Teeth loss after teriflunomide treatment: Casual or causal? A short case series

Veria Vacchiano, Nicola Frattaruolo, Luca Mancinelli, Matteo Foschi, Antonio Carotenuto, Cinzia Scandellari, Maurizio Piattelli, Vincenzo Brescia Morra, Alessandra Lugaresi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Teriflunomide is a once-daily oral immunomodulator approved for the treatment of relapsing-remitting multiple sclerosis (RRMS) with a consistent safety profile in clinical trials. We report three cases of multiple teeth loss during teriflunomide treatment. Case reports: Case 1: a 39 year-old woman started teriflunomide for RRMS, switching from interferon beta. Four months later she complained about mandibular pain followed by the sudden loss of 4 teeth, in the absence of bleeding or trauma. Suspecting a causal role, we discontinued teriflunomide and started the accelerated elimination procedure with cholestyramine. Orthopantomography and a subsequent dental CT scan showed diffuse alveolar atrophy and periapical bone loss in several residual roots. Investigating retrospectively the patient's dental history, and revising previous orthopantomographies dating from 2009, we highlighted a chronic and progressive dental pathology with several cavities and teeth loss. Case 2: A 52-year-old woman affected by multiple sclerosis (MS) since 1988, switched from interferon beta to teriflunomide treatment due to poor tolerability. One year later she experienced the sudden loss of five teeth in the absence of traumatic events. Dental assessment and orthopantomography confirmed moderate chronic periodontitis. Teriflunomide was discontinued and the accelerated elimination procedure with cholestyramine was performed. Case 3: A 56-year-old woman affected by MS for thirty years. She switched from interferon beta to teriflunomide due to injection site reactions. After eighteen months she experienced hypermobility of several teeth without gum inflammation or pain, followed by sudden loss of twelve teeth. No dental examination is available. Teriflunomide was discontinued without accelerated elimination procedure. Discussion: Odontogenic infections (periodontal disease and dental caries) are common and can cause teeth loss if left untreated as in case 1. It is conceivable that local infections favoured by teriflunomide accelerated pulpitis, endodontic infections and periapical reactions followed by teeth loss in predisposed subjects. Poor oral hygiene is common in MS patients and might favour dental infections. Conclusions: We underline the importance to assess concomitant teeth morbidity and to recommend accurate oral hygiene before and during teriflunomide treatment.

Original languageEnglish
Pages (from-to)120-122
Number of pages3
JournalMultiple Sclerosis and Related Disorders
Volume24
DOIs
Publication statusPublished - Aug 1 2018

Fingerprint

Tooth Loss
Tooth
Panoramic Radiography
Interferon-beta
Multiple Sclerosis
Cholestyramine Resin
Therapeutics
Relapsing-Remitting Multiple Sclerosis
Oral Hygiene
Infection
Pulpitis
teriflunomide
Alveolar Bone Loss
Pain
Chronic Periodontitis
Endodontics
Immunologic Factors
Dental Caries
Gingiva
Periodontal Diseases

Keywords

  • Dental caries
  • Leflunomide
  • Multiple sclerosis
  • Periodontitis
  • Teriflunomide

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Teeth loss after teriflunomide treatment : Casual or causal? A short case series. / Vacchiano, Veria; Frattaruolo, Nicola; Mancinelli, Luca; Foschi, Matteo; Carotenuto, Antonio; Scandellari, Cinzia; Piattelli, Maurizio; Brescia Morra, Vincenzo; Lugaresi, Alessandra.

In: Multiple Sclerosis and Related Disorders, Vol. 24, 01.08.2018, p. 120-122.

Research output: Contribution to journalArticle

Vacchiano, V, Frattaruolo, N, Mancinelli, L, Foschi, M, Carotenuto, A, Scandellari, C, Piattelli, M, Brescia Morra, V & Lugaresi, A 2018, 'Teeth loss after teriflunomide treatment: Casual or causal? A short case series', Multiple Sclerosis and Related Disorders, vol. 24, pp. 120-122. https://doi.org/10.1016/j.msard.2018.06.018
Vacchiano, Veria ; Frattaruolo, Nicola ; Mancinelli, Luca ; Foschi, Matteo ; Carotenuto, Antonio ; Scandellari, Cinzia ; Piattelli, Maurizio ; Brescia Morra, Vincenzo ; Lugaresi, Alessandra. / Teeth loss after teriflunomide treatment : Casual or causal? A short case series. In: Multiple Sclerosis and Related Disorders. 2018 ; Vol. 24. pp. 120-122.
@article{1ce174f7dde8440e995a3098b110365a,
title = "Teeth loss after teriflunomide treatment: Casual or causal? A short case series",
abstract = "Background: Teriflunomide is a once-daily oral immunomodulator approved for the treatment of relapsing-remitting multiple sclerosis (RRMS) with a consistent safety profile in clinical trials. We report three cases of multiple teeth loss during teriflunomide treatment. Case reports: Case 1: a 39 year-old woman started teriflunomide for RRMS, switching from interferon beta. Four months later she complained about mandibular pain followed by the sudden loss of 4 teeth, in the absence of bleeding or trauma. Suspecting a causal role, we discontinued teriflunomide and started the accelerated elimination procedure with cholestyramine. Orthopantomography and a subsequent dental CT scan showed diffuse alveolar atrophy and periapical bone loss in several residual roots. Investigating retrospectively the patient's dental history, and revising previous orthopantomographies dating from 2009, we highlighted a chronic and progressive dental pathology with several cavities and teeth loss. Case 2: A 52-year-old woman affected by multiple sclerosis (MS) since 1988, switched from interferon beta to teriflunomide treatment due to poor tolerability. One year later she experienced the sudden loss of five teeth in the absence of traumatic events. Dental assessment and orthopantomography confirmed moderate chronic periodontitis. Teriflunomide was discontinued and the accelerated elimination procedure with cholestyramine was performed. Case 3: A 56-year-old woman affected by MS for thirty years. She switched from interferon beta to teriflunomide due to injection site reactions. After eighteen months she experienced hypermobility of several teeth without gum inflammation or pain, followed by sudden loss of twelve teeth. No dental examination is available. Teriflunomide was discontinued without accelerated elimination procedure. Discussion: Odontogenic infections (periodontal disease and dental caries) are common and can cause teeth loss if left untreated as in case 1. It is conceivable that local infections favoured by teriflunomide accelerated pulpitis, endodontic infections and periapical reactions followed by teeth loss in predisposed subjects. Poor oral hygiene is common in MS patients and might favour dental infections. Conclusions: We underline the importance to assess concomitant teeth morbidity and to recommend accurate oral hygiene before and during teriflunomide treatment.",
keywords = "Dental caries, Leflunomide, Multiple sclerosis, Periodontitis, Teriflunomide",
author = "Veria Vacchiano and Nicola Frattaruolo and Luca Mancinelli and Matteo Foschi and Antonio Carotenuto and Cinzia Scandellari and Maurizio Piattelli and {Brescia Morra}, Vincenzo and Alessandra Lugaresi",
note = "Ricercatore distaccato presso IRCCS a seguito Convenzione esclusiva con Universit{\`a} di Bologna (Lugaresi Alessandra). Richiesto CORRIGENDUM per affiliazione imprecisa. La Prof.ssa A. Lugaresi viene da altro Istituto e lavori con affiliazioni diverse usciranno ancora nei prossimi anni.",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.msard.2018.06.018",
language = "English",
volume = "24",
pages = "120--122",
journal = "Multiple Sclerosis and Related Disorders",
issn = "2211-0348",
publisher = "Elsevier",

}

TY - JOUR

T1 - Teeth loss after teriflunomide treatment

T2 - Casual or causal? A short case series

AU - Vacchiano, Veria

AU - Frattaruolo, Nicola

AU - Mancinelli, Luca

AU - Foschi, Matteo

AU - Carotenuto, Antonio

AU - Scandellari, Cinzia

AU - Piattelli, Maurizio

AU - Brescia Morra, Vincenzo

AU - Lugaresi, Alessandra

N1 - Ricercatore distaccato presso IRCCS a seguito Convenzione esclusiva con Università di Bologna (Lugaresi Alessandra). Richiesto CORRIGENDUM per affiliazione imprecisa. La Prof.ssa A. Lugaresi viene da altro Istituto e lavori con affiliazioni diverse usciranno ancora nei prossimi anni.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Teriflunomide is a once-daily oral immunomodulator approved for the treatment of relapsing-remitting multiple sclerosis (RRMS) with a consistent safety profile in clinical trials. We report three cases of multiple teeth loss during teriflunomide treatment. Case reports: Case 1: a 39 year-old woman started teriflunomide for RRMS, switching from interferon beta. Four months later she complained about mandibular pain followed by the sudden loss of 4 teeth, in the absence of bleeding or trauma. Suspecting a causal role, we discontinued teriflunomide and started the accelerated elimination procedure with cholestyramine. Orthopantomography and a subsequent dental CT scan showed diffuse alveolar atrophy and periapical bone loss in several residual roots. Investigating retrospectively the patient's dental history, and revising previous orthopantomographies dating from 2009, we highlighted a chronic and progressive dental pathology with several cavities and teeth loss. Case 2: A 52-year-old woman affected by multiple sclerosis (MS) since 1988, switched from interferon beta to teriflunomide treatment due to poor tolerability. One year later she experienced the sudden loss of five teeth in the absence of traumatic events. Dental assessment and orthopantomography confirmed moderate chronic periodontitis. Teriflunomide was discontinued and the accelerated elimination procedure with cholestyramine was performed. Case 3: A 56-year-old woman affected by MS for thirty years. She switched from interferon beta to teriflunomide due to injection site reactions. After eighteen months she experienced hypermobility of several teeth without gum inflammation or pain, followed by sudden loss of twelve teeth. No dental examination is available. Teriflunomide was discontinued without accelerated elimination procedure. Discussion: Odontogenic infections (periodontal disease and dental caries) are common and can cause teeth loss if left untreated as in case 1. It is conceivable that local infections favoured by teriflunomide accelerated pulpitis, endodontic infections and periapical reactions followed by teeth loss in predisposed subjects. Poor oral hygiene is common in MS patients and might favour dental infections. Conclusions: We underline the importance to assess concomitant teeth morbidity and to recommend accurate oral hygiene before and during teriflunomide treatment.

AB - Background: Teriflunomide is a once-daily oral immunomodulator approved for the treatment of relapsing-remitting multiple sclerosis (RRMS) with a consistent safety profile in clinical trials. We report three cases of multiple teeth loss during teriflunomide treatment. Case reports: Case 1: a 39 year-old woman started teriflunomide for RRMS, switching from interferon beta. Four months later she complained about mandibular pain followed by the sudden loss of 4 teeth, in the absence of bleeding or trauma. Suspecting a causal role, we discontinued teriflunomide and started the accelerated elimination procedure with cholestyramine. Orthopantomography and a subsequent dental CT scan showed diffuse alveolar atrophy and periapical bone loss in several residual roots. Investigating retrospectively the patient's dental history, and revising previous orthopantomographies dating from 2009, we highlighted a chronic and progressive dental pathology with several cavities and teeth loss. Case 2: A 52-year-old woman affected by multiple sclerosis (MS) since 1988, switched from interferon beta to teriflunomide treatment due to poor tolerability. One year later she experienced the sudden loss of five teeth in the absence of traumatic events. Dental assessment and orthopantomography confirmed moderate chronic periodontitis. Teriflunomide was discontinued and the accelerated elimination procedure with cholestyramine was performed. Case 3: A 56-year-old woman affected by MS for thirty years. She switched from interferon beta to teriflunomide due to injection site reactions. After eighteen months she experienced hypermobility of several teeth without gum inflammation or pain, followed by sudden loss of twelve teeth. No dental examination is available. Teriflunomide was discontinued without accelerated elimination procedure. Discussion: Odontogenic infections (periodontal disease and dental caries) are common and can cause teeth loss if left untreated as in case 1. It is conceivable that local infections favoured by teriflunomide accelerated pulpitis, endodontic infections and periapical reactions followed by teeth loss in predisposed subjects. Poor oral hygiene is common in MS patients and might favour dental infections. Conclusions: We underline the importance to assess concomitant teeth morbidity and to recommend accurate oral hygiene before and during teriflunomide treatment.

KW - Dental caries

KW - Leflunomide

KW - Multiple sclerosis

KW - Periodontitis

KW - Teriflunomide

UR - http://www.scopus.com/inward/record.url?scp=85049466065&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049466065&partnerID=8YFLogxK

U2 - 10.1016/j.msard.2018.06.018

DO - 10.1016/j.msard.2018.06.018

M3 - Article

C2 - 29982109

AN - SCOPUS:85049466065

VL - 24

SP - 120

EP - 122

JO - Multiple Sclerosis and Related Disorders

JF - Multiple Sclerosis and Related Disorders

SN - 2211-0348

ER -