Page 57 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Management and maintenance of oral health

radiological features demonstrating progressive bone Therefore, the International Task Force on Osteonecrosis
destruction (both exposed and unexposed) [3-5] . Common of the Jaw recommends that during invasive oral surgery,
signs and symptoms of MRONJ include exposed necrotic patients should have their anti-resorptive therapy
bone, sinus tract or fistula, recurring abscesses, gingival withheld until soft-tissue healing occurs . Another
[33]
swelling, bad breath, loosening of teeth, jaw fracture, equally important recommendation includes initiating
sinus pain, and numbness or dysesthesia of the lower lip. MRONJ prevention before, during, and after the end of
Diagnosis of MRONJ is considered when exposed bone antiresorptive therapy [6,10,26,27,33-36] (Table 1). For low-risk
in the maxillofacial region does not heal within 8 weeks patients, the same recommendations apply to preventive
in a patient treated with an antiresorptive agent [1-7] . While dental visits, maintaining optimal oral health aligned
MRONJ is reported as a rare adverse event in patients with with general population standards. However, for cancer
osteoporosis, its incidence is higher in cancer patients patients, the dental checks will be more stringent.
with bone metastases or malignant hypercalcemia (up to
1 – 10% of patients) [8,9] . However, even in patients with 2. Systematic review methods
osteoporosis, there is an increased risk of MRONJ following We conducted a literature review to compile practical
oral surgical therapies. For this reason, an evaluation of guidelines for health-care professionals regarding the
the route of administration of antiresorptive drugs, the management and maintenance of oral health in patients
duration of treatment, and the drug withdrawal period are at risk of MRONJ. The search for scientific articles
essential to prevent post-operative MRONJ in this patient was conducted on medical databases such as PubMed,
category . The pathophysiology of MRONJ remains Cochrane, and Google Scholar on October 23, 2023. The
[10]
incompletely understood, with oral microbiota and dental keywords used were “Prevention and MRONJ,” “Oral
infections considered central to its development [11-14] . hygiene and MRONJ,” and “Microbiota and MRONJ”. In
Since the initial reporting of MRONJ more than 20 years addition, a manual search was conducted to improve the
ago, attention has been directed toward the association article pool. The search strategy is summarized in Table 2.
between tooth extraction and adverse events in patients After preliminary screening and removal of duplicates,
already receiving ONJ-related medications [15,16] . Recently, the abstracts and titles of articles were assessed to
dentoperiodontal and peri-implant infections have been determine eligibility for further evaluation. The selected
highlighted as key local risk factors for MRONJ, often
serving as the primary rationale for surgical procedures Table 1. Prevention of osteonecrosis of the jaw related to
involving tooth extraction or implant removal [17-22] . The antiresorptive drugs
link between periodontal disease and the development
of MRONJ has been extensively demonstrated, with the Prevention • First visit with complete radiographic examinations
spread of bacteria through periodontal pockets identified before, during, • Complete oral‑dental examination, evaluation of the
mucous membranes and tongue
as a primary mechanism for infection propagation through and after • Careful examination of the condition of the back of
treatment
the alveolar bone. Notably, the promotion of MRONJ the tongue
development is likely influenced not only by the presence • Dental formula
of Porphyromonas gingivalis and other periodontogenic • Compilation/updating of the periodontal record
bacteria in the periodontal pockets but also by IgG • Evaluation of the quantity and consistency of saliva
products [3,18,23-26] . • Mapping of oral lesions
• Photographic documentation
• Oral checks (4 – 6 months)
1.1. Monitoring and evaluation of the patient • Instruct the patients to maintain optimal oral health and
candidate for therapy with antiresorptive drugs to recognize possible signs and symptoms of MRONJ
Primary prevention aims to eliminate oral and dental
risk factors by focusing on restoring and/or maintaining Table 2. Article search strategy
good oral health, thereby reducing the risk of pathological
conditions or other adverse events [26-30] . Search strategy Parameters
Keywords • Prevention and MRONJ
The preventive protocols and recommendations • Microbiota and MRONJ
include several key practices, including completing • Oral hygiene and MRONJ
necessary oral surgery before initiating antiresorptive drug Publication years • 2003 – 2023
therapy, administering antibiotics 2 – 4 days before and 7 Electronic database • PubMed
– 10 days after the surgery procedures, using antimicrobial • Cochrane
mouthwash, ensuring adequate wound closure after • Google Scholar
tooth extraction, and maintaining good oral hygiene [31,32] . Abbreviation: MRONJ: Medication-related osteonecrosis of the jaw.

Volume 7 Issue 1 (2024) 2 https://doi.org/10.36922/itps.1419