Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of this paper is to describe the new paradigm by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of MRONJ, prior to and during/after the administration of the aforementioned ONJ-related drugs. In reducing the risk of MRONJ, dentists and oral hygienists are key figures in applying a correct protocol of primary prevention for pre-treatment and in-treatment patients. However, the necessity of a multidisciplinary standardized approach, with a sustained dialogue among specialists involved, should be always adopted in order to improve the efficacy of preventive strategies and to ameliorate the patient's quality of life.
Highlights
Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare but potentially serious and debilitating complication
Due to the huge number of patients in the world affected by osteometabolic diseases, in terms of frequency, approximately 40% of patients affected by MRONJ are non-cancer patients [28]
The number of cancer and non-cancer patients being treated with ONJ-related drugs and, the number of potentially adverse events seem constantly on the increase, on the light of new drug related to ONJ
Summary
Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare but potentially serious and debilitating complication. Similar results have been obtained from other research groups, which highlighted the crucial role played by the physician and the dentist in the primary prevention [9, 21,22,23] It is the responsibility of the physician to provide all relevant information regarding the risk of developing MRONJ for patients who are about to commence treatment with antiresorptive (AR) and/or antiangiogenic (AA) drugs. It is the physicians’ duty to advise the patients about the relevance of an examination by an oral health specialist with the aim of assessing the necessity for preventive dental management This should be performed prior to commencing, during and after the treatment with ONJ-related drugs, in order to eliminate any infective outbreaks of MRONJ [14, 24, 25]. Both are necessary for maintaining oral health, reducing the outbreak of MRONJ, and/or detecting possible signs of the early symptoms of this disease
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