The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists

Rodolfo Mauceri,Domenico Tomassi,Rita Coniglio,Francesco Bertoldo,Vera Panzarella,Alberto Bedogni,Vittorio Fusco,Giuseppina Campisi,Antonia Abbinante,Paola Carcieri,Olga Di Fede

doi:10.1007/s00520-022-06940-8

Abstract

PurposeThe prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ.MethodsThe expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Association, AIDI and National Union of Dental Hygienists, UNID) and authors of the latest Italian recommendations regarding MRONJ from the field of dentistry and maxillofacial surgery.ResultsThe oral care protocol outlined in this position paper is focused on the role of dental hygienist in patients at risk or affected by MRONJ, and it regards 3 main issues: primary prevention, secondary prevention and supporting the treatment of MRONJ. Each issue contains easy-to-apply indications and procedures, as described by the authors, regarding the role of the dental hygienist.ConclusionReferring to the main issues under consideration (primary prevention, secondary prevention and the treatment of MRONJ), a clinical examination of periodontal tissue is critical in preventing MRONJ. It is the opinion of the authors of this study that the application of a periodontal screening score is fundamental in defining personalised strategies for patients at risk of MRONJ. By means of these basic procedures, a protocol for assisting the health care provider and the presentation of a practical approach for patients at risk or affected by MRONJ are described in this study.

Highlights

Osteonecrosis of the jaw (ONJ) can be defined as “an adverse reaction, which is characterised by the progressive destruction and necrosis of the mandibular and/or maxillary bone, in subjects exposed to treatment with drugs with an established increased risk of disease, in the absence of previous radiation treatment” [1, 2].The disease mostly affects cancer patients and patients with osteometabolic diseases, who are exposed to drugs with antiresorptive activity (AR; e.g. bisphosphonates, denosumab) and/or drugs with anti-angiogenic action (AA; e.g. bevacizumab) [2–10]
This position paper is the result of the work of a Board of experts, in the light of the following: new findings, the publication in 2020 of the new Italian recommendations regarding medication-related osteonecrosis of the jaw (MRONJ) and the best practice shared in the 2021 ONJ Update Conference [2, 3, 6, 23–31]
The role of the dental hygienist is central in this regard in: preparing the patient for surgery, maintaining the patient's oral health and, if available, applying conservative adjuvant healing techniques. This is the first position paper in the literature describing the best practice of dental hygienists and MRONJ prevention procedures

Summary

Introduction

Osteonecrosis of the jaw (ONJ) can be defined as “an adverse reaction, which is characterised by the progressive destruction and necrosis of the mandibular and/or maxillary bone, in subjects exposed to treatment with drugs with an established increased risk of disease, in the absence of previous radiation treatment” [1, 2].The disease mostly affects cancer patients and patients with osteometabolic diseases, who are exposed to drugs with antiresorptive activity (AR; e.g. bisphosphonates, denosumab) and/or drugs with anti-angiogenic action (AA; e.g. bevacizumab) [2–10]. ONJ has been associated with several drugs; the term medication-related osteonecrosis of the jaw (MRONJ) is frequently used in the literature and clinical practice [3, 5, 11]. The role of the hygienist is fundamental to the development of preventive strategies relating to MRONJ, only a few papers in the international literature have addressed the work of the dental hygienist[19–22]. This position paper is the result of the work of a Board of experts, in the light of the following: new findings, the publication in 2020 of the new Italian recommendations regarding MRONJ and the best practice shared in the 2021 ONJ Update Conference (www.onjupdate.it) [2, 3, 6, 23–31]

Objectives

Conclusion