Increased Periodontal Disease Risk from Androgen Deprivation Cancer Therapy

June 5, 2023 Lee Ann Brady DMD

I know we are all familiar with the devastating effects cancer therapy can have on our patient’s oral health. We think of chemo and radiation and know this can increase the risk of caries and root resorption. A very common cancer therapy called Androgen Deprivation Therapy can have a significant impact on periodontal risk.

This therapy is an injectable medication given to a significant number of men who have been diagnosed with prostate cancer. It is a commonly chosen therapy because, on the medical side, it is one of the medications with the lowest impact on the patient’s life and ability to more forward with other medical procedures.

Now that it is common among our older male dental patients, I’ve been reading about it. It turns out that this therapy does significantly increase the periodontal risk of bone loss.

When they study males receiving chemotherapy for prostate cancer, 80%+ of the patients on Androgen Deprivation Therapy develop periodontal bone loss. Less than 10% of the males receiving different chemotherapies develop periodontal bone loss.

This is interesting because we think of periodontal disease as being driven by our immune system and that some patients are hyperresponsive to the bacteria in their mouths. In this case, the origin of periodontal risk appears to be different but there is no argument that the risk is there.

Knowing our patients’ medical histories is important yet again! When you do your med-history reviews with your patients, ask them if they are receiving cancer therapy and review the drugs they are on.

As soon as we know a patient is on Androgen Deprivation therapy, we need to start the preventative high-recall, high-maintenance process. Take them to three-month recalls instead of six-month recalls. Apply chlorhexidine varnish and start home hygiene protocols–brushing with baking soda…hydrogen peroxide…all the things we normally advise for our patients when we know they are at high periodontal risk.

Start this as soon as possible even though the patient is presenting with a healthy mouth. The risk percentile is in the 80s, so we can expect to see loss of mucogingival attachment, deepening pocket development, and bone loss.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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