What Is MRONJ?

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious complication that can damage the jawbone. It can occur after treatments like pulling a tooth or treating severe gum disease. It affects some people who are taking or have taken medications to protect bones. These medications, like bisphosphonates, may be used at high doses to help manage bone cancer or other types of cancer that have spread to the bone. They also may be prescribed to people who have severely weakened bones from conditions like osteogenesis imperfecta. Much lower doses are also used to manage osteoporosis. In people taking these medications, MRONJ may keep the jaw from healing properly after procedures that affect the bone, especially the extraction of 1 or more teeth. MRONJ can cause loss of bone, pain, infection, loose teeth, and exposed bone. Researchers estimate that 10 of 100 people with cancer who have taken these medications develop MRONJ.1American Dental AssociationOncology agents and medication-related osteonecrosis of the jaw. 2019.https://www.ada.org/en/member-center/oral-health-topics/oncology-agents-and-medication-related-osteonecrosis-of-the-jawGoogle Scholar For those taking these medications for osteoporosis this number drops to 1 in 10,000.2American Dental AssociationOsteoporosis medications and medication-related osteonecrosis of the jaw. 2019.https://www.ada.org/en/member-center/oral-health-topics/osteoporosis-medicationsGoogle Scholar Other factors that increase the risk of developing MRONJ include3American Dental AssociationThe ADA Practical Guide to Patients With Medical Conditions. John Wiley & Sons, 2016Google Scholar ▪being older than 65 years▪periodontitis▪smoking▪ill-fitting dentures▪diabetes Symptoms of MRONJ include4Otto S. Pautke C. Van den Wyngaert T. Niepel D. Schiødt M. Medication-related osteonecrosis of the jaw: prevention, diagnosis and management in patients with cancer and bone metastases.Cancer Treat Rev. 2018; 69: 177-187Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar ▪pain, swelling, or infection of the gums or jaw▪loose teeth▪numbness or a feeling of heaviness in the jaw▪gums that do not heal or bone that does not have gum tissue protecting it When you are facing cancer, seeing the dentist might not seem important,5Ruggiero S.L. Dodson T.B. Fantasia J. et al.American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw: 2014 update.J Oral Maxillofac Surg. 2014; 72: 1938-1956Abstract Full Text Full Text PDF PubMed Scopus (1323) Google Scholar but a complete dental examination could help identify disease that should be treated before you start taking medications for bone strength. Give your dentist a complete health history, including any medications you have taken, are taking, or could start taking in the near future. If you are being treated for osteoporosis, consider all of the risks involved. Although taking some osteoporosis medications carries a small risk of developing MRONJ, the risk of breaking a bone due to osteoporosis is much higher. In addition to seeing your dentist, good dental care at home is important:▪brush your teeth twice a day with a fluoride toothpaste▪clean between your teeth daily▪eat a healthy diet that is low in sugar MRONJ is a rare but serious condition that affects the jawbone. It can develop after dental treatments that involve the bone in people taking some bone-strengthening medications. Keeping up with your daily dental care at home and regular visits to your dentist may limit the need for treatments that increase the risk of developing MRONJ.