Oral Health Status and Quality of Life in Patients Receiving Low-Dose Bone-Modifying Agents for Cancer Treatment-Induced Bone Loss (CTIBL): A Single-Center Exploratory Study

Rodolfo Mauceri¹Martina Coppini^1*Sara Maria Marchese¹Nicola Mauceri²Rita Coniglio¹Marco Nisi³Maria Elena Mauceri⁴Vittorio Fusco⁵Maria Rosaria Valerio⁶Giuseppina Campisi²

• ¹Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy
• ²Universita degli Studi di Palermo Dipartimento di Biomedicina Neuroscienze e Diagnostica avanzata, Palermo, Italy
• ³Universita degli Studi di Pisa Dipartimento di Patologia Chirurgica Medica Molecolare e dell'Area Critica, Pisa, Italy
• ⁴Universita degli Studi di Palermo Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche, Palermo, Italy
• ⁵Azienda Ospedaliero - Universitaria SS Antonio e Biagio e Cesare Arrigo - Alessandria, Alessandria, Italy
• ⁶Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy

Introduction. Breast cancer patients, undergoing low-dose bone-modifying agent (LD-BMA) therapy for cancer treatment-induced bone loss (CTIBL), represent an emerging category at risk of Medication-Related (MRONJ) low (<1%) but not absent. However, data on their oral health status and quality of life related are currently limited. This single-center exploratory study aimed to assess oral health conditions, periodontal status, and oral health-related quality of life in non-metastatic breast cancer patients under LD-BMA therapy for CTIBL. Materials and Methods. Forty patients were consecutively and unselectively enrolled and divided into two groups based on the duration of LD-BMA therapy (<3 years vs. ≥3 years). Oral examination by decayed‐missing‐filled teeth index (DMFT) and Periodontal Screening and Recording (PSR) was performed, and the OHIP-14 questionnaire was administered to assess their oral health-related quality of life. Results. No statistically significant differences were observed between the two groups in PSR, DMFT, or OHIP-14 scores. PSR scores indicating moderate-to-severe periodontal involvement (3–4) were reported in 73.3% of patients treated for <3 years and 70% of those treated ≥3 years. Mean 2 DMFT values were 9.7 and 12.0, respectively. Although patients treated for ≥ 3 years reported higher OHIP-14 scores, this trend did not reach statistical significance. No cases of MRONJ were observed in the study groups. Conclusions. Patients affected by breast cancer receiving LD-BMA therapy for CTIBL and recruited in a preventive program appear to have a very low risk of MRONJ. Despite comparable clinical findings across treatment durations, longer LD-BMA therapy may be associated with a perceived reduction in oral well-being, possibly related to systemic and psychosocial burdens. These findings, with the limitation of a small sample size, support the implementation of individualized, risk-based dental and psychological preventive strategies, and reinforce the relevance of long-term dental surveillance in this under-explored population.