 19, 407-417 (1990).
10. Skaar D.,O’Connor, H., Lunos, S., Luepker, R. & Michalowicz, B. S. Dental procedures and risk of experiencing a second vascular event in a Medicare population.J. Am. Dent. Assoc. 143, 1190-1198 (2012).
11. Yarows S. A., Vornovitsky O., Eber R. M., Bisognano J. D.& Basile, J. Canceling dental procedures due to elevated blood pressure: is it appropriate?J. Am. Dent. Assoc. 151, 239-244 (2020).
12. Seminario-Amez, M., González-Navarro, B., Ayuso-Montero, R., Jané-Salas, E. & López-López, J. Use of local anesthetics with a vasoconstrictor agent during dental treatment in hypertensive and coronary disease patients. A systematic review.J. Evid. Based Dent. Pract. 21, 101569(2021).
13. Brennan, M. T.et al.Aspirin use and post-operative bleeding from dental extractions.J. Dent. Res. 87, 740-744 (2008).
14. Jeske A. H.& Suchko, G. D. Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment.J. Am. Dent. Assoc. 134, 1492-1497 (2003).
15. Russo G., Corso L. D., Biasiolo A., Berengo M.& Pengo, V. Simple and safe method to prepare patients with prosthetic heart valves for surgical dental procedures.Clin. Appl. Thromb. Hemost. 6, 90-93 (2000).
16. Devani, P., Lavery, K. M.& Howell, C. J. Dental extractions in patients on warfarin: is alteration of anticoagulant regime necessary?Br. J. Oral Maxillofac. Surg. 36, 107-111 (1998).
17. Lahti, S. M.et al.Association of depression and anxiety with different aspects of dental anxiety in pregnant mothers and their partners.Community Dent. Oral Epidemiol. 48, 137-142 (2020).
18. Martin E., Nimmo A., Lee A.& Jennings, E. Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment.BDJ Open 7, 27(2021).
19. Guimaraes, C. C.et al.Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis.BMJ Open 11, e044357(2021).
20. Margaix Muñoz, M., Jiménez Soriano, Y., Poveda Roda, R. & Sarrión, G. Cardiovascular diseases in dental practice. Practical considerations.Med. Oral Patol. Oral Cir. Bucal 13, E296-E302 (2008).
21. Niwa H., Sugimura M., Satoh Y.& Tanimoto, A. Cardiovascular response to epinephrine-containing local anesthesia in patients with cardiovascular disease.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 92, 610-616 (2001).
22. Wilson, W. R.et al.Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association.Circulation 143, e963-e978 (2021).
23. Aminoshariae A., Kulild J. C., Mickel A.& Fouad, A. F. Association between systemic diseases and endodontic outcome: a systematic review.J. Endod. 43, 514-519 (2017).
24. Segura-Egea, J. J., Cabanillas-Balsera, D., Martín-González, J. & Cintra, L. T. A. Impact of systemic health on treatment outcomes in endodontics.Int. Endod. J. 56, 219-235 (2023).
25. Wang, C. H.et al.Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment.J. Endod. 37, 1-5 (2011).
26. Mindiola, M. J.et al.Endodontic treatment in an American Indian population: a 10-year retrospective study.J. Endod. 32, 828-832 (2006).
27. Khalighinejad, N.et al.Association between systemic diseases and apical periodontitis.J. Endod. 42, 1427-1434 (2016).
28. Georgiou A. C., Crielaard W., Armenis I., de Vries, R. & van der Waal, S. V. Apical periodontitis is associated with elevated concentrations of inflammatory mediators in peripheral blood: a systematic review and meta-analysis. J. Endod 45,1279-1295.e1273 (2019).
29. Dash, G.et al. Prevalence and quality of endodontic treatment in patients with cardiovascular disease and associated risk factors. J. Clin. Med. 11, https://doi.org/10.3390/jcm11206046 (2022).
30. Aminoshariae, A., Kulild, J.& Fouad, A. F. The impact of cardiovascular disease and endodontic outcome: a systematic review of longitudinal studies.Clin. Oral Investig. 24, 3813-3819 (2020).
31. Laukkanen, E., Vehkalahti, M. M.& Kotiranta, A. K. Impact of systemic diseases and tooth-based factors on outcome of root canal treatment.Int. Endod. J. 52, 1417-1426 (2019).
32. Yi Xiaowei, H. D. & Zhang, L. Pathogenesis and clinical management of apical periodontitis in diabetic patients.Int. J. Stomatol. 45, 214-218 (2018).
33. Miley D. D.& Terezhalmy, G. T. The patient with diabetes mellitus: etiology, epidemiology, principles of medical management, oral disease burden, and principles of dental management.Quintessence Int. 36, 779-795 (2005).
34. Nazir, M. A.et al.The burden of diabetes, its oral complications and their prevention and management.Open Access Maced. J. Med. Sci. 6, 1545-1553 (2018).
35. Michael, G. (ed.) In The Oral-Systemic Health Connection: A Guide to Patient Care. 125-131
(Quintessence Publishing Co., 2014)..
36. McKenna, S. J. Dental management of patients with diabetes.Dent. Clin. N. Am. 50, 591-606 (2006).
37. Santos-Paul, M. A. D., Neves, I. L. I., Neves, R. S. & Ramires, J. A. F. Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study.Clinics 70, 185-189 (2015).
38. Gibson E.Dental management of the medically compromised patient (7th edition).Br. Dent. J. 203, 616-616 (2007).
39. Segura-Egea, J. J., Martín-González, J. & Castellanos-Cosano, L. Endodontic medicine: connections between apical periodontitis and systemic diseases.Int. Endod. J. 48, 933-951, (2015).
40. Segura-Egea, J. J., Cabanillas-Balsera, D., Jiménez-Sánchez, M. C. & Martín-González, J. Endodontics and diabetes: association versus causation.Int. Endod. J. 52, 790-802 (2019).
41. Llambés F.,Arias-Herrera, S. & Caffesse, R. Relationship between diabetes and periodontal infection.World J. Diabetes 6, 927-935, (2015).
42. Setzer F. C., Boyer K. R., Jeppson J. R., Karabucak B.& Kim, S. Long-term prognosis of endodontically treated teeth: a retrospective analysis of preoperative factors in molars.J. Endod. 37, 21-25 (2011).
43. Yuan, Q.et al.Dental implant treatment for renal failure patients on dialysis: a clinical guideline.Int. J. Oral Sci. 9, 125-132 (2017).
44. Krishnan, M. Preoperative care of patients with kidney disease. Am. Fam. Physician 66, 1471-1476(2002). 1379.
45. Klassen J. T.& Krasko, B. M. The dental health status of dialysis patients.J. Can. Dent. Assoc. 68, 34-38 (2002).
46. Naylor G. D.& Fredericks, M. R. Pharmacologic considerations in the dental management of the patient with disorders of the renal system.Dent. Clin. N. Am. 40, 665-683 (1996).
47. Saif I., Adkins A., Kewley V., Woywodt A.& Brookes, V. Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant. Part 1.Dent. Update 38, 185-176 (2011).
48. Sulejmanagić H., Sulejmanagić N., Prohić S., Secić S.& Miseljić, S. Dental treatment of patients with kidney diseases-review.Bosn. J. Basic Med. Sci. 5, 52-56 (2005).
49. Baker M.& Perazella, M. A. NSAIDs in CKD: are they safe?Am. J. Kidney Dis. 76, 546-557 (2020).
50. Broussard I. M.& Kahwaji, C. I. StatPearls (StatPearls Publishing Copyright©, StatPearls Publishing LLC., 2024).
51. Harte J. A.Standard and transmission-based precautions: an update for dentistry.J. Am. Dent. Assoc. 141, 572-581 (2010).
52. Molinari J. A.Infection control: its evolution to the current standard precautions.J. Am. Dent. Assoc. 134, 569-574 (2003).
53. Goss A. N.The dental management of medically compromised patients.Int. Dent. J. 34, 227-231 (1984).
54. Lewden, C.et al.HIV-infected adults with a CD4 cell count greater than 500 cells/mm³ on long-term combination antiretroviral therapy reach same mortality rates as the general population.J. Acquir. Immune Defic. Syndr. 46, 72-77 (2007).
55. Jaén, A.et al.Determinants of HIV progression and assessment of the optimal time to initiate highly active antiretroviral therapy: PISCIS Cohort (Spain).J. Acquir. Immune Defic. Syndr. 47, 212-220 (2008).
56. Kaplan, J. E.et al.Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy.Clin. Infect. Dis. 30, S5-S14 (2000).
57. Quesnell, B. T.et al.The effect of human immunodeficiency virus on endodontic treatment outcome.J. Endod. 31, 633-636 (2005).
58. Tootla S.& Owen, C. P. A comparison of endodontic treatment outcomes between HIV-positive and HIV-negative patients.S. Afr. Dent. J. 67, 322-325 (2012).
59. Suchina J. A., Levine D., Flaitz C. M., Nichols C. M.& Hicks, M. J. Retrospective clinical and radiologic evaluation of nonsurgical endodontic treatment in human immunodeficiency virus (HIV) infection.J. Contemp. Dent. Pract. 7, 1-8 (2006).
60. Leitner, J. M., Graninger, W.& Thalhammer, F. Hepatotoxicity of antibacterials: pathomechanisms and clinical.Infection 38, 3-11 (2010).
61. Golla, K., Epstein, J. B.& Cabay, R. J. Liver disease: current perspectives on medical and dental management.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 98, 516-521, (2004).
62. Ward B. B.& Weideman, E. M. Long-term postoperative bleeding after dentoalveolar surgery in the pretransplant liver failure patient.J. Oral Maxillofac. Surg. 64, 1469-1474 (2006).
63. Inoue, C. N.et al.Efficacy of early dental and ENT therapy in preventing nephropathy in pediatric Henoch-Schönlein purpura.Clin. Rheumatol. 27, 1489-1496 (2008).
64. Malmström M.& Jokinen, E. J. Free rheumatoid factor in dental periapical lesions and gingivae of patients with rheumatoid disease.Scand. J. Rheumatol. 4, 121-124 (1975).
65. Ishii, K.et al.Expression of the Forkhead box transcription factor Foxo3a in human periapical granulomas.J. Oral Sci. 60, 479-483 (2018).
66. Grønkjær L. L.& Vilstrup, H. Oral health in patients with liver cirrhosis.Eur. J. Gastroenterol. Hepatol. 27, 834-839 (2015).
67. Caly W. R.& Strauss, E. A prospective study of bacterial infections in patients with cirrhosis.J. Hepatol. 18, 353-358 (1993).
68. Cohen, G. Immune dysfunction in uremia2020. Toxins 12, https://doi.org/10.3390/toxins12070439 (2020).
69. Nakaseko, H.et al.High prevalence of sinusitis in children with Henoch-Schönlein purpura.Int. J. Pediatr. 2011, 562638(2011).
70. Pertiwi A. S.P. Henoch-Schönlein purpura in children: its relation to oral and dental health.Dent. J. Maj. Kedokt. Gigi 45, 127-132 (2012).
71. Tahmassebi J. F.& Paterson, S. A. Development of acute Henoch-Schönlein purpura subsequent to endodontic treatment.Int. J. Paediatr. Dent. 17, 217-222 (2007).
72. Nakamura, K.et al.Effect of methotrexate-induced neutropenia on pulpal inflammation in rats.J. Endod. 28, 287-290 (2002).
73. Yoshinari N., Kameyama Y., Aoyama Y., Nishiyama H.& Noguchi, T. Effect of long-term methotrexate-induced neutropenia on experimental periodontal lesion in rats.J. Periodontal Res. 29, 393-400 (1994).
74. Teixeira F. B., Gomes B. P., Ferraz C. C., Souza-Filho, F. J. & Zaia, A. A. Radiographic analysis of the development of periapical lesions in normal rats, sialoadenectomized rats and sialoadenectomized-immunosuppressed rats.Endod. Dent. Traumatol. 16, 154-157 (2000).
75. Bahmani M., Sarrafchi A., Shirzad H.& Rafieian-Kopaei, M. Autism: pathophysiology and promising herbal remedies.Curr. Pharm. Des. 22, 277-285 (2016).
76. Scheltens, P.et al.Alzheimer’s disease.Lancet 397, 1577-1590 (2021).
77. Asher R.Munchausen’s syndrome.Lancet 1, 339-341 (1951).
78. Khawaja S. N.& Sultan, A. S. Munchausen syndrome: report of a case and implications for dentists.Gen. Dent. 69, 56-59 (2021).
79. Cohen, A. S.et al.Psychiatric risk assessment from the clinician’s perspective: lessons for the future.Community Ment. Health J. 55, 1165-1172 (2019).
80. Robbins M. R.Dental management of special needs patients who have epilepsy.Dent. Clin. N. Am. 53, 295-309 (2009).
81. Goswami, M., Johar, S.& Khokhar, A. Oral health considerations and dental management for epileptic children in pediatric dental care.Int. J. Clin. Pediatr. Dent. 16, 170-176 (2023).
82. Malamed, S. F. & Orr, D. L. in Medical Emergencies in the Dental Office 7th edn (eds Malamed, S. F. & Orr, D. L.) 314-335 (Mosby, 2015).
83. Bloem, B. R., Okun, M. S.& Klein, C. Parkinson’s disease.Lancet 397, 2284-2303 (2021).
84. Winge K., Skau A. M., Stimpel H., Nielsen K. K.& Werdelin, L. Prevalence of bladder dysfunction in Parkinsons disease.Neurourol. Urodyn. 25, 116-122 (2006).
85. Winocur E., Gavish A., Voikovitch M., Emodi-Perlman, A. & Eli, I. Drugs and bruxism: a critical review.J. Orofac. Pain 17, 99-111 (2003).
86. Friedlander A. H., Mahler M., Norman K. M.& Ettinger, R. L. Parkinson disease: systemic and orofacial manifestations, medical and dental management.J. Am. Dent. Assoc. 140, 658-669 (2009).
87. Berthold M.Third dental therapeutics guide debuts at ADA session. J. Am. Dent. Assoc. 134, 1444. https://doi.org/10.14219/jada.archive.2003.0067(2003).
88. Collins R.Special considerations for the dental patient with Parkinson’s disease.Tex. Dent. J. 107, 31-32 (1990).
89. Alexander R. E.& Gage, T. W. Parkinson’s disease: an update for dentists.Gen. Dent. 48, 581-572 (2000).
90. Kritsidima, M., Newton, T.& Asimakopoulou, K. The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial.Community Dent. Oral Epidemiol. 38, 83-87 (2010).
91. Arrow, P.et al.Atraumatic restorative treatments and oral health-related quality of life and dental anxiety in Australian Aboriginal children: a cluster-randomized trial.Community Dent. Oral Epidemiol. 50, 513-521 (2022).
92. Hoffmann, B.et al.Management strategies for adult patients with dental anxiety in the dental clinic: a systematic review.Aust. Dent. J. 67, S3-S13 (2022).
93. Mallineni S. K.& Yiu, C. K. Dental treatment under general anesthesia for special-needs patients: analysis of the literature.J. Investig. Clin. Dent. 7, 325-331 (2016).
94. Chen, G. Y.et al. Association between general anesthesia and root canal treatment outcomes in patients with mental disability: a retrospective cohort study. J. Pers. Med. 12, https://doi.org/10.3390/jpm12020213 (2022).
95. Kühl S., Walter C., Acham S., Pfeffer R.& Lambrecht, J. T. Bisphosphonate-related osteonecrosis of the jaws-a review.Oral Oncol. 48, 938-947 (2012).
96. Gelazius R., Poskevicius L., Sakavicius D., Grimuta V.& Juodzbalys, G. Dental implant placement in patients on bisphosphonate therapy: a systematic review.J. Oral Maxillofac. Res. 9, e2(2018).
97. Wutzl, A.et al.Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients.Wien. Klin. Wochenschr. 118, 473-478 (2006).
98. Moinzadeh A. T., Shemesh H., Neirynck N. A., Aubert C.& Wesselink, P. R. Bisphosphonates and their clinical implications in endodontic therapy.Int. Endod. J. 46, 391-398 (2013).
99. Zamparini, F.et al.Root canal treatment of compromised teeth as alternative treatment for patients receiving bisphosphonates: 60-month results of a prospective clinical study.Int. Endod. J. 54, 156-171 (2021).
100. Tempesta, A.et al.Medication-related osteonecrosis of the jaw triggered by endodontic failure in oncologic patients.Oral Dis. 29, 2799-2805 (2023).
101. Kyrgidis A.Novel hypotheses in the etiopathogenesis of bisphosphonate-related osteonecrosis of the jaws.J. Oral Maxillofac. Surg. 67, 2554(2009).
102. Kyrgidis A.Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials.Breast Cancer Res. Treat. 119, 253-254 (2010).
103. Kyrgidis A.& Andreadis, C. Epidemiologic studies are needed to clarify whether dental modalities could be predictors of bisphosphonate osteonecrosis of the jaw in breast cancer patients.Oncologist 14, 101-102 (2009).
104. Sedghizadeh, P. P.et al.Identification of microbial biofilms in osteonecrosis of the jaws secondary to bisphosphonate therapy.J. Oral Maxillofac. Surg. 66, 767-775 (2008).
105. Cousido, M. C.et al.In vivo substantivity of 0.12% and 0.2% chlorhexidine mouthrinses on salivary bacteria.Clin. Oral Investig. 14, 397-402 (2010).
106. Wali R., Sacco R., Singh, G. & Patel, V. The clinical effect of radiotherapy on pulpal microvasculature: a systematic review. Br. Dent. J. https://doi.org/10.1038/s41415-022-5301-8 (2022).
107. Meyer, I., Shklar, G.& Turner, J. A comparison of the effects of 200 KV. radiation and cobalt-60 radiation on the jaws and dental structure of the white rat. A preliminary report.Oral Surg. Oral Med. Oral Pathol. 15, 1098-1108 (1962).
108. Weissheimer, T.et al.Head and neck radiotherapy effects on the dental pulp vitality and response to sensitivity tests: a systematic review with meta-analysis.Int. Endod. J. 55, 563-578 (2022).
109. Ship J. A.& Hu, K. Radiotherapy-induced salivary dysfunction.Semin. Oncol. 31, 29-36 (2004).
110. Hong C. H.L. et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines.Support. Care Cancer 27, 3949-3967 (2019).
111. Chambers M. S., Toth B. B., Martin J. W., Fleming T. J.& Lemon, J. C. Oral and dental management of the cancer patient: prevention and treatment of complications.Support. Care Cancer 3, 168-175 (1995).
112. Harding J.Dental care of cancer patients before, during and after treatment.BDJ Team 4, 17008(2017).
113. Siegel M. A.& Jacobson, J. J. Inflammatory bowel diseases and the oral cavity.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 87, 12-14 (1999).