High Risk for Periodontal Disease in Men on Androgen-Deprivation Therapy

April 10, 2007 — Androgen-deprivation therapy (ADT) for prostate cancer is already known to increase the risk for osteoporosis, but it also appears to increase the risk for periodontal disease, a small study suggests. Clinicians treating such men should be aware of the increased need for dental visits to identify periodontal disease before tooth loss occurs, say the researchers.

The finding is reported in the March issue of the Journal of Urology by a team from the University of Pittsburgh School of Dental Medicine, in Pennsylvania.

"Urologists and oncologists, in particular, should heed these findings and refer their patients for periodontal screening early in the course of their ADT," commented lead author Pouran Famili, DMD, PhD. This early referral is standard for other groups of at-risk patient populations, such as transplant recipients, he pointed out.

The study found that men with prostate cancer on ADT were 3 times as likely to show signs of periodontal disease as a similar group of men with prostate cancer who were not receiving such therapy. The comparison was based on 68 men, of whom 41 had received ADT for an average of 18 months. The majority of these men (80%) had periodontal disease, the researchers report. In contrast, only 4% of the men not receiving ADT had periodontal disease.

"To our knowledge, this is the first report of a high prevalence of periodontal disease in men on ADT," the researchers comment. "If confirmed in other, larger studies, this observation could have major public health consequences, given the increasing number of men with prostate cancer and the increasing use of ADT to treat these men." They note that prostate cancer is being diagnosed at an earlier stage, and ADT is being administered earlier in the course of the disease. Many of these men survive for years after the diagnosis, and as a result, can end up taking ADT for prolonged periods.

In their study, most of the men in the group taking ADT who were found to have periodontal disease were "highly educated, visited the dentist regularly, and had good plaque control," the team writes in the paper. Commenting further in a press statement, Dr. Famili said: "As the majority of these men were quite conscientious about their oral hygiene, the need for early intervention by a dental care provider is paramount. It could prevent the need for more extensive treatment down the road. "

The team speculates that the association between periodontal disease and androgen deprivation may be due to osteoporotic bone loss as a result of the therapy. They note that previous studies have reported that ADT can cause a severe bone loss and osteoporosis, and they speculate that ADT may enhance rapid bone loss around the teeth and may initiate or accelerate periodontal disease despite good plaque control.

"Because ADT is needed to treat prostate cancer but has a negative impact on dental health, oncologists must be aware of this to encourage dental care and follow-up," the team concludes.

J Urol. 2007;177:921-924


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