Medication-related osteonecrosis of the jaw and the role of the doctor of dental surgery: a literature review
Keywords:Diphosphonates; Bisphosphonate-associated osteonecrosis of the jaw; Dentist’s role.
Introduction: Medication-related Osteonecrosis of the Jaw (MRONJ) is a condition that may affect patients undergoing oral surgery procedures that use antiresorptive drugs. It is essential that the Doctor of Dental Surgery (DDS) is familiar with the pathology and how to diagnose, prevent and approach it. Objectives: To perform a literature review on MRONJ and to guide the DDS on how to manage the affected patients. Methodology: a systematized search was conducted on the PubMed virtual database using the terms: "diphosphonates", "dentist's practice pattern", "dentists", "dentist's role" and "Bisphosphonate-Associated Osteonecrosis of the Jaw". 29 articles in English, published in the last 5 years, were included. Results and discussion: MRONJ is characterized by exposed and necrotic bone that persists for more than 8 weeks and happens in patients taking antiresorptive agents. It is multifactorial and its severity depends on the dosage, route of administration, and treatment duration. Its management must be multidisciplinary to improve the patient's quality of life. The DDS must focus on prevention. Every patient should have their oral health evaluated before starting antiresorptive therapy and be informed of its risks and benefits. Most DDSs do not feel confident to adequately manage these cases, even though information on MRONJ is more widespread among younger DDSs and recent graduates. Conclusion: MRONJ is a harmful condition for the patient and it is the DDS's responsibility to know how to treat and prevent it, by having adequate knowledge of this pathology and making decisions based on the latest scientific evidence.
Aparecida Cariolatto, F., Carelli, J., de Campos Moreira, T., Pietrobon, R., Rodrigues, C., & Bonilauri Ferreira, A. P. (2018). Recommendations for the Prevention of Bisphosphonate-Related Osteonecrosis of the Jaw: A Systematic Review. The journal of evidence-based dental practice, 18(2), 142–152. https://doi.org/10.1016/j.jebdp.2017.11.002
Arnaud, M. P., Talibi, S., & Lejeune-Cairon, S. (2022). Knowledge and attitudes of French dentists on bone resorption inhibitors (bisphosphonates and denosumab): A cross-sectional study. Journal of stomatology, oral and maxillofacial surgery, 123(2), 163–170. https://doi.org/10.1016/j.jormas.2021.04.010
Bruckmoser, E., Palaoro, M., Latzko, L., Schnabl, D., Neururer, S. B., & Laimer, J. (2021). Choosing the Right Partner for Medication Related Osteonecrosis of the Jaw: What Central European Dentists Know. International journal of environmental research and public health, 18(9), 4466. https://doi.org/10.3390/ijerph18094466
Cavalcante, R. C., & Tomasetti, G. (2020). Pentoxifylline and tocopherol protocol to treat medication-related osteonecrosis of the jaw: A systematic literature review. Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery, 48(11), 1080–1086. https://doi.org/10.1016/j.jcms.2020.09.008
Chalem, M., Medina, A., Sarmiento, A. K., Gonzalez, D., Olarte, C., Pinilla, E., Paz, J., Casas, N., Vega, M. P., & Diaz, E. (2020). Therapeutic approach and management algorithms in medication-related osteonecrosis of the jaw (MONJ): recommendations of a multidisciplinary group of experts. Archives of osteoporosis, 15(1), 101. https://doi.org/10.1007/s11657-020-00761-0
Choi, Y., Park, H., Hong, N., Rhee, Y., & Park, W. (2022). Qualitative focus group interview study of communication between patients, dentists and physicians for efficient osteonecrosis of the jaw practices. BMJ open, 12(3), e051054. https://doi.org/10.1136/bmjopen-2021-051054
Dahlgren, M., & Larsson Wexell, C. (2020). Uncertainty managing patients treated with antiresorptive drugs: a cross-sectional study of attitudes and self-reported behavior among dentists in Sweden. Acta odontologica Scandinavica, 78(2), 109–117. https://doi.org/10.1080/00016357.2019.1655586
Daron, C., Deschaumes, C., Soubrier, M., & Mathieu, S. (2018). Viewpoints of dentists on the use of bisphosphonates in rheumatology patients. International dental journal, 68(4), 279–286. https://doi.org/10.1111/idj.12363
El-Rabbany, M., Blanas, N., Sutherland, S., Shah, P. S., Lam, D. K., & Azarpazhooh, A. (2022). Development and evaluation of the clinimetric properties of the Medication-Related Osteonecrosis of the Jaw Quality of Life Questionnaire (MRONJ-QoL). International journal of oral and maxillofacial surgery, 51(6), 768–775. https://doi.org/10.1016/j.ijom.2021.11.007
El-Rabbany, M., Sgro, A., Lam, D. K., Shah, P. S., & Azarpazhooh, A. (2017). Effectiveness of treatments for medication-related osteonecrosis of the jaw: A systematic review and meta-analysis. Journal of the American Dental Association (1939), 148(8), 584–594.e2. https://doi.org/10.1016/j.adaj.2017.04.002
Escobedo, M., García-Consuegra, L., Junquera, S., Olay, S., Ascani, G., & Junquera, L. (2018). Medication-related osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain). Journal of stomatology, oral and maxillofacial surgery, 119(5), 395–400. https://doi.org/10.1016/j.jormas.2018.04.008
Favia, G., Tempesta, A., Limongelli, L., Crincoli, V., Iannone, F., Lapadula, G., & Maiorano, E. (2017). A Case of Osteonecrosis of the Jaw in a Patient with Crohn's Disease Treated with Infliximab. The American journal of case reports, 18, 1351–1356. https://doi.org/10.12659/AJCR.905355
Gelazius, R., Poskevicius, L., Sakavicius, D., Grimuta, V., & Juodzbalys, G. (2018). Dental Implant Placement in Patients on Bisphosphonate Therapy: a Systematic Review. Journal of oral & maxillofacial research, 9(3), e2. https://doi.org/10.5037/jomr.2018.9302
Han A. L. (2021). The awareness and practice of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey. BMC oral health, 21(1), 155. https://doi.org/10.1186/s12903-021-01475-6
Kim, J. W., Kwak, M. K., Han, J. J., Lee, S. T., Kim, H. Y., Kim, S. H., Jung, J., Lee, J. K., Lee, Y. K., Kwon, Y. D., & Kim, D. Y. (2021). Medication Related Osteonecrosis of the Jaw: 2021 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons. Journal of bone metabolism, 28(4), 279–296. https://doi.org/10.11005/jbm.2021.28.4.279
Kim, J. E., Yoo, S., & Choi, S. C. (2020). Several issues regarding the diagnostic imaging of medication-related osteonecrosis of the jaw. Imaging science in dentistry, 50(4), 273–279. https://doi.org/10.5624/isd.2020.50.4.273
Kizub, D. A., Miao, J., Schubert, M. M., Paterson, A. H. G., Clemons, M., Dees, E. C., Ingle, J. N., Falkson, C. I., Barlow, W. E., Hortobagyi, G. N., & Gralow, J. R. (2021). Risk factors for bisphosphonate-associated osteonecrosis of the jaw in the prospective randomized trial of adjuvant bisphosphonates for early-stage breast cancer (SWOG 0307). Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 29(5), 2509–2517. https://doi.org/10.1007/s00520-020-05748-8
Miranda-Silva, W., Montezuma, M. A., Benites, B. M., Bruno, J. S., Fonseca, F. P., & Fregnani, E. R. (2020). Current knowledge regarding medication-related osteonecrosis of the jaw among different health professionals. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 28(11), 5397–5404. https://doi.org/10.1007/s00520-020-05374-4
Ogura, I., Minami, Y., Ono, J., Kanri, Y., Okada, Y., Igarashi, K., Haga-Tsujimura, M., Nakahara, K., & Kobayashi, E. (2021). CBCT imaging and histopathological characteristics of osteoradionecrosis and medication-related osteonecrosis of the jaw. Imaging science in dentistry, 51(1), 73–80. https://doi.org/10.5624/isd.20200230
Ozkan, E., Bereket, M. C., & Ozkan, N. (2021). Knowledge and attitude regarding bisphosphonates and related osteonecrosis among Turkish dentist: A cross sectional study. Nigerian journal of clinical practice, 24(10), 1485–1491. https://doi.org/10.4103/njcp.njcp_684_20
Patil, V., Acharya, S., Vineetha, R., & Nikhil, K. (2020). Awareness About Medication-Related Osteonecrosis of the Jaw Among Dental Professionals: A Multicentre Study. Oral health & preventive dentistry, 18(1), 505–509. https://doi.org/10.3290/j.ohpd.a43361
Ruggiero, S. L., Dodson, T. B., Aghaloo, T., Carlson, E. R., Ward, B. B., & Kademani, D. (2022). American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 80(5), 920–943. https://doi.org/10.1016/j.joms.2022.02.008
Şahin, O., Odabaşı, O., Aliyev, T., & Tatar, B. (2019). Risk factors of medication-related osteonecrosis of the jaw: a retrospective study in a Turkish subpopulation. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 45(2), 108–115. https://doi.org/10.5125/jkaoms.2019.45.2.108
Santos, M., Silveira, K., Souza, N., Costa, D., & Inaoka, S. (2019). Extensive osteonecrosis of the maxilla caused by bisphosphonates: Report of a rare case. Journal of clinical and experimental dentistry, 11(2), e203–e207. https://doi.org/10.4317/jced.55151
Shin, W. J., & Kim, C. H. (2018). Prognostic factors for outcome of surgical treatment in medication-related osteonecrosis of the jaw. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 44(4), 174–181. https://doi.org/10.5125/jkaoms.2018.44.4.174
Simpione, G., Caldas, R. J., Soares, M. Q. S., Rubira-Bullen, I. R. F., & Santos, P. S. S. (2020). Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis. Journal of clinical and experimental dentistry, 12(3), e285–e290. https://doi.org/10.4317/jced.56265
Souza, M. T. D., Silva, M. D. D., & Carvalho, R. D. (2010). Revisão integrativa: o que é e como fazer. Einstein (São Paulo), 8, 102-106.
Tajima, S., Matsuno, H., Matsumoto, F., & Ikeda, K. (2022). A case of bisphosphonate-related osteonecrosis of the maxilla with orbital cellulitis. Ear, nose, & throat journal, 1455613221086028. Advance online publication. https://doi.org/10.1177/01455613221086028
Torres, A. A., de Freitas, B. L., Carneiro, P. P., de Sousa, A. L. A., Arêa Leão Ferraz, M. Â., de Pinho Mendes, J., Costa, A. L. F., & Pinto, A. S. B. (2020). Medication-Related Osteonecrosis of the Jaw and Low-Level Laser Therapy as Adjuvant Treatment: A Case Report. Journal of lasers in medical sciences, 11(4), 497–499. https://doi.org/10.34172/jlms.2020.78
Viviano, M., Addamo, A., & Cocca, S. (2017). A case of bisphosphonate-related osteonecrosis of the jaw with a particularly unfavourable course: a case report. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 43(4), 272–275. https://doi.org/10.5125/jkaoms.2017.43.4.272
Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of advanced nursing, 52(5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
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Copyright (c) 2023 Juliana Lima de Oliveira Amorim Cabral; Susana Braga Santoro Santiago; Nicole Serqueira da Silva ; Livia Cristina Buriche Ferreira da Silva; Carina Maciel Silva-Boghossian; Inger Teixeira de Campos Tuñas
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