Steroid Therapy and Dental Extractions: Unveiling the Risks of Delayed Healing and Osteonecrosis – A Systematic Review

Abstract

Purpose:

This systematic review aimed to evaluate the complications, particularly delayed healing and osteonecrosis of the jaw (ONJ), associated with dental extractions in patients on long-term steroid therapy. Additionally, it sought to identify risk factors and preventive strategies to mitigate these complications.

Methods:

A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases, focusing on studies published from 2000 to 2023. The inclusion criteria encompassed human studies examining patients on long-term corticosteroid therapy undergoing dental extractions, with reported outcomes such as delayed healing, ONJ, and other complications. The selected studies were analyzed for incidence rates, risk factors, and preventive measures. Data were synthesized narratively, with a focus on studies reporting odds ratios (OR) and confidence intervals (CI).

Results:

Six studies met the inclusion criteria, comprising both retrospective and prospective cohort studies. Delayed healing was the most common complication, reported in up to 37.5% of patients, particularly in those receiving more than 8 mg/day of prednisolone. ONJ was observed in 2.5% of cases, primarily in patients with concurrent bisphosphonate use or osteosclerotic changes. Key risk factors included high steroid doses, long-term therapy, low platelet and hemoglobin levels, and immunosuppressive status. Preventive measures, such as antibiotic prophylaxis and close monitoring, were effective in reducing the incidence of complications.

Conclusions:

Long-term steroid therapy significantly increases the risk of delayed healing and ONJ following dental extractions, particularly at higher doses and longer treatment durations. Preventive strategies, including antibiotic prophylaxis and careful monitoring of steroid dosages, can mitigate these risks. However, further randomized controlled trials are needed to establish standardized guidelines for managing dental extractions in patients on steroid therapy.

Clinical Relevance:

Understanding the risk factors and implementing preventive measures in patients undergoing long-term steroid therapy is critical to reducing post-extraction complications, improving patient outcomes, and ensuring optimal healing.