The study was conducted at the Small Animal Clinic of the Veterinary Faculty at the University of Ljubljana in Slovenia. The dogs had permanent dentition and were undergoing clinically indicated closed or open extractions. The investigators excluded animals with conditions or treatments that could impair wound healing, those requiring perioperative or postoperative antibiotics, and dogs with an oronasal fistula. No perioperative or immediate postoperative antibiotics or antiseptics were administered. All 87 animals were discharged on the day of surgery with pain management as clinically indicated, received a routine non-sedated examination 10 days later, and, if a healing complication was detected, underwent weekly in-person or telemedicine follow-up until healing was confirmed.

Dehiscence was defined by incomplete epithelial healing and separation of the wound edges, with defects of varying extent and granulation tissue accompanied by signs of inflammation. Investigators adapted a numerical scoring system for examination without sedation, meaning the assessment focused on wound-edge separation, gap size, and the presence of bridging granulation tissue. Features such as discharge, ulceration, necrotic tissue, debris, and inflammation could not be evaluated consistently in awake dogs and were not included in the score. Of the 17 affected sites, 13, or 76.5%, were classified as mild, while four had gaps larger than 10 mm that were not bridged by granulation tissue at the first examination.

Most complications involved large, functionally important teeth. Canine teeth accounted for six of the 17 affected sites, maxillary fourth premolars for four, and the mandibular first molar for one; together, these teeth represented 11 of 17 cases. Three affected dogs received antibiotics beginning five days after surgery, and one additional dog received extended analgesia because owners reported pain during eating. Two of the antibiotic-treated dogs had mandibular canine extraction sites, marked halitosis, and pain with eating. No affected site required revision surgery. After continued home-care measures, including soft food, avoidance of tooth brushing at the site, prevention of access to hard chew toys, and saline rinsing after meals, all wounds healed within 31 days.

Statistical analysis found several factors associated with dehiscence, although the observational design means these were associations rather than proof of causation. Each additional kilogram of body weight was associated with 13% higher odds of the complication, with an odds ratio of 1.13 and a 95% confidence interval of 1.04 to 1.23. Age was not associated with dehiscence. Compared with closed extractions, open procedures had nearly 17-fold higher odds, but that estimate had a wide 95% confidence interval of 2.11 to 141.91. The relatively small number of events and the strong relationship between surgical technique and procedural difficulty limit interpretation of these estimates.

Anatomical location also mattered. Sites in the rostral mandible, extending from the mandibular canine to the third premolar, had 23.25 times the odds of dehiscence seen in the incisive region, with a 95% confidence interval of 4.03 to 134.27. The rostral maxilla also had higher odds in the main model, although that difference did not remain significant after correction for multiple comparisons. The investigators proposed that persistent tension from the lower lip and perioral muscles may contribute to wound separation in the rostral mandible, but the study did not directly measure tissue tension. Caudal maxillary and mandibular sites were not significantly associated with dehiscence relative to the incisive region.

The extent of surgery showed a strong association. Removal of at least 50% of the alveolar bone was associated with nearly 19-fold higher odds of dehiscence compared with no buccal bone removal, although the 95% confidence interval was broad, from 2.36 to 151.59. Extractions for traumatic dentoalveolar injury had 9.20 times the odds associated with extractions for periodontal disease, while other extraction indications were not significantly associated. The authors suggested that fractured, periodontally healthy teeth may require more traumatic removal, whereas extensive bone removal may serve as a marker of extraction difficulty rather than being the sole cause of wound breakdown.

Flap design produced a notable but potentially confounded pattern. Among open extractions, triangular flaps were associated with higher estimated odds of dehiscence than envelope flaps. In the Bayesian model, the posterior median odds ratio was 4.44 for triangular versus envelope flaps among open procedures, with a 95% credible interval of 1.18 to 20.00. Pedicle flaps also had elevated estimated odds, but the estimate was imprecise because only five sites used that technique. Triangular flaps were more frequently used in procedures requiring removal of at least half the alveolar bone, so the researchers cautioned that the result may reflect extraction complexity and tissue trauma rather than flap design alone.

Other perioperative measurements did not show clear associations. Anesthesia duration, hypotension requiring a crystalloid bolus, and intraoperative root fracture were not significantly associated with dehiscence. Higher minimum body temperature was associated with greater odds in the primary model, but the relationship disappeared after adjustment for body weight, suggesting confounding. Root fracture occurred at 9.9% of extraction sites and involved 27.6% of the dogs, but fractured roots were successfully retrieved. The study also recorded two cases of late suborbital swelling after apparently uncomplicated healing, one linked to a subcutaneous foreign body and the other to panniculitis and myositis, showing that not every postoperative facial sign necessarily reflects the extraction wound itself.

Several limitations constrain the findings. The first examination occurred 10 days after surgery, so an earlier assessment might have detected more dehiscence while a later one might have missed mild cases that had already healed. Because examinations were performed without sedation, the investigators could not assess every tissue feature or bone healing consistently. The sample also came from one veterinary clinic, included only 17 dehiscence events, and contained relatively few pedicle-flap cases. Factors such as flap design, bone removal, extraction type, fracture, and body weight were interrelated, making it difficult to isolate the independent effect of any one factor. The authors called for more uniform canine populations and further prospective studies, while describing their cohort as the largest prospective clinical study of post-extraction wound-healing complications in healthy adult dogs reported to date.

Subject of Research: Prospective study of post-extraction wound dehiscence and associated risk factors in healthy adult dogs

Article Title: Wound healing complications after tooth extraction in dogs

Article References: Šparaš, L., Pavlica, M., Lukanc, B., & Nemec, A. (2026). Wound healing complications after tooth extraction in dogs. Frontiers in Veterinary Science, 13, 1962193. https://doi.org/10.3389/fvets.2026.1962193

Image Credits: AI Generated

DOI: 10.3389/fvets.2026.1962193

Keywords: veterinary dentistry, tooth extraction, wound dehiscence, dogs, second-intention healing, oral surgery, periodontal disease, dental fractures, Wound, healing, complications, tooth

The drugs at the center of the findings, known as antiresorptives, are a cornerstone of modern treatment for bone metastases. Breast cancer that has spread to the skeleton disrupts the normal balance of bone remodeling, tipping it toward excessive breakdown by cells called osteoclasts. This process causes pain, fractures, spinal cord compression and dangerously high calcium levels. Antiresorptive drugs work by suppressing osteoclast activity. Bisphosphonates, such as zoledronic acid, bind to bone mineral and poison the resorption machinery of osteoclasts, while denosumab, a monoclonal antibody, blocks RANKL, the signaling molecule that osteoclasts need to form, function and survive. By dampening bone turnover, these agents reduce skeletal complications and improve quality of life for patients with metastatic disease.

Yet the same mechanism that protects the skeleton carries a paradoxical risk in the jaw. Osteonecrosis of the jaw associated with these medications, abbreviated MRONJ, typically appears as exposed bone in the mouth that fails to heal for more than eight weeks, in patients with no history of radiation therapy to the head or neck. The jawbone is subject to constant mechanical stress from chewing and is frequently challenged by dental infections and procedures. When bone remodeling is profoundly suppressed, the normal repair of tiny injuries in the jaw may be impaired, and dead bone can persist as an open, infection-prone wound. The condition can cause pain, swelling, loose teeth and recurrent infections, and it is notoriously difficult to treat once established.

The Oulu research team designed their study as a retrospective nationwide registry analysis, combining data from the Finnish Institute for Health and Welfare and the Social Insurance Institution of Finland. This approach gave them access to a complete, population-based dataset rather than the selected patient groups seen at single hospitals. The cohort consisted of 652 breast cancer patients with bone metastases who received antiresorptive treatment between 2013 and 2015, and the researchers followed the patients until the end of 2020. That multi-year window matters, because osteonecrosis of the jaw can develop slowly over an extended period, and studies with shorter observation times may substantially underestimate how often it occurs.

The headline figures, 12.6 percent for denosumab alone and 15.3 percent for patients who switched from bisphosphonates to denosumab, are notably higher than many earlier estimates, which often ranged from a few percent in pooled analyses. The Finnish team attributes part of this difference to their long follow-up and their ability to capture diagnoses across the entire national healthcare system. Because the dataset covered all of Finland, the researchers could assess the incidence of the condition and the factors associated with it specifically among Finnish patients with breast cancer that had spread to the bones, something that had never been done before in the country.

Beyond the overall incidence, the study uncovered a telling pattern in the dental records. Dental procedures related to oral infections were associated with the development of osteonecrosis of the jaw. Tooth extraction and root canal treatment, in particular, were linked to a higher risk of the condition. Tooth extraction has long been recognized in the international literature as the most common triggering event for MRONJ, because it creates an open wound in bone whose healing capacity has been chemically dampened. The association with root canal treatment is more novel, but the researchers urge caution in interpreting it: the number of patients in the cohort who underwent root canal treatment was small, and the finding does not establish that the procedure itself causes osteonecrosis of the jaw. It may instead serve as a marker of underlying oral infection or inflammation.

Miika Kujanpää, a doctoral researcher at the University of Oulu, emphasized that the results should not alarm patients into abandoning their cancer treatment. The findings alone do not warrant changing or discontinuing antiresorptive therapy, he noted, and the benefits and potential risks must be assessed on an individual basis. Nor, he stressed, should necessary dental treatment be withheld because of the associations observed. What the results do highlight, according to Kujanpää, is the importance of identifying and adequately treating potential sources of oral infection before starting antiresorptive therapy, and of monitoring oral health continuously throughout the course of treatment. Achieving that, he said, requires close collaboration between oncology and oral healthcare professionals, two specialties that historically have not always coordinated closely.

This preventive message carries real clinical weight. If active infections and non-healing dental problems are resolved before a patient begins denosumab or bisphosphonates, the jaw enters treatment in the best possible condition, with no open wounds to seed necrosis. Once therapy has started, invasive dental work becomes more hazardous, because the suppressed bone turnover persists for months or even years after each dose, particularly with denosumab’s long-acting antibody mechanism. Many international guidelines already recommend a dental examination before initiating antiresorptive therapy, but adherence varies widely, and the Finnish data provide fresh, population-based evidence for why that recommendation matters in everyday oncology practice.

The researchers are careful to frame their study as a beginning rather than an endpoint. They call for further research into how drug dosage, treatment duration and cumulative exposure are associated with osteonecrosis of the jaw, questions that registry data alone cannot fully resolve. More precise information is also needed on the timing of oral infections, dental procedures and the onset of the condition, so that the effects of different contributing factors can be disentangled. And they underline the necessity of sufficiently long follow-up in future studies, since the condition can emerge over an extended period and shorter observation windows risk understating its true incidence.

Perhaps the most consequential question the study raises is also the most practical: how much planned, preventive oral healthcare can actually reduce the risk of osteonecrosis of the jaw? If a structured program of dental screening, infection control and timely treatment before and during antiresorptive therapy can meaningfully lower the incidence observed in Finland, the payoff for patients with metastatic breast cancer could be substantial, sparing them a painful and disabling complication without compromising the bone protection they need. The study was supported by research grants from the Finnish Dental Society Apollonia, and its publication in Clinical Oral Investigations marks a step toward evidence-based, jointly managed care at the intersection of cancer medicine and dentistry. For the hundreds of thousands of women worldwide living with breast cancer that has reached their bones, the message from Finland is clear: the teeth and jaws deserve a place on the treatment plan.

Subject of Research: Incidence and risk factors of medication-related osteonecrosis of the jaw in breast cancer patients with bone metastases receiving antiresorptive treatment

Article Title: Jawbone necrosis in advanced breast cancer: Finnish study highlights the importance of oral health

Article References: Jawbone necrosis in advanced breast cancer: Finnish study highlights the importance of oral health. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: osteonecrosis of the jaw, breast cancer, bone metastases, denosumab, bisphosphonates, antiresorptive drugs, oral health, tooth extraction, registry study, Finland, University of Oulu, Clinical Oral Investigations

Researchers led by Yu Zhang and Wei Cui of the Fourth Military Medical University in Xi’an, working with colleagues at Xi’an Medical University, distributed a cross-sectional questionnaire to all 109 public institutions approved by China’s Ministry of Education to offer undergraduate dentistry programs between 2021 and 2023. The questionnaire was adapted from validated frameworks used in the United Kingdom, reviewed by five subject-matter experts and pilot-tested before deployment. Forty-nine institutions returned valid responses, a participation rate of 45 percent, but the sample carried considerable weight: it included all 28 institutions holding an official discipline ranking of C-minus or above in the most recent national evaluation, and it spanned all seven major geographic regions of China.

The structural findings show a remarkable degree of consensus on how the subject is delivered. Nearly all responding institutions, 47 of 49 or 95.92 percent, teach dentoalveolar surgery not as a standalone course but embedded within a broader oral and maxillofacial surgery curriculum. Three-quarters of schools, 75.51 percent, schedule the material in the fourth academic year, positioning it after students have completed foundational biomedical coursework and general dental training but before graduation and clinical licensure.

Beneath that structural agreement, however, lies substantial variability in time commitment. For both theoretical and practical instruction, the most commonly reported duration was 10 to 20 hours, yet the actual range was dramatic: theory teaching ranged from as little as 4 hours to as many as 36 hours, while practical teaching spanned from 4 hours to more than 36 hours. That means a student at one Chinese dental school might receive nine times the hands-on surgical instruction of a peer at another institution, a disparity with potential implications for entry-level competence in procedures that carry real risks of nerve injury, fracture and infection.

The content itself follows an internationally recognizable core. Institutions consistently reported covering tooth extraction, local anesthesia, the extraction of impacted mandibular third molars, and the management of post-extraction healing and complications. These are the bread-and-butter procedures of general dental practice, and their prominence reflects the reality that most graduates will perform them daily rather than pursue surgical specialization.

Where the survey offers its most actionable insights is in the details of practical training pathways. Thirty institutions, 61.22 percent, described a progressive training sequence that moves students from instrument familiarization, through phantom-head simulation on artificial jaw models, to supervised peer-to-peer practice of local anesthesia injections. This staged approach mirrors competency-based models advocated in dental education literature, allowing students to build psychomotor skills incrementally before touching a patient. Yet simulation for more complex procedures lagged considerably: only 53.06 percent of schools provided simulation training for the surgical removal of impacted mandibular third molars, 42.86 percent for root or fractured-root removal, and just 36.73 percent for the extraction of other impacted teeth. These are precisely the procedures where inexperienced operators face the steepest learning curves and the highest complication rates.

Digital teaching tools present a similar picture of uneven adoption. Videos were nearly universal, used by 95.92 percent of institutions, and animations were employed by 79.59 percent, reflecting how inexpensive and easily deployed these passive formats have become. Interactive virtual programs, by contrast, were reported by only 24.49 percent of schools. The distinction matters educationally: passive media support observation and conceptual understanding, while interactive simulation platforms provide deliberate practice with feedback, the mechanism most strongly associated with skill acquisition in the surgical education literature.

Pedagogical innovation shows a clear hierarchy as well. Problem-based learning was the most widely adopted active-learning method, reported by 71.43 percent of institutions, followed by case-based learning at 42.86 percent and flipped-classroom teaching at 34.69 percent. These approaches ask students to reason through clinical scenarios before or instead of receiving didactic lectures, and their growing footprint suggests Chinese dental educators are engaging with international trends in health-professions education, even if penetration remains incomplete.

Assessment practices reveal perhaps the most significant gap between theory and practice in Chinese dentoalveolar surgery education. Summative theoretical examinations were nearly universal at 95.92 percent, confirming that knowledge acquisition is rigorously tested. But practical skills assessment was implemented at only 59.18 percent of institutions, and phantom-head assessment, in which students demonstrate operative technique on simulation models, at just 48.98 percent. In other words, at roughly half of Chinese dental schools, a student could complete the surgical component of their degree without ever being formally examined on their ability to perform the procedures they studied.

The authors conclude that undergraduate dentoalveolar surgery education in China has an established framework centered on tooth extraction and local anesthesia, with broad use of practical and digital teaching methods, but that marked variation persists in teaching hours, complex-procedure simulation, interactive digital tools and practical assessment. They suggest that future curriculum development may consider competency-guided learning objectives, strengthened simulation and case-based training, and more comprehensive assessment strategies, while cautioning that the educational effectiveness of such reforms requires empirical evaluation. For a country graduating thousands of dentists annually into a health system where tooth extraction remains one of the most commonly performed surgical procedures, the findings offer a data-driven baseline for national conversations about standardization, and a reminder that what happens in the simulation laboratory may matter as much as what happens in the lecture hall.

Subject of Research: Curriculum structure, simulation training and assessment in undergraduate dentoalveolar surgery education across Chinese dental schools

Article Title: Dentoalveolar surgery education in Chinese undergraduate dental schools: a national survey of curriculum structure, simulation training and assessment

Article References: Zhang, Y., Cui, W., Hu, K., Mo, J., He, F., Wang, Y., Wang, J., Zhang, W., Zhang, Z., Wang, Y., & Xue, Y. (2026). Dentoalveolar surgery education in Chinese undergraduate dental schools: a national survey of curriculum structure, simulation training and assessment. BMC Medical Education. https://doi.org/10.1186/s12909-026-10374-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10374-9

Keywords: dentoalveolar surgery, dental education, undergraduate curriculum, simulation training, tooth extraction, local anesthesia, China, BMC Medical Education, problem-based learning, phantom head, assessment, oral and maxillofacial surgery