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MRONJ Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What medications can predispose a person to MRONJ?

A 
Bisphosphonates
Rank ligand inhibitor - DENOSAB
anti angiogenic drugs
- tyrosine kinase inhibitors
- monoclonal antibodies
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2
Q

Describe the action of Bisphosphonates..

A

Deposited in bone where they persist
Inhibit formation and function of osteoclasts
Increase apoptosis
Anti angiogenic

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3
Q

What are the indications for Bisphosphonates?

A 
Osteoporosis
Osteogenesis Imperfecta
Primary hyperparathyroidism
Pagers disease
Fibrous dysphasia
Cystic fibrosis
Multiple myeloma 
Breast and prostate cancer
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4
Q

What are the routes of administration for Bisphosphonates?

A

Oral- osteoporosis
IV- cancer related
Yearly osteoporosis

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5
Q

Describe the action of DENOSUMAB

A

Antibody against RANK - Ligand
Inhibits osteoclasts function
Inhibits bone resorption
Does no bind to bone

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6
Q

What are the indications of DENOSUMAB?

A

Osteoporosis

Metastatic bone disorders

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7
Q

Name anti angiogenics

A

Sunitinib

Bevacizumab

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8
Q

What are the indications for anti angiogenics?

A

RANK

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9
Q

What is the pathogenesis of MRONJ?

A 
Reduced bone turnover
Reduced vascularity
Inflammation/ infection 
Adverse effects on soft tissues
Immune dysfunction
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10
Q

What tx is low risk for MRONJ?

A

Oral or IV Bisphosphonates for osteoporosis or pagers or DENOSUMAB tx

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11
Q

What tx is high risk for mronj?

A

All tx for malignant conditions

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12
Q

What are other high risk factors for MRONJ?

A 
Previous MRONJ
Systemic corticosteroids 
Immunosuppressants
Coagulopathy
Chemotherapy 
Radiotherapy
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13
Q

What are high risk factors re. Dental tx?

A

Implant preparations

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14
Q

What are low risk dental tx?

A

XLA

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15
Q

What are the stages of necrosis?

A 
At risk- a symptomatic
Stage O- no evidence of necrotic bone
No symptoms
Clinical and radiographic evidence only 
Stage 1- exposed and necrotic bone
No evidence of infection
No symptoms
Stage2- exposed and necrotic bone
Pain, erythema and  infection
Stage 3-
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16
Q

What is the management of stage 0?

A

Symptomatic tx

17
Q

Management of stage 1?

A

Anti microbial rinses

18
Q

Management of stage 2?

A

Rinses and systemic antibiotics and analgesics

19
Q

Management of stage 3?

A

As for stage 2 + surgical debridement

20
Q

What is the definition of MRONJ?

A

Patient under current or previous tx with antirsorptive or antiangiogenic agents
Exposed bone in maxilla facial region that has persisted for +8 weeks
No hx of radiation therapy or metas tic disease to jaw

CMS (14 decks)

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