MRONJ Flashcards
what is the initial management of patients at risk of MRONJ
get as dentally fit as possible
advise of the risk of MRONJ but that risk is small
give personalised OHI
prioritise care which reduces mucosal trauma
liaise with specialists
what do you do for a low risk patient who requires an extraction
discuss risks and benefits of extraction
no antibiotic prophylaxis
contact practice if they have concerns
review healing if extraction socket not healed at 8 weeks then refer
what do you do if you suspect a patient has spontaneous MRONJ
refer to oral surgery/special care dentistry
what do you do if a high risk MRONJ patient requires an extraction
discuss risks and benefits
no antibiotic prophylaxis
contact practice if have concerns
review healing at 8 weeks then refer
what are the signs and symptoms of MRONJ
delayed healing following dental extraction
pain
soft tissue infection and swelling
numbness
paraesthesia
exposed bone
what is the hypothesised aetiology for MRONJ
suppression of bone turnover
inhibition angiogenesis
toxic effects on soft tissue
inflammation or infection
what is the risk of MRONJ in cancer patients
1%
what is the risk of MRONJ in osteoporosis patients
0-0.1%
what is the function of anti-resorptive drugs
inhibit osteoclast differentiation and function leading to decreased bone resorption and remodelling
what are the 2 main anti-resorptive drugs associated with osteonecrosis of the jaw
bisphosphonates and denosumab
how do bisphosphonates work
reduce bone resorption by inhibiting enzymes essential to the formation, recruitment and function of osteoclasts
how long do bisphosphonates stay in the body system for
10 years
what kind of drug is denosumab
monoclonal antibody
how does denosumab work
inhibits osteoclast function and associated bone resorption by binding to RANKL
how long does denosumab effects stay in the body
9 months
what are anti-angiogenic drugs
drugs which target the processes by which new blood vessels are formed
what risk factors are there in dentistry for MRONJ
dentoalveolar surgery (extraction)
ill fitting dentures
mucosal trauma
untreated perio disease
dental infection
other than the USE of bisphosphonates what other factor can influence MRONJ risk
the time they have been using bisphosphonates for
what should you do if a patient has an implant and then starts taking anti-resorptive drugs
advise the patient of the small risk of spontaneous MRONJ at these sites and provide OHI
what should you do if osteoporosis patients would like implants during or after anti-resorptive drugs
advise of compromised bone healing and MRONJ following procedure and lifelong risk of implant failure
how should you assess someones MRONJ risk
based on medical condition, type and duration of drug therapy and other complicating factors
who will always be in a high risk MRONJ category
cancer patients treated with anti-resorptive drugs
what type of non-cancer bisphosphonate user is high risk for MRONJ
people taking them for over 5 years
people on these for any length of time AND on systemic glucocorticoids
what should personalised preventive advice be like for patients on anti-resorptives
diet
excellent oral hygiene
using fluoride toothpaste and mouthwash
stop smoking
limit alcohol intake
regular dental checks
report symptoms
how do you prioritise care which reduces mucosal trauma
obtain radiographs
undertake remedial dental work
extract teeth of poor prognosis
focus on minimising periodontal infection or disease
adjust or replace poorly fitting dentures
prescribe high fluoride toothpaste
