managing patients at risk of MRONJ

Question 1

What is MRONJ

Answer 1

side effect of antiresorptive and anti- angiogenic drugs
- exposed bone that has not healed for over 8 weeks
- in pts with history of treatement with these drugs and no history of radiation therapy

Question 2

What are some signs and symptoms of MRONJ?

Answer 2

• delayed healing
• pain
• soft tissue infection and swelling
• numbness
• paraeasthesia
• exposed bone

Question 3

What cancers should be warning signs for potential development of MRONJ after dental extractions?

Answer 3

• breast cancer
• prostate cancer
• multiple myeloma

Question 4

Who is at more risk of developing MRONJ after dental extractions? cancer pts or osteoporosis patients?

Answer 4

Cancer pts

Question 5

What are antiresorptive drugs and how do they work?

Answer 5

they inhibit osteoclast differentiation and function, leading to decreased bone resorption and remodelling

Question 6

What are the two main types of anti-resorptive drugs that have been associated with MRONJ?

Answer 6

bisphosphonates and denosumab

Question 7

What is the half life of alendroate in bone?

Answer 7

10 years

Question 8

What are anti-angiogenic drugs and how do they work?

Answer 8

they target the process by which new blood vessels are formed and used to restrict tumour vascularisation

Question 9

What are some risk factors for development of MRONJ?

Answer 9

• tooth extractions
• previous episode of MRONJ
• duration of bisphosphonate therapy
• dental trauma
• antresorptive drugs and chronic system glucocorticoid taken together

Question 10

What risk status would a patient be at for MRONJ if they are being treated for osteoporosis with oral bisphosphonates for <5 years and not taking systemic glucocorticosteroids?

Answer 10

low risk

Question 11

Denusmab for osteoporosis and not taking systemic glucocorticoids mronj risk?

Answer 11

low risk

Question 12

treated for osteoporosis with quarterly/yearly iv bisphosphnates for less than 5 years and not taking systemic glucocorticoid?

Answer 12

low risk

Question 13

treated for osteoporosis with bisphosphonates for more than 5 years?

Answer 13

high risk

Question 14

treated for MRONJ with bisphosphonates , denusmab and taking systemic glucorticosteroids?

Answer 14

high risk

Question 15

treated for cancer with anti-resorptives or anti-angiogenic drugs

Answer 15

high risk

Question 16

what is the goal of the dentist when a patient is about to start anti-esorptive or anti-angiogenic drug therapy?

Answer 16

Get pt dentally fit

Question 17

How should patieints be managed if they have been previously started anto-resorptive or anti-angiogenic drug therapy?

Answer 17

• prevention advice (OHI, smoking cessation, alcohol limitation, diet advice and regular dental checks)
• XLA of teeth with poor prognosis
• adjust poorly fitting dentures
• high fluoride toothpaste
• perio treatment