Medication-Related Osteonecrosis of The Jaw: Commonly Asked Questions


Medication-Related Osteonecrosis of the Jaw (MRONJ) is a condition that patients can experience if they are taking certain medications, such as medications normally prescribed for Osteoporosis. With the advancement of newer medications, additional drugs are added to the list of medications that can cause this condition such as Antiangiogenic drugs, commonly used in cancer treatment.

What is MRONJ?

It is a condition where the patient’s bone has necrosis (partial death of bone in the jaws). For a patient to be diagnosed with MRONJ, a specific criterion has to be met. This includes:

  1. Current or previous treatment with antiresorptive or antiangiogenic agent
  2. Exposed bone or a bone that can be probed through intra or extra oral fistula for a period of more than 8 weeks
  3. No history of radiation therapy to the jaws or obvious metastasis to the jaws

What are the most commonly used drugs that cause MRONJ?

  • Bisphosphonate Medications: Fosamax, Actonel, Boniva and Zometa
  • Antibody Agonist Medications (RANK ligated inhibitor Denosumab): Prolia and Xgeva
  • Antiagiogenic Medications
  • Other unknown drugs might also be involved in causing MRONJ

How common is MRONJ?

Luckily, MRONJ is not very common. If a patient is using oral medication, the risk is 0.01-0.04% of having spontaneous MRONJ. If surgery is performed, the risk increases. However, IV bisphosphonates are much more potent and have a risk of 0.8%-12% of causing MRONJ.

What should I do before starting a medication that can cause MRONJ?

It is very important to discuss the side effects of these medications with your medical provider and with your dental provider to minimize the future risk of developing MRONJ. Some of the guidelines are listed here on what needs to be done:

  • Clinical dental exam that includes a panoramic radiograph
  • Restore dentition
  • Proper fit of removable prosthesis
  • Remove abscessed and non-restorable teeth and teeth with severe periodontal disease and poor long time prognosis
  • If systemic conditions permit, delay Bisphosphonate therapy for 21 days post-extractions
  • Scheduled surveillance appointments

Can MRONJ be treated?

Yes, your Oral and Maxillofacial Surgeon is best equipped to manage a diagnosis of MRONJ. Depending on the severity of MRONJ and the patient’s unique medical history, a patient-specific treatment plan will be developed by the oral surgeon to manage MRONJ. The treatment plan can include a variety of interventions, ranging from monitoring and occasional use of pharmacologic agents to major debridement and even resection when needed. Therefore, patients who are taking a medication that can predispose them to MRONJ need to be closely managed by their dentist and oral surgeon to provide the optimum care and best outcome for patients with MRONJ. Prevention is always the key.
 
To learn more about MRONJ and the treatment options available to you, contact us or find a dentist near you on our website.