The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention

Biomed Res Int. 2018 Sep 16:2018:2684924. doi: 10.1155/2018/2684924. eCollection 2018.

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of this paper is to describe the new paradigm by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of MRONJ, prior to and during/after the administration of the aforementioned ONJ-related drugs. In reducing the risk of MRONJ, dentists and oral hygienists are key figures in applying a correct protocol of primary prevention for pre-treatment and in-treatment patients. However, the necessity of a multidisciplinary standardized approach, with a sustained dialogue among specialists involved, should be always adopted in order to improve the efficacy of preventive strategies and to ameliorate the patient's quality of life.

Publication types

  • Review

MeSH terms

  • Angiogenesis Inhibitors / adverse effects
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / epidemiology
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / prevention & control
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / therapy
  • Bone Density Conservation Agents / adverse effects
  • Bone Density Conservation Agents / therapeutic use
  • Diphosphonates / adverse effects
  • Humans
  • Neoplasms / drug therapy
  • Osteoporosis / drug therapy

Substances

  • Angiogenesis Inhibitors
  • Bone Density Conservation Agents
  • Diphosphonates