Medication-related osteonecrosis of the jaw
| Medication-related osteonecrosis of the jaw | |
|---|---|
| Other names | MON of the jaw, Medication-related osteonecrosis of the jaw (MRONJ), Medication-induced osteonecrosis of the jaw (MIONJ), Bisphosphonate-related osteonecrosis of the jaw (BRONJ) (formerly) |
| Specialty | Oral and maxillofacial surgery |
| Symptoms | Exposed bone after extraction, pain |
| Complications | Osteomyelitis of the jaw |
| Usual onset | After dental extractions |
| Duration | Variable |
| Types | Stage 1-Stage 3 |
| Causes | Medications related to cancer therapy, and osteoporosis in combination with dental surgery |
| Risk factors | Duration of anti-resorptive or anti-angiogenic drugs, intravenous vs by-mouth |
| Diagnostic method | Exposed bone >8 weeks |
| Differential diagnosis | Osteomyelitis, Osteoradionecrosis |
| Prevention | Having all dental work done before taking biphosphonates, maintaining healthy teeth in order for no future dental work being done. |
| Treatment | antibacterial rinses, antibiotics, removal exposed bone |
| Prognosis | good |
| Frequency | 0.2% for those on biphosphonate type drugs >4 years |
Medication-related osteonecrosis of the jaw (MON, MRONJ) is progressive death of the jawbone in a person exposed to a medication known to increase the risk of disease, in the absence of a previous radiation treatment. It may lead to surgical complication in the form of impaired wound healing following oral and maxillofacial surgery, periodontal surgery, or endodontic therapy.[1]
Particular medications can result in MRONJ, a serious but uncommon side effect in certain individuals. Such medications are frequently used to treat diseases that cause bone resorption such as osteoporosis, or to treat cancer. The main groups of drugs involved are anti-resorptive drugs, and anti-angiogenic drugs.
This condition was previously known as bisphosphonate-related osteonecrosis of the jaw (BON or BRONJ) because osteonecrosis of the jaw correlating with bisphosphonate treatment was frequently encountered, with its first incident occurring in 2003.[2][3][4][5] Osteonecrotic complications associated with denosumab, another antiresorptive drug from a different drug category, were soon determined to be related to this condition. Newer medications such as anti-angiogenic drugs have been potentially implicated causing a very similar condition and consensus shifted to refer to the related conditions as MRONJ; however, this has not been definitively demonstrated.[4]
There is no known prevention for bisphosphonate-associated osteonecrosis of the jaw.[6] Avoiding the use of bisphosphonates is not a viable preventive strategy on a general-population basis because the medications are beneficial in the treatment and prevention of osteoporosis (including prevention of bony fractures) and treatment of bone cancers. Current recommendations are for a 2-month drug holiday prior to dental surgery for those who are at risk (intravenous drug therapy, greater than 4 years of by-mouth drug therapy, other factors that increase risk such as steroid therapy).[7]
It usually develops after dental treatments involving exposure of bone or trauma, but may arise spontaneously. Patients who develop MRONJ may experience prolonged healing, pain, swelling, infection and exposed bone after dental procedures, though some patients may have no signs/symptoms.[8]
- ^ Nase JB, Suzuki JB (August 2006). "Osteonecrosis of the jaw and oral bisphosphonate treatment". Journal of the American Dental Association. 137 (8): 1115–9, quiz 1169–70. doi:10.14219/jada.archive.2006.0350. PMID 16873327. Archived from the original on 2008-10-12. Retrieved 2008-09-11.
- ^ Marx RE (September 2003). "Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic". Journal of Oral and Maxillofacial Surgery. 61 (9): 1115–7. doi:10.1016/s0278-2391(03)00720-1. PMID 12966493.
- ^ Migliorati CA (November 2003). "Bisphosphanates and oral cavity avascular bone necrosis". Journal of Clinical Oncology. 21 (22): 4253–4. doi:10.1200/JCO.2003.99.132. PMID 14615459.
- ^ a b Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F (October 2014). "American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update". Journal of Oral and Maxillofacial Surgery. 72 (10): 1938–56. doi:10.1016/j.joms.2014.04.031. PMID 25234529.
- ^ Sigua-Rodriguez EA, da Costa Ribeiro R, de Brito AC, Alvarez-Pinzon N, de Albergaria-Barbosa JR (2014). "Bisphosphonate-related osteonecrosis of the jaw: a review of the literature". International Journal of Dentistry. 2014: 192320. doi:10.1155/2014/192320. PMC 4020455. PMID 24868206.
- ^ Osteoporosis medications and your dental health pamphlet #W418, American Dental Association/National Osteoporosis Foundation, 2008
- ^ Cite error: The named reference
AAOMS14was invoked but never defined (see the help page). - ^ "Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw" (PDF). Scottish Dental Clinical Effectiveness Programme. March 2017.