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Quick Review #121: #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental #MRONJ #osteonecrosis #osteomyelitis
At Risk Stage:
• Patients who have been treated with either oral or IV bisphosphonates but show no clinical evidence of necrotic bone.
• No treatment is indicated in this stage, and patient education is recommended.
Stage 0:
• No clinical evidence of necrotic bone but potentially with symptoms as follows:
• Patients may have nonspecific clinical findings, radiographic changes, and symptoms such as odontalgia, dull aching bone pain in the body of the mandible, sinus pain, altered neurosensory function, loosening of teeth, periapical/periodontal fistula, alveolar bone loss or resorption, changes to trabecular pattern, and thickening/obscuring of periodontal ligament.
• Treatment at this stage includes pain management and clinical follow-up, along with patient education and review of risks associated bisphosphonate therapy in setting of dentoalveolar treatment.
Stage 1:
• Exposed, necrotic bone without evidence of infection.
• Patients are usually asymptomatic, but may be or become symptomatic.
• Antibacterial mouth rinse and clinical follow-up on a quarterly basis are recommended.
Stage 2:
• Exposed, necrotic bone associated with infection as evidenced by pain and/or erythema in the region.
• The patient is typically symptomatic.
• Treatment includes debridement, antibiotics, and antibacterial oral rinses.
Stage 3:
• Severe cases with extensive bone necrosis, significant infection, and possible pathologic fracture, extraoral fistula or osteolysis extending to the inferior border of the mandible.
• Treatment may require surgical intervention, including resection of the affected bone and reconstruction.
References:
1. Vuletić, M., Lončar Brzak, B., Smojver, I., Gabríc, D., & Alajbeg, I. Ž. (2020). Application of photodynamic therapy in the treatment of osteonecrosis of the jaw. November 2020. DOI:10.1007/978-3-030-29604-9_8. (https://www.researchgate.net/publication/345236971_Clinical_appearance_of_MRONJ-exposed_bone_Zometa)
2. American Association of Oral and Maxillofacial Surgeons (AAOMS). (2014). Medication-Related Osteonecrosis of the Jaw (MRONJ): Information for Patients. (https://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/mronj_patient_info.pdf)
3. Crandall, C. J., Liu, J., & Moazzez, A. (2019). Bisphosphonate-Associated Osteonecrosis of the Jaw: A Review of Current Knowledge. Journal of Oral and Maxillofacial Surgery, 77(4), 699-706. doi:10.1016/j.joms.2018.12.002
3. American Dental Association (ADA) Council on Scientific Affairs. (2019). Medication-Related Osteonecrosis of the Jaw: Information for Dental Professionals. (https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/medication-related-osteonecrosis-of-the-jaw-mronj)
4. Grok. 2024.