Page 56 - ITPS-7-1

INNOSC Theranostics

and Pharmacological Sciences

REVIEW ARTICLE
Management and maintenance of oral health:

Personalized primary prevention strategies
and protocols in patients at risk of developing

medication-related osteonecrosis of the jaw

Giovanna Mosaico * and Cinzia Casu 2
1
1 Independent Researcher, Carovigno, Brindisi, Italy
2 Department of Surgical Science, Oral Biotechology Laboratory, University of Cagliari, Italy

Abstract

Skeletal complications arising from osteoporosis or bone metastases are associated
with considerable pain, increased mortality, and diminished quality of life. Agents that
prevent bone resorption, such as bisphosphonates, denosumab, and antiangiogenic
agents, prove effective in reducing fracture risk and find extensive use in patients with
osteoporosis or bone cancer metastases. Medication-related osteonecrosis of the
jaw (MRONJ) is a potentially serious adverse event associated with high cumulative
doses of antiresorptive drugs. Other risk factors for osteonecrosis of the jaw include
glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic
inflammation, diabetes mellitus, inappropriate dentures, and other MRONJ-related
*Corresponding author: medications. Preventive strategies encompass completing necessary oral surgery
Giovanna Mosaico before initiating antiresorptive drug therapy, administering antibiotics before and/or
(gimosaico@tiscali.it) after the procedure, rinsing the mouth with chlorhexidine, ensuring adequate wound
Citation: Mosaico G, Casu C. 2024, healing post-tooth extraction, and maintaining good oral hygiene. The primary goal
Management and maintenance of of treatment is to improve the patient’s quality of life by managing pain and infection,
oral health: Personalized primary
prevention strategies and protocols preventing the development of new lesions, and decelerating disease progression.
in patients at risk of developing Dentists and dental hygienists, operating within a multi-professional team, play a key
medication-related osteonecrosis of role in the primary prevention of MRONJ. However, a standardized multidisciplinary
the jaw. INNOSC Theranostics and
Pharmacological Sciences, 7(1): 1419. approach, fostering sustained dialog between specialists involved in the management
https://doi.org/10.36922/itps.1419 of patients at risk for MRONJ, remains essential. This review describes the preventive
Received: July 31, 2023 and individualized oral hygiene management in patients at risk for this condition.
Accepted: November 9, 2023
Keywords: Preventive protocols; Patients at risk of MRONJ; Antiresorptive drugs; Oral
Published Online: January 11, 2024
hygiene; Healthy lifestyles
Copyright: © 2024 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution, 1. Introduction
and reproduction in any medium,
provided the original work is Medication-related osteonecrosis of the jaw (MRONJ) is an adverse event associated with
properly cited. antiresorptive drug therapy, often administered in combination with anti-angiogenics. It
Publisher’s Note: AccScience is a potentially serious and debilitating complication defined by the American Association
Publishing remains neutral with of Oral and Maxillofacial Surgeons as the presence of an area of exposed bone in the
regard to jurisdictional claims in
published maps and institutional maxillofacial region persisting for more than 8 weeks in the absence of prior radiotherapy
affiliations. treatment [1,2] . The diagnosis of MRONJ relies on the patient’s history and clinical and

Volume 7 Issue 1 (2024) 1 https://doi.org/10.36922/itps.1419