MRONJ

Question 1

What is criteria to have MRONJ?

Answer 1

Exposed bone > 8 weeks
No hx of RT
Pt on drug linked MRONJ

Question 2

What medications are related MRONJ?

Answer 2

Bisphosphonates
Monoclonal ab - denosumab
Tyrosine kinase inhibitor - sunitinib

Question 3

Example monoclonal ab?

Answer 3

Denosumab

Question 4

Example tryosine kinase inhibitor

Answer 4

Sunitinib

Question 5

What is bisphosphonate?

Answer 5

Drug that slows/ prevent loss of bone density

Question 6

Most common scenario for pt to be on bisphosphonate?

Answer 6

Osteoporosis
Cancer
Paget’s

Question 7

When are bisphosphonates given IV?

Answer 7

Metastatic disease

Question 8

Examples of bisphosphonates?

Answer 8

Alendronic acid
Zolendronic acid
Disdoium pamidronate
Risedronate sodium

Question 9

How do bisphosphonates work?

Answer 9

Reduction bone turn over via effect osteoclasts

Question 10

Chemical composition bisphosphonte?

Answer 10

Carbon core
2 x phosphonate groups
2 x side changes = R group

Question 11

Purpose phosphonate group

Answer 11

Bind calcium - bind bone

Question 12

Purpose of R group?

Answer 12

Toxic to osteoclasts

Question 13

Prevention MRONJ?

Answer 13

Pre-tx dental assess
Maintain dental fit - good OHI
Minimal surgical intervention
Consent

Question 14

Management of MRONJ

Answer 14

Specialist centre - difficult

Question 15

Why MRONJ occur?

Answer 15

Anti-angigonesis = compromised blood supply

Direct toxicity to cells in bone = necrotic