How can the risk of MRONJ be decreased when dentoalveolar surgery cannot be avoided? The following may decrease the risk of MRONJ for a patient taking antiresorptive medication when dentoalveolar surgery cannot be avoided: • Extract the tooth as atraumatically as possible, with primary closure • Extract 1 tooth at a time and ensure complete healing after 2 months before extracting the next tooth • Book a follow-up appointment 2 months after dentoalveolar surgery to ensure healing • Prescribe a chlorhexidine rinse. The patient should rinsewith 15ml of 0.12%chlorhexidine for 30 seconds before and after the extraction and then twice daily for 2 months • Prescribe a prophylactic antibiotic (such as amoxicillin 500 mg TID) for 14 days, starting 1–2 days before the procedure How can MRONJ be managed? Resection of MRONJ lesions is an option for all stages of MRONJ. However, non-surgical management can also be used in all stages of MRONJ. Conservative management includes: • Regular monitoring including radiographs • Emphasizing good oral hygiene • Prescribing chlorhexidine • Managing pain • Prescribing antibiotics if stage-2 MRONJ (symptomatic with pain and/or inflammation) A patient should be referred to an oral and maxillofacial surgeon for management of MRONJ when conservative treatment is not successful or if the disease is progressing. There is insufficient evidence to support adjunctive therapy to manage MRONJ such as hyperbaric oxygen, ozone therapy, vitamin E and pentoxifylline. MRONJ can resolve spontaneously. Key Takeaways: The risk of MRONJ for a patient taking oral bisphosphonates is extremely low. A dentist may perform an extraction but should warn the patient of the low risk of MRONJ. If the patient is taking an injectable antiresorptive, try to avoid surgery. If an extraction must be done, consider referring to an oral and maxillofacial surgeon or using methods to decrease risk. For more details, refer to the American Association of Oral and Maxillofacial Surgeons Position Paper on MRONJ, available at: www.aaoms.org/docs/govt_affairs/ advocacy_white_papers/mronj_position_paper.pdf References 1. Colella A, Yu E, Sambrook P, Hughes T, Goss A. What is the Risk of Developing Osteonecrosis Following Dental Extractions for Patients on Denosumab for Osteoporosis? J Oral Maxillofac Surg. 2023 Feb;81(2):232–37. 2.Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F and American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons Position Paper onMedication-related Osteonecrosis of the Jaw–2022 update J Oral Maxillofac Surg 2022. 3. Ottesen C, Schiodt M, Gotfredsen K. Efficacy of a High-dose Antiresorptive Drug Holiday to Reduce the Risk of MedicationrelatedOsteonecrosis of the Jaw (MRONJ): A Systematic Review. Heliyon 2020 Apr 27;6(4):e03795. Dr. Sanjukta Mohanta and Dr. Ramez Salti discuss antiresorptive medications on CDA Oasis at: bit.ly/4e6uDxs 40 | 2024 | Issue 5 SupportingYour Practice
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