MRONJ Flashcards
describe MRONJ to a patient
medication related osteonecrosis of the jaw
Rare side effect of anti resorptive and anti angiogenic drugs
Sees an area of exposed bone present for more than 8 weeks in patients with history of above drug treatments and no history of radiotherapy or metatastic disease to jaw
signs and symptoms of MRONJ
pain
delayed healing
loose teeth
paraaesthesia/ anaesthesia
ST swelling
what patients are at highest risk of MRONJ
- bisphosphonate treatment for more than 5 years
- anti angiogenic or anti resorptive for cancer treatment
- previous MRONJ
- anti resorptive in combination with systemic glucocorticoid
describe anti resorptive drug to patient and name 2 examples
bisphosphonates and denosumab
Inhibit osteoclasts which are cells responsible for resorbing bone therefore decreasing bone remodelling
describe anti angiogenic drugs to patient and name 2 examples
target the process of new blood vessel formation aiming to stop tumour vascularisation
sutininib, bevacisumab
management of patient at risk of MRONJ
- advise patient of risk but warn against stopping medications
- offer preventive advice (stop smoking, limit alcohol, good OH, halthy diet)
- Focus on preventing need for bone involving procedures or mucosal trauma
risk of MRONJ in osteoporosis and cancer treatment patients
cancer - <5% risk
osteoporosis - <0.1% risk
dry socket proper name
alveolar osteitis
diagnosis of dry socket
usually starts 3-4 days after extraction
dull aching pain
may radiate to ear
bad tase/ smell
sleeploss
how long for dry socket to resolve
7-14 days, even with treatment
5 predisposing factors for dry socket
female
oral contraceptive
smoker
excessive mouth rinsing
posterior mandibular
management of dry socket
reassure patient - common complication (2-3% of all extractions)
not an infection
Give LA, irrigate and debride with saline, pack with alvogyl and suture if required
advise on analgesia and warm salty mouth rinse
