Management of patients with Medication Related Osteonecrosis of the Jaw - biphosphonates Flashcards
what is MRONJ?
Medication-related osteonecrosis of the jaw
It is defined as exposed bone, or bone that can be probed through an intraoral or extraoral fistula, in the maxillofacial region
is a rare but serious side effect of certain medications that can cause progressive jawbone death
What are symptoms of MRONJ?
Delayed healing following extraction
Pain
Soft tissue infection
Swelling
Numbness
Paraesthesia
Exposed bone
what are are anti-resorptive drugs and how do they work?
Bisphosphonates
Drugs that reduce bone resorption by hindering the formation and function of osteoclasts
what are some conditions that may be treated with biphosphonates?
Osteoporosis
Paget’s disease
Osteogenesis imperfecta
Breast Cancer
Prostate Cancer
Bony Metastatic Cancer
some common biphosphonates
Alendronic acid
Trade name- Binosto, Fosamax, Fosavance
Risedronate sodium
Trade name- Actonel, Actonel Combi
Zoledronic acid
Trade name- Aclasta, Zometa
Ibandronic acid
Trade name- Bondronat, Bonviva, Lasibon, Quodixor
Pamidronate disodium
Trade name- Aredia
Sodium clodronate
Trade name- Bonefos, Clasteon, Loron
What Are Anti-angiogenic Drugs and How Do They Work?
what can this drug lead to?
target the way in which new blood vessels are formed and used in cancer treatment to restrict tumour vascularisation
Some have been known to cause osteonecrosis of the jaw
They can be used in combination with bisphosphonates in cancer treatment
There is a possibility that this can lead to a greater risk of MRONJ
guidance for treatment with patients on biphosphonates
Maintaining good oral hygiene
Having a healthy diet
Stopping smoking
Limiting alcohol
Regular dental checks
Report any symptoms such as exposed bone, non healing areas as soon as possible
what are biphosphonates prescribed for?
reduce the risk of bones breaking and strength in bones
It’s crucial to avoid invasive dental procedures, such as tooth extractions, while on bisphosphonates unless absolutely necessary why?
dental procedures like tooth extractions can trigger bone damage or infections in the jaw that may not heal properly in individuals on bisphosphonates. This is because bisphosphonates inhibit normal bone turnover and healing, which increases the risk of osteonecrosis of the jaw (ONJ). Therefore, these procedures should be avoided or carefully planned, with close collaboration between healthcare providers to minimize risks.
