SCDEP - MRONJ

Question 1

What makes pt high risk of MRONJ?

Answer 1

Previous dx of MRONJ
Anti-resoptive/anti-angiogenics for metastatic disease
Pt bisphosphonate more 5 years
Pt on bisphospohnate and gluticosteorids

Question 2

What is anti-resorptive?

Answer 2

Inhibit osteoclast differentiation and function

Question 3

Example of anti-resoprtive?

Answer 3

Bisphosphoante

Monoclonal ab

Question 4

Example of anti-angiogenic?

Answer 4

Tyrosine kinase inhibitor

Question 5

What are anti-angiogenic?

Answer 5

Disrupt process in which new blood vessels are formed

Question 6

What pt are at low risk of MRONJ

Answer 6

Pt on denosumab (inc last 9 months)

Pt on bisphosphonate less 5 years

Question 7

How manage pt at risk MRONJ?

Answer 7

Advise pt risk of MRONJ - low risk, don’t stop meds
Ideally dental fit prior medication, maintain OHI
If XLA poor prognosis teeth consider risk MRONJ
- low risk XLA practice
- high risk consider all other measures
Review healing 8 weeks

Question 8

When refer oral surgery?

Answer 8

Spontaneous MRONJ

No healing after 8 weeks XLA

Question 9

How give steroid cover?

Answer 9

If less 10mg prednisolone - no cover
More 10mg prednisolone - double dose or 25mg hydrocortisone IV/IM
More 40mg - don’t double dose, place IV cannula in case adrenal crisis

Question 10

How tx pt w/ hx of steroids?

Answer 10

If last 3 months - tx as if still on steroid

More 3 months - no cover needed