MRONJ Flashcards
What is the initial management of patients at risk of MRONJ (7)
> Risk assessment - high or low
Informed consent including risk of MRONJ
OHI, diet, smoking cessation reinforced
Low risk carry out XLa’s required ideally 2wks before tx begins
Atraumatic, consider suture + plan in morning
Adjust ill fitting dentures/sharp trauma regions
Follow up 8wks refer if not healing, explain signs + symptoms of MRONJ so pt aware
What risk category is a patient who has taken bisphosphonates in the past?
High
What risk category is a patient who has taken Denosumab in the past 9mths
High
What are some alternatives for high risk patients requiring XLa?
RR in absence of infection
What is MRONJ?
> Medication related osteonecrosis of the jaw
> Death of jaw bone tissue
> Rare side effect of anti-resorptive + anti-angiogenic drugs
What features would lead you to a diagnosis of MRONJ in a patient?
> Pt with hx of antiresorptive/anti-angiogenic drugs
> No hx of radiation to jaw/metastatic disease of jaws
> Signs + symptoms of MRONJ
List the signs + symptoms of MRONJ (7)
> Pain
> Infection
> Swelling
> Delayed healing
following XLa
> Exposed bone can be probed I/O or E/O
> Altered sensation/numbness
> Paraesthesia
What are the medical factors that influence the risk for MRONJ? (4)
> Drug type
> Duration of drug use
> Medical condition being treated
> Concurrent tx with systemic glucocorticoids
What are the dental risk factors that influence the risk for MRONJ? (2)
> XLa’s
> Dental trauma - including mucosal trauma from ill fitting dentures
Name examples of anti-resorptive drugs (2)
> Bisphosphonates
> Denosumab
Action of Denosumab
RANKL inhibitor
Action of anti-angiogenic drugs
> Restrict tumour vascularisation
> Targets the processes by which new BV’s are formed
Give a patient friendly description about bisphosphonates and their risks for XLa’s
Bisphosphonates are drugs that affect cells in charge of bone resorption (bone removal/ bone turnover)
When taking a tooth out, bone turnover is a key stage for good healing
Bisphosphonates can impair this healing and adversely can increase the risk of a rare side effect called MRONJ
MRONJ is an area of delayed/exposed healing - jaw cells die off in this area
High risk patients for MRONJ
> Oral/IV bisphosphonates for more than 5yrs
Cancer pt
Being tx with either antiresorptive drug (bisphosphonate or denosumab) for any length of time + systemic glucocorticoid
Previous MRONJ
When should tx ideally be carried out for high risk patients?
2 wks prior to commencement of bisphosphonate tx
