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OSOMOP > MRONJ > Flashcards

MRONJ Flashcards

1
Q

Name 3 criteria a person must fulfil to be considered to have MRONJ

A
  1. Current or previous treatment with anti resorptive drugs
  2. Exposed bone persisting for over 8 weeks
  3. No history of radiotherapy or metastatic bone disease in jaws
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2
Q

Name 2 common drugs which cause MRONJ

A
  1. Bisphosphonates

2. Denosumab

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3
Q

Describe 5 theories of the pathogenesis of MRONJ

A
  1. Inhibition of bone remodelling (cannot remove necrotic bone)
  2. Inflammation / Infection
  3. Anti-angiogenesis (bisphosphonates)
  4. Soft tissue toxicity (bisphosphonates)
  5. Immune dysfunction (reduction of blood supply)
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4
Q

Name 6 common signs and symptoms of MRONJ

A
  1. Pain
  2. Exposed bone
  3. Bad taste
  4. Numbness / paraesthesia
  5. Swelling / sinus formation
  6. Delayed healing following surgery
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5
Q

Describe stage 0 of MRONJ

A
  • No clinical evidence of necrotic bone

- Non specific clinical findings, radiographic changes and symptoms

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6
Q

Describe stage 1 of MRONJ

A
  • Exposed and necrotic bone, or fistula that probes into bone
  • Asymptomatic and no evidence of infection
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7
Q

Describe stage 2 of MRONJ

A
  • Exposed and necrotic bone, or fistula that probes into bone
  • Infection evidenced by pain and erythema in region of exposed bone
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8
Q

Describe stage 3 of MRONJ

A
  • Exposed and necrotic bone, or fistula that probes into bone, extending beyond region of alveolar bone
  • Pathogenic fracture
  • Extra oral fistula
  • Oral nasal / Oral antral communication
  • Osteolysis
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9
Q

Describe the treatment for stage 0 MRONJ

A

Systemic management including use of antibiotics and pain medication

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10
Q

Describe the treatment for stage 1 MRONJ

A
  • Antibacterial mouth rinse
  • Clinical follow up on quarterly basis
  • Patient education
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11
Q

Describe the treatment for stage 2 MRONJ

A
  • Symptomatic treatment with oral antibiotics
  • Pain control
  • Debridement to relieve soft tissue irritation and infection control
  • Oral antibacterial mouth rinse
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12
Q

Describe the treatment for stage 3 MRONJ

A
  • Antibacterial mouth rinse
  • Antibiotic therapy and pain control
  • Surgical debridement for long term palliation of infection and pain
  • Surgical resection for long term palliation of infection and pain
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13
Q

What is the current guidelines used for management of MRONJ?

A

Best Practice Guidelines - Belfast Trust

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14
Q

Why may previous bisphosphonate treatment be a risk factor for MRONJ?

A

Linger in the system as they bind to the skeleton and remain after treatment has finished

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15
Q

What is a concurrent condition which may increase a patient receiving bisphosphonates risk of developing MRONJ?

A

Immunosuppression

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16
Q

Why may anatomical site be a risk factor for MRONJ?

A

Mandible is less vascular than maxilla so more likely to develop MRONJ

17
Q

Describe the components of preventative care of patients on bisphosphonates or denosumab

A
  • Advise patients on risk of MRONJ
  • Oral hygeine and diet advice
  • Fluoride mouthrinses
  • Smoking cessation
  • Ensure patient is dentally fit before treatment commences
18
Q

Describe 4 steps taken to ensure a patient is dentally fit before undergoing treatment which may carry the risk of MRONJ

A
  1. Extract teeth with a poor prognosis
  2. Reduce periodontal infection
  3. Adjust or replace poorly fitting dentures
  4. Undertake all remedial dental work
19
Q

What is the initiating event in most MRONJ?

A

Dental extraction

20
Q

Name 4 things which make a person high risk for MRONJ

A
  1. Patients being treated with oral bisphosphonates or infusions for non malignant diseases for more than 5 years
  2. Patients being treated with bisphosphonates or RANKL inhibitors for non malignant diseases and immunosuppressants for any time
  3. Patients taking anti-resorptive drug as part of cancer management
  4. Previous diagnosis of MRONJ
21
Q

Name 3 things which make a person low risk for MRONJ

A
  1. Patients being treated with oral bisphosphonates for non-malignant diseases for less than 5 years with no concurrent immunosuppressants
  2. Patients being treated with IV bisphosphonates for non-malignant diseases for less than 5 years with no concurrent immunosuppressants
  3. Patients being treated with bisphosphonates or RANKL inhibitors for non malignant diseases with no immunosuppressants
22
Q

What is the major difference in dental therapy which impacts on bones between low and high risk patients?

A
  • Low risk is discuss risks, proceed with treatment, no prophylaxis, review healing at 8 weeks
  • High risk is explore all alternatives possible then discuss risks, proceed with treatment, no prophylaxis, review healing at 8 weeks
23
Q

Discuss “drug holidays” for patients on bisphosphonates or RANKL inhibitors when needing dental extractions

A
  • Guidance varies
  • Tends to have some indications for small benefits
  • Write to physician prescribing treatment and ask if patient can have holiday
  • Most patients may be able to come off for 2 months without risk of fracture
24
Q

Name 2 types of anti-angiogenic medications with examples of both

A

Tyrosine Kinase Inhibitors - Sunitinib

Vascular Endothelial Growth Factor Inhibitors - Bevacizumab / Aflibercept

OSOMOP (14 decks)

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