Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Human Systems and Diseases > Bisphosphonates and MRONJ > Flashcards

Bisphosphonates and MRONJ Flashcards

1
Q

What is MRONJ?

A

Medication-related osteonecrosis of the jaw.

Exposed bone or bone probed through an intramural or extra oral fistula, in the maxillofacial region that has persisted for more than 8 weeks in patients with a history of treatment with anti-resorptive or anti-angiogenic drugs, there there is no history of radiation therapy to the jaw and no obvious metastatic disease of the jaw.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs and symptoms of MRONJ?

A

Area of exposed bone for more than 8 weeks
Pain or altered sensation to exposed bone
Swelling
Numbness
Paraesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the risk of MRONJ if someone is taking bisphosphonates for osteoporosis?

A

0.01-0.1%

1 in 10,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the risk of MRONJ if someone is taking bisphosphonates for cancer treatment?

A

1 in 20 (according to SDCEP updated March 2024)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are bisphosphonates?

A

Reduce bone resorption by inhibiting enzymes which are essential in the formation, recruitment and function of osteoclasts.
- RANKL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the half life of alendonric acid?

A

10 years.
This is why, even if someone has stopped taking alendrotnic acid for a number of years, it will still be in their system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is denosumab?

A

Human monoclonal antibody hat binds to RANKL, inhibiting osteoclast activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the half life of denosumab?

A

roughly 4-5 months- will be out of the patients system by 9 months time because it does not bind to bind directly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are anti-angiogenic drugs?

A

These drugs target the processes by which new blood vessels are formed and are used in cancer treatment to restrict revascularisation of tumours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give some examples of anti-angiogenic drugs?

A

Bevacizumab
Aflibercept
RTK inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What factors would make a patient high risk for MRONJ?

A

Patient has been taking bisphosphonates for more than 5 years.
Patient is taking bisphosphonates for cancer treatment.
Patients being treated concurrently with bisphosphonates and glucorticoids.
Patients with a previous history of MRONJ.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If someone has a history of taking bisphonates in the past or Denosumab in the last 9 months, what risk would they allocated to?

A

Allocated to the risk group as if they were still taking the drug.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Some patients, might not know that they’re on an anti-resorptive or anti-angiogenic drug, what kind of questions would be useful to ask the patient?

A

Have you been prescribed any medication for your bones?
Do you take a medicine once a week?
Have you ever had a drug infusion for your bones?
Do you take any long term steroid tablets for any condition?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is it important to get the patient dentally fit before commencing on these drugs?

A

You want to minimise the need to have invasive treatment, involving bone, in the future.

Prioritise treatment in the pre-assessment prior to them starting bisphosphonates- i.e. extractions, anything involving the gingivae and bone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the key role of a GDP for these patients?

A

Prevention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What things should you tell a patient who is just about to start on these types of drugs?

A

Explain what MRONJ is and that there is a small risk of this happening when they are on these drugs.

Personalised preventative advice
- Diet advice
- OHI
- Fluoride toothpaste and Fluoride mouthwashes
- Stopping smoking
- Limiting alcohol

Make them aware of symptoms- exposed bone, loose teeth, non-healing sores, pus or discharge, tingling, numbness, altered sensation, pain or swelling.

17
Q

What priorities would there be in treatment planning for these patients?

A

Appropriate radiographs- bitewings for caries assessment, OPT, PA.
Extract teeth of poor prognosis
Minimise periodontal.dental infection and disease
Prevention- diet advice, OHI, fluoride varnish, high fluoride toothpaste
Adjust poorly fitting dentures to minimise future mucosal trauma

18
Q

If a patient is low risk for MRONJ, how would this impact treatment planning, if an extraction was required?

A

Discuss pros and cons/risks of treatment with the patient.
Procede with he extraction.
Do not prescribe antibiotics.
Advise patient to contact the practice if they have pain, tingling, altered sensation or numbness in the area.
Arrange a review at 2-3 weeks- if not healed within 8 weeks, then refer to oral surgery.

19
Q

Is antibiotic prophylaxis required in high risk MRONJ patients?

A

No- low equality evidence for this.

20
Q

If a patient was high risk for MRONJ, how would this impact treatment planning, if an extraction was required?

A

Seek advice from oral surgery/special care department.
Consider coronectomy.
If extraction still indicated- same process as someone who is low risk.

21
Q

What drugs are associated with MRONJ?

A

Alendronic acid
Risedronate sodium
Zolendronic acid
Ibandronic acid
Pamidronate disoium
Sodium Clodronate

Denosumab

Bevacizumab
Sunitinib
Afibercept

22
Q

At the initial appointment, what would you aim to do?

A

Assess risk for MRONJ- document this in the notes.
Advise patient of this risk and what MRONJ is.
Preventative advice.
Aim to get the patient as dentally fit as possible.

23
Q

What points should be mentioned when informing the patient about MRONJ?

A

Explain that this is a side effect caused by the drug they are taking and not because of the dental treatment- tell the patient to NOT stop taking the drug. Important to continue to keep taking the drug.
Inform patients with dental implants that there is a risk of MRONJ after they start taking the drug.
Give signs and symptoms of MRONJ and what it is.
Explain benefits of these drugs- reduces chance of fracture in osteoporosis, restrict the growth of tumours in cancer patients.
Emphasise the importance of continuing to take the drug and not stopping it.

24
Q

What is the incidence of MRONJ after a tooth extraction?

A

Cancer patient- 2.9%
Osteoporosis patient- 0.15%

25
Q

What advice can you give the patient in order to reduce their chance of developing MRONJ?

A

Reduce alcohol intake
Good OH
Stop smoking
Better diet
Attend the dentist regularly

26
Q

What can you provide the patient with, in order to reduce their chance of developing MRONJ?

A

OHI
Diet advice
Smoking cessation advice
Alcohol counselling
High fluoride toothpaste
Fluoride varnish
PMPR
Coronectomy instead of full extraction
Atraumatic extraction technique

27
Q

Your patient has presented with exposed bone 8 weeks post-extraction. You have let them know that they will require to be referred to a specialist. They wish to know what the specialist might do, what would you advise them?

A

If it is a small amount of exposed bone, potentially the specialist will simply monitor the area over time, give OHI, antibiotics or antimicrobial mouthwashes.

If it is a large area of exposed bone, then it may require surgery.

28
Q

Why might a child be taking bisphosphonates?

A

Fibrous Dysplasia
Crohn’s disease
Osteogenesis Imperfecta
Bone dysplasia

29
Q

A patient at risk of MRONJ comes to you and says they want implants, what would you say?

A

Advise against it- explain MRONJ, why they’re at risk and why implants are a risk procedure for these patients.

30
Q

A patient tells you they no longer take bisphosphonates so they won’t be at risk of MRONJ anymore. What would you say?

A

These drugs can stay in your body for a long time, even after you stop taking them.
Alendronic acid can still be in your body 10 years after you stop taking it.
So still assigned a risk level for at least 5 years after taking it.

31
Q

What treatment might be required for MRONJ?

A

Monitor and review
Chlorhexidine mouthwash
Irrigation of exposed bone
Removal of sharp edges of bone
Surgical debridement
Surgical sequestrectomy
Hyperbaric oxygen

32
Q

What types of disease might bisphosphonates be used for?

A

Osteoporosis
Paget’s disease
Breast cancer, prostate cancer
Hypercalcaemia in malignancy
Reasons in children

33
Q

What symptoms would you warn the patient of?

A

Swelling
Tingling
Altered sensation
Numbness
Pain

In the extraction site.

34
Q

What are some of the dental risk factors for MRONJ?

A

Poorly fitting dentures
Extractions
Infection
Periodontal disease
Dental implants- avoid in these patients

Human Systems and Diseases (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions