MRONJ Flashcards
What are the different classes of anti-angiogenic drugs?
VEGF Inhibitor
Tyrosine kinase inhibitor
Fusion protein
What is stage 0 MRONJ?
What is the treatment?
No clinical evidence of necrotic bone but radiological changes observed
Analgesics and Antibiotics
According to SDCEP what is a low risk MRONJ patient? (2)
Any of the following
- Treated for osteoporosis with oral or IV bisphosphonates for less than 5 years who are not taking systemic glucocorticoids
taking systemic glucocorticoids - Treated for osteoporosis with denosumab who are not taking systemic glucocorticoids
Essentially systemic glucocorticoids is peak
How do bisphosphonates work?
Inhibit bone resorption (via osteoclast apoptosis) with particularly high affinity to areas of bone turnover
What is stage 3 MRONJ?
What is the treatment?
Symptomatic exposed bone and infection.
Pathological fracture, presence of a fistula or signs of osteolysis.
Analgesics and antibiotics
Antiseptic mouthwash
Surgical debridement or resection for long term care
What does VEGF stand for?
Vascular endothelial growth factor
Bevacizumab is a VEGF inhibitor (anti-angiogenic for metastatic cancer)
What are some clinical presentations of MRONJ if the patient is symptomatic?
What are the 3 worst case presenations
Pain
Swelling
Halitosis
Delayed healing after XLA
Exposed bone & Infection
Numbness of ID nerve
Extra or Intra-oral fistula
Fracture
How do RANKL Inhibitors work?
Denosumab
Prevent osteoclast maturation
(Inhibit bone resorption)
What is the more common site of MRONJ, Maxilla or Mandible?
Mandible
What types of bisphophonates have an increased likelihood to cause MRONJ?
Nitrogen-containing bisphosphonates
What duration of oral and IV bisphosphonates puts a patient into a higher risk of MRONJ?
Oral - 5+ years
IV - 5+ years
What types of cancers may metastasise to bone?
Breast
Prostate
Lung
Kidney
Thyroid
Bowel
What is stage 1 MRONJ?
What is the treatment?
Asymptomatic exposed bone
Analgesics and antibiotics
Antiseptic mouthwash
Which teeth are more affected by MRONJ, Anterior or Posterior
Posterior
Which route increases the risk of MRONJ, Oral or IV?
IV