Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • General
  • Published:

What is the impact of biologics on the management of the oral surgery patient?

British Dental Journal volume 236, pages 637–640 (2024)Cite this article

Abstract

The use of biologics in medicine is on the rise. As dental professionals, it is becoming increasingly important that we are aware of this class of medications and the theoretical risks that they pose specific to the oral cavity to ensure safe delivery of dental treatment. This paper discusses some of these risks and recommendations to follow to manage patients undergoing oral surgery specifically.

Key points

  • Patients on biological therapy are a vulnerable patient cohort. The reader should understand the importance of shared care with the prescribing physician.

  • Patients on biological therapies may be at risk of complications or undesirable effects, including infection, osteonecrosis of the jaw, osteomyelitis and coagulation disorders.

  • The British Society of Rheumatology have issued guidance to help confidently and appropriately manage these patients. For major elective procedures, the guidelines advise withholding a biologic dose and scheduling surgery based on the specific drug‘s half-life, which may minimise post-operative infection concerns.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Radfar L, Ahmadabadi R E, Masood F, Scofield R H. Biological therapy and dentistry: a review paper. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120: 594-601.

  2. King R, Zebic L, Patel V. Deciphering novel chemotherapy and its impact on dentistry. Br Dent J 2020; 228: 415-421.

  3. Cillo Jr J E, Barbosa N. Adalimumab-Related Dental Implant Infection. J Oral Maxillofac Surg 2019; 77: 1165-1169.

  4. Colombel J F, Loftus Jr E V, Tremaine W J et al. Early postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004; 99: 878-883.

  5. Lau C, Phillips E, Bresee C, Fleshner P. Early use of low residue diet is superior to clear liquid diet after elective colorectal surgery: a randomized controlled trial. Ann Surg 2014; 260: 641-649.

  6. Cornilie F, Shealy D, D'Haens G et al. Infliximab induces potent anti-inflammatory and local immunomodulatory activity but no systemic immune suppression in patients with Crohn's disease. Aliment Pharmacol Ther 2001; 15: 463-473.

  7. Food and Drug Association. Briefing document: Arthritis Advisory Committee. Available at https://www.fda.gov/science-research/liver-toxicity-knowledge-base-ltkb/drug-induced-liver-injury-rank-dilirank-dataset (accessed March 2024).

  8. National Institute for Health and Care Excellence. British National Formulary. 2024. Available at https://bnf.nice.org.uk/ (accessed March 2024).

  9. Sri J C, Tsai C L, Deng A, Gaspari A A. Osteomyelitis occurring during infliximab treatment of severe psoriasis. J Drugs Dermatol 2007; 6: 207-210.

  10. Tsuchiya S, Sugimoto K, Omori M, Matsuda R, Fujio M, Hibi H. Mandibular osteomyelitis implicated in infliximab and periapical periodontitis: A case report. J Oral Maxillofac Surg Med Pathol 2016; 28: 410-415.

  11. Kushner G M, Alpert B. Osteomyelitis and osteoradionecrosis and BRONJ. In Miloro M (ed) Peterson's Principles of Oral and Maxillofacial Surgery. 2nd ed. pp 313-321. London: BC Decker, 2003.

  12. Resnik R R. Are Biologic Medications Becoming the New Catch-22 in Implant Dentistry? 2022. Available at https://www.dentistrytoday.com/are-biologics-becoming-the-new-catch-22-in-implant-dentistry/ (accessed March 2024).

  13. Hayashi M, Morimoto Y, Iida T, Tanaka Y, Sugiyama S. Risk of Delayed Healing of Tooth Extractions Wounds and Osteonecrosis of the Jaw among Patients Treated with Potential Immunosuppressive Drugs: A Retrospective Cohort Study. Tohoku J Exp Med 2018; 246: 257-264.

  14. Greuter S, Schmid F, Ruhstaller T, Thuerlimann B. Bevacizumab-associated osteonecrosis of the jaw. Ann Oncol 2008; 19: 2091-2092.

  15. Davila A, Magee R, France K. Complications after dental extractions in patients taking biologic agents. J Am Dent Assoc 2022; 11: 1060-1069.

  16. Royal College of Physicians. Medication-related osteonecrosis of the jaw: guidance for the oncology multidisciplinary team. 2019. Available at https://www.rcplondon.ac.uk/guidelines-policy/medication-related-osteonecrosis-jaw-guidance-oncology-multidisciplinary-team (accessed March 2024).

  17. Holroyd C R, Seth R, Bukhari M et al. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis. Rheumatology (Oxford) 2019; 58: 3-42.

  18. American College of Rheumatology. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients with Rhematic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. 2022. Available at https://rheumatology.org/perioperative-management-guideline (accessed March 2024).

  19. NHS England. Joint Guidelines for the Management of Interruption of Biologic Therapies for Elective Surgery in Adults and Children with Rheumatoid Arthritis, Psoriatic Arthritis, JIA and Ankylosing Spondylitis. 2022. Available at https://www.nnuh.nhs.uk/publication/download/interruption-of-biologic-therapy-jcg0030-v5/ (accessed March 2024).

  20. Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw. 2017. Available at https://www.sdcep.org.uk/media/m0ko0gng/sdcep-oral-health-management-of-patients-at-risk-of-mronj-guidance-full.pdf (accessed March 2024).

Download references

Author information

Authors and Affiliations

  1. Department of Oral Surgery, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham, B5 7EG, UK

    Ayesha Mohamed

Authors
  1. Ayesha Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ayesha Mohamed.

Ethics declarations

The author declares no conflicts of interest.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohamed, A. What is the impact of biologics on the management of the oral surgery patient?. Br Dent J 236, 637–640 (2024). https://doi.org/10.1038/s41415-024-7289-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-024-7289-8

Search

Advanced search

Quick links