MRONJ occurs in some people who have taken or are taking high doses of bisphosphonate medications intravenously or the drug denosumab, particularly if they have cancer or undergo oral surgery.
MRONJ can occur after tooth extraction, injury, radiation therapy, or for no apparent reason.
Treatment is best done by an experienced oral surgeon.
To help prevent MRONJ, any necessary oral surgery should be done whenever possible before a person takes bisphosphonates.
"Osteonecrosis of the jaw (ONJ)" usually is "medication related," occurring primarily in people with previous or ongoing use of bisphosphonates or denosumab; therefore, when related to medications, ONJ is called MRONJ. Bisphosphonates and denosumab are medications that limit the loss of bone density in people with conditions such as osteoporosis and bone cancer. Most people with MRONJ have had cancer treated with high doses of bisphosphonates by vein. Very rarely, MRONJ has been noticed in people receiving bisphosphonates by mouth for postmenopausal osteoporosis Osteoporosis Osteoporosis is a condition in which a decrease in the density of bones weakens the bones, making breaks (fractures) likely. Aging, estrogen deficiency, low vitamin D or calcium intake, and... read more . People who do not have cancer or who have not taken bisphosphonates or denosumab can develop osteonecrosis of the jaw, but it is extremely rare.
MRONJ may occur any time or after tooth extraction Osteonecrosis of the jaw Complications after a dental procedure that include swelling and pain, dry socket, osteomyelitis, bleeding, and osteonecrosis of the jaw comprise another set of urgent dental problems that require... read more or trauma. (Radiation therapy to the head and neck Side effects of treatment Mouth and throat cancers are cancers that originate on the lips, the roof, sides, or floor of the mouth, tongue, tonsils, or back of the throat. Mouth and throat cancers may look like open sores... read more can cause a similar disorder called osteoradionecrosis). Sometimes, a bone infection (osteomyelitis Osteomyelitis Osteomyelitis is a bone infection usually caused by bacteria, mycobacteria, or fungi. Bacteria, mycobacteria, or fungi can infect bones by spreading through the bloodstream or, more often, by... read more ) in the jaw is misdiagnosed as MRONJ.
The risk of MRONJ in people who have osteoporosis and are taking bisphosphonates by mouth is extremely low. People should still use bisphosphonates taken by mouth as prescribed. However, when possible, any necessary oral surgery should be done before use of bisphosphonates is begun. People should also continue good oral hygiene while taking bisphosphonates.
Symptoms of MRONJ
MRONJ is usually painful, and pus may be discharged from the mouth or jaw area. However, some people have no symptoms.
Diagnosis of MRONJ
Evaluation by a dentist, an oral surgeon, or a doctor
MRONJ is diagnosed when a person is evaluated by a dentist, oral surgeon, or sometimes a doctor.
Treatment of MRONJ
Removal of dead bone
Use of antibiotics and mouth rinses
Because MRONJ is challenging to treat, an oral surgeon with experience treating it should be consulted. Treatment of MRONJ typically involves scraping away some of the damaged bone, taking antibiotics by mouth, and using mouth rinses. After treatment, people should follow up with the oral surgeon who will evaluate healing and ensure the area is being kept clean with proper oral hygiene.
Removing the whole affected area with surgery may worsen the condition and is not the first choice of treatment.
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