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Flashcards in MRONJ Deck (22):
1

what is MRONJ?

current or previous treatment with antiresorptives or antiangiogenics
exposed bone/bone that can be probed through an intra oral lesion or an extra oral fistula in the maxillofacial region jaw that has persisted for more than 8 weeks
no history of radiation therapy/metastic disease to the jaws

2

what drugs can cause MRONJ?

bisphosphonates
RANK ligand inhibitor - denosumab
anti angiogenic - tyrosine kinase inhibitors, monofacial abs against vascular endothelial growth factor

3

what is the action of bisphosphonates?

deposited in bone and persist
inhibit formation, recruitment and function of osteoclasts
increase apoptosis
anti angiogenic

4

bisphosphonates used for?

osteoporosis
osteogenesis imperfecta
primary hyperparathyroidism
pagets disease
multilple myeloma
breast/prostate cancer
hypercalcaemia of malignancy

5

oral bisphosphonates for?
iv for?

- osteoporosis/osteopernia
- cancer related conditions and yearly for osteoporosis

6

what is denosumab?

antibody against rank ligand
inhibits osteoclast function
inhibits bone resorption
does not bind to bone

7

densoumab used for?

osteoporosis
metastic bone disease

8

what is the pathogenesis of MRONJ?

reduced bone turnover
reduced vascularity
inflammation/infection
adverse effects on soft tissues
immune dysfunction

9

risk factors of drugs to MRONJ?

potency
route of administration
cumulative dose
antiogenic and a bisphosphonate

10

what drugs are low risk?

oral/iv bisphosphonates/denosumab for osteroporosis or pagets

11

what drugs are high risk?

bisphosphonates iv, densosumab, anti angiogenics for malignant conditions

12

what med history makes a pt high risk for mronj?

prev mronj
systemic corticosteroids
immunosuppressants
coagulopathy
chemotherapy
radiotherapy

13

maxilla/mandible more likely to be affected?

mandible

14

increased risk if pt?

weares a denture
pre existing dental disease
increased risk with age
if pt is female

15

stages of mronj 0

no clinical evidence/necrotic bone/non spec symptoms, clinical/radiographic findings

16

stage 1?

exposed necrotic bone/fistulas that probe to bone in pts who are asymptomatic, no evidence of infection

17

stage 2?

exposed necrotic bone/fistulas with infection
pain and erythema

18

stage 3?

exposed necrotic bone/fistula with infection, pain and erythema with one of :
pathological fracture
extra oral fistula
oral antral/oral nasal communication
oseolysis extending to upper border of mandible sinus/floor

19

stage 0 tx?

close monitoring to symptoms

20

stage 1 tx?

antimicrobial rinses

21

stage 2 tx?

antimicrobial rinses and systemic antibiotic analgesics, debridement

22

stage 3 tx?

anto,icrobial rinses, systemic antibiotic analgesics, surgical debridement/resection