MRONJ Flashcards
what increases risk of MRONJ - give 3
previous diagnosis of MRONJ
currently taking bisphosphonate and has taken for more than five years
takes bisphosphonates and systemic glucocorticoid
what is MRONJ
medication related osteonecrosis of jaw
side effect of anti-resorptive andante-angiogenic drugs
exposure of bone
signs and symptoms of MRONJ
delayed healing following dental extraction/ surgery - 8 weeks
pain
soft tissue infection
swelling
numbness
medical history of pt with MRONJ
anti-resorptive or anti-angiodenic drugs
how do anti-resoroptive drugs function
inhibit osteoclast differentiation and function
why is the jaw adversely affected by action of anti-resorptive drugs
increased remodelling rate compared to other skeletal sites
two ant-resorptive drugs associated with MRONJ
bisphosphonates
denosumab
how do bisphonsphonates function
inhibit enzymes for formation recruitment and function of osteoclasts
half life of alendronate (bisphosphonate)
10 years
how does denosumab function
inhibits osteoclast function by binding to RANKL
what is bisphosphonates used to treat
osteoporosis
pagets disease
osteogenesis imperfecta
how do anti-angiogenic drugs function
inhibit new blood vessel formation - used in cancer treatment to limit tumour vascularisation
biggest risk factor for MRONJ
medical condition
cancer greater risk than osteoporosis
how does time taking bisphonsphonates influence risk of MRONJ
pt taking bisphosphonates for more than 5 years are at higher risk of MRONJ than patients taking for less time
why is taking break in bisphosphonates not effective in reducing MRONJ risk
can persist in skeletal tissue for years
what information do you need to assess MRONJ risk
medical condition
type and duration of drug therapy
MRONJ low risk patients
bisphosphonates for less than 5 years
higher risk of MRONJ patients
bisphosphonates for more than 5 years
patients being treated with bisphosphonates for any time alongside systemic glucocorticoids
anti-resorptive or anti-angiogenic drugs as part of cancer treatment
previous MRONJ
when is there risk of MRONJ with denosumab
if currently taking or taken in last 9 months - low risk
if taking with glucocorticoid then high risk
you have extracted a tooth from a patient taking bisphosphonate. in 8 weeks time the socket still has not healed. what do you suspect and what do you do
MRONJ
refer to oral surgery/SCD
2 examples of bisphonsphonate
alendronic acid
zoledronic acid
how long does exposed bone need to persist before MRONJ diagnosis
8 weeks - arrange 8 week review
