Medication-related osteonecrosis of the jaw

Abstract

.

Strategies for the dentist management of cancer patients: narrative literature review

“…Despite the low incidence, MRONJ causes an abrupt drop in patient's quality of life. 72 In this same context, it is important to also consider the use of antiangiogenic drugs, as this association increases the risks of developing MRONJ. 73 BPs are synthetic pyrophosphate-like drugs, which bind tightly to hydroxyapatite and reduce metabolism and bone remodeling.…”

“…73 The dentist is responsible for investigating the use of these drugs during anamnesis, both in cancer patients and in the general population, before defining the dental treatment plan. The ideal is that before starting the use of antiresorptive medications, patients should be evaluated and prepared by the dentist to minimize the subsequent need for invasive treatment, 72 and the patient should be guided and managed similarly to those subject to RT for H&N tumors 77 (Table 2).…”

“…The MRONJ management is still controversial and can include non-surgical procedures, such as pain and infection control (oral hygiene care, periodontal disease management, chlorhexidine gluconate 0.12% mouthwash, antibiotic therapy, and systemic corticosteroid therapy) and surgical treatment when necessary. 72 After the start of therapy, given the absolute indication for surgical procedures with bone manipulation, the minimally invasive surgical technique should be employed, that is, avoiding osteotomy and seeking primary synthesis, as well as assessing the need for antibiotic prophylaxis; mouthwash with 0,12% chlorhexidine should be used preoperatively and postoperatively until healing; suspension of therapy according to each case should be assessed. 73,75,77,78 For patients who have had oral BP for less than 4 years and do not have associated risk factors, changes in surgical planning are not necessary.…”