MRONJ Flashcards
what is MRONJ?
current or previous treatment with antiresorptives or antiangiogenics
exposed bone/bone that can be probed through an intra oral lesion or an extra oral fistula in the maxillofacial region jaw that has persisted for more than 8 weeks
no history of radiation therapy/metastic disease to the jaws
what drugs can cause MRONJ?
bisphosphonates
RANK ligand inhibitor - denosumab
anti angiogenic - tyrosine kinase inhibitors, monofacial abs against vascular endothelial growth factor
what is the action of bisphosphonates?
deposited in bone and persist
inhibit formation, recruitment and function of osteoclasts
increase apoptosis
anti angiogenic
bisphosphonates used for?
osteoporosis osteogenesis imperfecta primary hyperparathyroidism pagets disease multilple myeloma breast/prostate cancer hypercalcaemia of malignancy
oral bisphosphonates for?
iv for?
- osteoporosis/osteopernia
- cancer related conditions and yearly for osteoporosis
what is denosumab?
antibody against rank ligand
inhibits osteoclast function
inhibits bone resorption
does not bind to bone
densoumab used for?
osteoporosis
metastic bone disease
what is the pathogenesis of MRONJ?
reduced bone turnover reduced vascularity inflammation/infection adverse effects on soft tissues immune dysfunction
risk factors of drugs to MRONJ?
potency
route of administration
cumulative dose
antiogenic and a bisphosphonate
what drugs are low risk?
oral/iv bisphosphonates/denosumab for osteroporosis or pagets
what drugs are high risk?
bisphosphonates iv, densosumab, anti angiogenics for malignant conditions
what med history makes a pt high risk for mronj?
prev mronj systemic corticosteroids immunosuppressants coagulopathy chemotherapy radiotherapy
maxilla/mandible more likely to be affected?
mandible
increased risk if pt?
weares a denture
pre existing dental disease
increased risk with age
if pt is female
stages of mronj 0
no clinical evidence/necrotic bone/non spec symptoms, clinical/radiographic findings
stage 1?
exposed necrotic bone/fistulas that probe to bone in pts who are asymptomatic, no evidence of infection
stage 2?
exposed necrotic bone/fistulas with infection
pain and erythema
stage 3?
exposed necrotic bone/fistula with infection, pain and erythema with one of :
pathological fracture
extra oral fistula
oral antral/oral nasal communication
oseolysis extending to upper border of mandible sinus/floor
stage 0 tx?
close monitoring to symptoms
stage 1 tx?
antimicrobial rinses
stage 2 tx?
antimicrobial rinses and systemic antibiotic analgesics, debridement
stage 3 tx?
anto,icrobial rinses, systemic antibiotic analgesics, surgical debridement/resection
