MRONJ: Risk Factors, Treatments and Concerns

MRONJ (medication-related osteonecrosis of the jaw) is commonly associated with drugs that prevent bone resorption, such as bisphosphonates, and RANK ligand (RANKL) inhibitors such as denosumab. These drugs are used to treat osteoporosis or cancer that has metastasized to the bone and can interfere with the jawbone’s ability to heal properly after invasive dental procedures or injuries. 

The exact cause of MRONJ is not fully understood. Inflammation, poor oral hygiene and bony tori are additional risk factors.

Treatment for MRONJ

When treating MRONJ, a team of dental and medical professionals may work together to create a customized plan. The specific treatment approach depends on the severity of symptoms, which may be classified as staging. There are four stages of MRONJ: 0, 1, 2 and 3. Common treatments for MRONJ include:

• Antibiotics: If you have an infection, your oral and maxillofacial surgeon (OMS) may prescribe antibiotics to help fight the infection and reduce inflammation.
• Oral hygiene: Maintaining good oral hygiene is important in the treatment of MRONJ. Best practices include gently brushing twice daily, flossing daily and using an antimicrobial mouthwash as recommended by your OMS. Your OMS may also recommend daily irrigation with a water pick.
• Surgical intervention: In some cases, surgical procedures may be needed to remove damaged bone. These procedures require careful planning and coordination with a medical team to minimize the risk of complications. 
• Pain management: If you have pain or discomfort, pain relievers may be prescribed.

Concerns about MRONJ

MRONJ poses potential health concerns, including:

• Slow healing: One of the primary symptoms of MRONJ is delayed healing after a dental procedure. If your jawbone does not heal properly, you may experience ongoing pain, infections and the development of mouth sores.
• Impact on quality of life: MRONJ can affect your ability to eat, speak and carry out daily activities comfortably. 
• Long-term management: Patients with MRONJ may require ongoing treatment (including additional surgeries) and monitoring to keep the condition stable. Regular dental visits and open communication with your OMS are important for effective treatment of MRONJ. Depending on the severity of your disease, you may require additional surgical procedures to treat it.

The risk for developing MRONJ is lower when taking these drugs for osteoporosis when compared to the risk to taking the same drugs for cancer treatment. In both cases, the risks must be weighed against the clinical benefits. Your physicians can coordinate with your OMS to provide personalized advice, monitor your oral health and address any questions or concerns you may have if you are taking either a bisphosphonate or denosumab.