MRONJ

Question 1

what is the initial management of patients at risk of MRONJ

Answer 1

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

Question 2

what do you do for a low risk patient who requires an extraction

Answer 2

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

Question 3

what do you do if you suspect a patient has spontaneous MRONJ

Answer 3

refer to oral surgery/special care dentistry

Question 4

what do you do if a high risk MRONJ patient requires an extraction

Answer 4

discuss risks and benefits
no antibiotic prophylaxis
contact practice if have concerns
review healing at 8 weeks then refer

Question 5

what are the signs and symptoms of MRONJ

Answer 5

delayed healing following dental extraction
pain
soft tissue infection and swelling
numbness
paraesthesia
exposed bone

Question 6

what is the hypothesised aetiology for MRONJ

Answer 6

suppression of bone turnover
inhibition angiogenesis
toxic effects on soft tissue
inflammation or infection

Question 7

what is the risk of MRONJ in cancer patients

Answer 7

1%

Question 8

what is the risk of MRONJ in osteoporosis patients

Answer 8

0-0.1%

Question 9

what is the function of anti-resorptive drugs

Answer 9

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

Question 10

what are the 2 main anti-resorptive drugs associated with osteonecrosis of the jaw

Answer 10

bisphosphonates and denosumab

Question 11

how do bisphosphonates work

Answer 11

reduce bone resorption by inhibiting enzymes essential to the formation, recruitment and function of osteoclasts

Question 12

how long do bisphosphonates stay in the body system for

Answer 12

10 years

Question 13

what kind of drug is denosumab

Answer 13

monoclonal antibody

Question 14

how does denosumab work

Answer 14

inhibits osteoclast function and associated bone resorption by binding to RANKL

Question 15

how long does denosumab effects stay in the body

Answer 15

9 months

Question 16

what are anti-angiogenic drugs

Answer 16

drugs which target the processes by which new blood vessels are formed

Question 17

what risk factors are there in dentistry for MRONJ

Answer 17

dentoalveolar surgery (extraction)
ill fitting dentures
mucosal trauma
untreated perio disease
dental infection

Question 18

other than the USE of bisphosphonates what other factor can influence MRONJ risk

Answer 18

the time they have been using bisphosphonates for

Question 19

what should you do if a patient has an implant and then starts taking anti-resorptive drugs

Answer 19

advise the patient of the small risk of spontaneous MRONJ at these sites and provide OHI

Question 20

what should you do if osteoporosis patients would like implants during or after anti-resorptive drugs

Answer 20

advise of compromised bone healing and MRONJ following procedure and lifelong risk of implant failure

Question 21

how should you assess someones MRONJ risk

Answer 21

based on medical condition, type and duration of drug therapy and other complicating factors

Question 22

who will always be in a high risk MRONJ category

Answer 22

cancer patients treated with anti-resorptive drugs

Question 23

what type of non-cancer bisphosphonate user is high risk for MRONJ

Answer 23

people taking them for over 5 years

people on these for any length of time AND on systemic glucocorticoids

Question 24

what should personalised preventive advice be like for patients on anti-resorptives

Answer 24

diet
excellent oral hygiene
using fluoride toothpaste and mouthwash
stop smoking
limit alcohol intake
regular dental checks
report symptoms

Question 25

how do you prioritise care which reduces mucosal trauma

Answer 25

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