Summary about Disease
Medication-Related Osteonecrosis of the Jaw (MRONJ), often referred to as osteonecrosis of the jaw (ONJ), is a condition characterized by the progressive destruction and death (necrosis) of jawbone. This occurs primarily in people exposed to certain medications that reduce bone turnover. The most common medications associated with MRONJ are bisphosphonates and denosumab, which are used to treat osteoporosis, cancer-related bone problems, and other conditions.
Symptoms
Exposed bone in the jaw that doesn't heal within 6-8 weeks
Pain, swelling, or inflammation in the jaw
Loose teeth
Numbness, tingling, or a heavy sensation in the jaw
Drainage from the affected area
In some cases, no symptoms are present in the early stages
Causes
Bisphosphonates: These drugs, such as alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Zometa), inhibit bone resorption.
Denosumab: This is a monoclonal antibody (Prolia, Xgeva) that also inhibits bone resorption.
Other potential factors: Poor oral hygiene, dental extractions, trauma to the jaw, infection, chemotherapy, corticosteroids, and certain medical conditions (e.g., cancer, anemia).
Medicine Used
Antibiotics: To treat or prevent infection.
Oral rinses: Chlorhexidine rinse to maintain oral hygiene and reduce bacterial load.
Pain relievers: To manage pain.
Surgical debridement: In some cases, surgical removal of necrotic bone may be necessary.
Teriparatide (Forteo): Bone anabolic agent which is reported to have some benefit in stimulating bone remodeling and healing.
Is Communicable
No. Osteonecrosis of the jaw is not a communicable or contagious disease. It cannot be spread from person to person.
Precautions
Good oral hygiene: Regular brushing, flossing, and dental checkups.
Inform healthcare providers: Tell your dentist and physician about any bisphosphonate or denosumab use before any dental procedures.
Dental work: Complete necessary dental work before starting bisphosphonate or denosumab therapy, if possible.
Minimize invasive procedures: Avoid unnecessary dental extractions or other invasive procedures while on bisphosphonates or denosumab.
Consider drug holidays: In some cases, a temporary cessation of bisphosphonate or denosumab therapy ("drug holiday") may be considered before and after certain dental procedures, but this should be done in consultation with your physician.
How long does an outbreak last?
The duration of an MRONJ "outbreak" (meaning the active period of bone necrosis and symptoms) varies widely. It can last for weeks, months, or even years. The healing process can be slow and unpredictable. Some cases may resolve with conservative treatment, while others require more extensive surgical intervention.
How is it diagnosed?
Clinical examination: Visual inspection of the jaw for exposed bone.
Patient history: Review of the patient's medical history, including medication use (especially bisphosphonates and denosumab).
Radiographic imaging: X-rays, CT scans, or MRI to assess the extent of bone involvement.
Exclusion of other conditions: Ruling out other possible causes of jaw pain or bone lesions, such as infection or malignancy.
Timeline of Symptoms
The timeline of symptoms can vary significantly from person to person. It depends on the extent of the necrosis, the patient's overall health, and the treatments received. In some instances, the individual may experience the following:
Early stages: No symptoms may be present.
Initial symptoms: Pain, swelling, or inflammation in the jaw.
Progression: Exposed bone, loose teeth, drainage, numbness, or tingling.
Chronic stage: Persistent pain, infection, and bone loss.
Important Considerations
MRONJ is a relatively rare but serious complication of bisphosphonate and denosumab therapy.
The risk of MRONJ is higher with intravenous bisphosphonates (used for cancer treatment) than with oral bisphosphonates (used for osteoporosis).
Patients should be educated about the risk of MRONJ and the importance of good oral hygiene.
Early diagnosis and treatment are crucial for improving outcomes.
A multidisciplinary approach involving dentists, oral surgeons, and physicians is often necessary for managing MRONJ.