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A student guide to MRONJ

BDJ Student (2022)Cite this article

Medication related osteonecrosis of the jaws (MRONJ) is a side-effect of anti-angiogenic and anti-resorptive drugs. These drugs are predominantly used to treat bone metastases from cancers, such as breast and prostate carcinomas, and in the treatment of patients suffering from multiple myeloma and other cancers of the blood. They are also used to treat osteoporosis, Paget's disease, osteogenesis imperfecta and fibrous dysplasia. Patients with primary hyperparathyroidism and cystic fibrosis can also take such medications for prophylactic treatment.1

According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), the definitive diagnosis of MRONJ is dependent on the patient exhibiting all the following characteristics:

  • Previous or current treatment with anti-resorptive or anti-angiogenic agents

  • Bone that is exposed or bone in the maxillofacial region that can be probed through an intra- or extra-oral fistula, which must have persisted for eight or more weeks

  • There must be no history of radiotherapy to the jaw or any obvious metastatic disease in the jaw region.2

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References

  1. Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw: Scottish Dental Clinical Effectiveness Programme. 2017. Available online at: www.sdcep.org.uk/wp-content/uploads/2017/04/SDCEP-Oral-Health-Management-of-Patients-at-Risk-of-MRONJ-Guidance-full.pdf (Accessed February 2022).

  2. American Association of Oral and Maxillofacial Surgeons. Medication-Related Osteonecrosis of the Jaw. 2014. Available online at: www.aaoms.org/docs/govt_affairs/advocacy_white_papers/mronj_position_paper.pdf (Accessed February 2022).

  3. Bhanji A H. Medication related osteonecrosis of the jaws (MRONJ); Review of care at Royal Albert and Edward Infirmary (RAEI): British Association of Oral and Maxillofacial Surgeons. 2016-2017. Available online at: www.baoms.org.uk/_userfiles/pages/files/professionals/student_bursaries_2016/2016_a_bhanji_medication_related_osteonecrosis_of_the_jaws_mronj_review_of_care_at_royal_albert_and_edward_infirmary_raei.pdf (Accessed February 2022).

  4. Malden N, Beltes C, Lopes V. Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm. Br Dent J 2009; 206: 93.

  5. Nicolatou-Galitis O, Schiødt M, Mendes R A, Ripamonti C, Hope S, Drudge-Coates L, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127: 117-135.

  6. Beth-Tasdogan N H, Mayer B, Hussein H, Zolk O. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database of Systematic Reviews 2017; 10.

  7. Pimolbutr K, Porter S, Fedele S. Osteonecrosis of the Jaw Associated with Antiangiogenics in Antiresorptive-Naïve Patient: A Comprehensive Review of the Literature. BioMed Res Int 2018; 2018: 8071579.

  8. Odell E W, Cawson R A. Cawson's essentials of oral pathology and oral medicine. Ninth ed. Edinburgh: Elsevier; 2017.

  9. General Dental Council. Obtain valid consent. 2021. Available online at: https://standards.gdc-uk.org/pages/principle3/principle3.aspx (Accessed February 2022).

  10. Coleman R, Body J J, Aapro M, Hadji P, Herrstedt J. Bone health in cancer patients: ESMO Clinical Practice Guidelines †. Ann Oncol 2014; 25: iii124-iii37.

  11. Delivering Better Oral Health: an evidence-based toolkit for prevention. Available online at: www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention#full-publication-update-history (Accessed February 2022).

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Authors and Affiliations

  1. Hatfield Peverel Dental Surgery, Chelmsford, UK

    Nita Mandalia

  2. Fleet Dental Centre, Fleet, UK

    Nisha Mandalia

Authors
  1. Nita Mandalia
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  2. Nisha Mandalia
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Correspondence to Nita Mandalia.

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Mandalia, N., Mandalia, N. A student guide to MRONJ. BDJ Student (2022). https://doi.org/10.1038/s41406-021-0238-y

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