Bisphosphonates Flashcards
what is MRONJ
medication related osteonecrosis of the jaw - side effect of anti-resorptive and anti-angiogenic drugs defined as exposed bone or bone that can be probed through a fistula
do cancer patients or patients on osteoporosis drugs have higher risk for MRONJ
cancer patients
what do anti-resorptive drugs do
inhibit osteoclast differentiation and function leading to decreased bone resorption and remodelling
how do bisphosphonates reduce bone resorption
by inhibiting enzymes essential to the formation, recruitment and function of osteoclasts
what are bisphosphonates used for
reduce symptoms and complications of metastatic bone disease
what conditions are bisphosphonates indicated for
osteoporosis
pagets disease
osteogenesis imperfecta
fibrous dysplasia
prophylactic against steroid effects
aside from bisphosphonates what other drug can give MRONJ
denosumab
what are the risk factors for MRONJ
the underlying medical condition for which the patient is being treated
dental treatment
duration of bisphosphonate therapy
other concurrent medication
dental implants
what do you do if a patient with implants is about to start bisphosphonates
inform them that they have a small risk of spontaneous MRONJ at the implant sites
if a patient is on bisphosphonates and wants to get implants what would you advise
they have a risk of compromised bone healing and MRONJ following the procedure and risk of long-term implant failure
if a patient is on six monthly injections of denosumab what should you do for their dental treatment
delay non-urgent invasive treatment until the month prior to the patients next scheduled drug administration
how long does denosumab’s effect on bone turnover remain within the body after treatment completion
9 months
who is in the low risk category for MRONJ
patients being treated for osteoporosis with oral or intravenous bisphosphonates for less than 5 years and not on steroids
patients on denosumab not being treated with steroids
who is in the higher risk category for MRONJ
patients on oral or IV bisphosphonates for more than 5 years or any length of time with steroids
patients on anti-resorptives as part of cancer treatment
patients with previous diagnosis of MRONJ
what is the best practice for determining risk of a patient for MRONJ
ask about past, current or possible future use of anti-resorptive drugs
assign a risk level based on assessment of medical condition patient being treated for
assign them to a risk category based on previous treatment
what is the best thing to do BEFORE a patient starts anti-resorptive drug therapy
aim to get the patient as dentally fit as possible
if a patient needs treatment and has started drug therapy what do you do
advise there may be a risk of MRONJ
give personalised preventative advice
prioritise care that will reduce mucosal trauma
seek advice if struggling
what type of preventative advice do we give patients at risk of MRONJ
have healthy diet
maintain OH
use fluoride toothpaste and mouthwash
stop smoking
limit alcohol intake
regular dental check ups
report symptoms as soon as they happen
what is included in the continuing management of patients at risk of MRONJ
carry out all routine dental treatment and provide preventative advice in primary care
adopt conservative approach in high risk patients
if you do an extraction on a patient and the socket has not healed in 8 weeks and you suspect the patient has MRONJ what do you do
refer to oral surgery/special care
how do you treat a low risk patient after you have them as dentally fit as possible
carry out treatment as normal
discuss risks and benefits of treatment
advise to contact practice if they have concerns after treatment
refer if you suspect spontaneous MRONJ
how do you treat a high risk patient after you have them as dentally fit as possible
carry out treatment as normal
seek advice regarding clinical assessment and treatment planning
if extraction needed explore alternatives where you could retain the roots
if suspect MRONJ refer
