A Dentist's Perspective on the Need for Interdisciplinary Collaboration to Reduce Medication-Related Osteonecrosis of the Jaw.

Abstract

Antiresorptive medications, including bisphosphonates and RANK-L inhibitors, are commonly used to treat various skeletal pathologies. One devastating complication associated with these drugs is medication-related osteonecrosis of the jaw (MRONJ). Patients who develop MRONJ suffer immensely from oral lesions that may persist, even with treatment, until their death. The jawbone is known to remodel 5 to 10 times faster than skeletal bone. Dentists are at the forefront in managing the severe maxillofacial repercussions of MRONJ. Because MRONJ risk is relatively low (reportedly 0.7% to 6.7%) it is underappreciated by many clinical specialties. The minimization of MRONJ is further compounded because it may take months or years to develop. To date, dental treatment protocols are based more on expert opinion than concrete scientific evidence. This iatrogenic, intractable illness is discouraging for both the patient and the treating dentist. To promote multidisciplinary understanding and cooperation, a single MRONJ case caused by intravenous pamidronate is presented, along with commentary from a dentist's perspective. The intent is that these data will increase awareness of MRONJ's stomatognathic consequences to the physician, who prescribed the causative agent, and the pharmacist, who dispensed it. Collaboration between the dentist, physician, and pharmacist has tremendous potential to improve treatment strategies and, ultimately, optimize patient care.