Page 58 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Management and maintenance of oral health

articles were ultimately included for qualitative analysis. diabetes, hypovitaminosis D, rheumatoid arthritis,
The inclusion criteria encompassed articles in any language hypocalcemia, osteomyelitis, chronic renal failure, and
reporting clinical trials, expert reviews, literature reviews, anemia, pose challenges in terms of modification, they
meta-analyses, and systematic reviews. The exclusion remain open to improvement. In contrast, local risk
criteria were scientific articles not reporting on primary factors are modifiable and offer a wide field of intervention
prevention and oral hygiene in patients with MRONJ, as through primary prevention and secondary. The control
well as case reports. of local inflammatory factors, especially those associated
with dento-periodontal and peri-implant conditions, is
3. Results considered one of the main risk factors contributing to
A total of 1,735 articles were retrieved from manual and the development of ONJ. The ONJ International Task
electronic databases. Out of these, 1,323 articles were Force highlights the importance of managing periodontal
reviewed, and eight were considered to meet the inclusion disease before the commencement of antiresorptive
[6,9,26,27,32,37-52]
criteria for qualitative review (Figure 1). therapy . Preventive protocols and
comprehensive oral and extraoral clinical examination
3.1. Synthesis of results must be conducted indiscriminately in patients with
dentition, as well as in edentulous patients, especially for
In efforts to prevent MRONJ, there is a significant focus on those utilizing removable dentures. This is crucial since
optimizing oral health, given its demonstrated effectiveness removable dentures are identified as risk factors linked
in reducing the associated risk. The included articles to ONJ and have the potential to induce microtrauma to
concur that primary prevention plays a fundamental role the oral mucosa, creating an environment conducive to
in maintaining healthy oral microbiota and mitigating the predominantly fungal bacteriology. Mechanical cleansing
risk of MRONJ (Table 3). of the mucous membranes is beneficial not only for

4. Discussion disorganizing the bacterial biofilm but also for stimulating
blood circulation and improving resistance to trauma .
[53]
The included studies affirm and emphasize the need for Therefore, even in these patients, the initial pre-treatment
multidisciplinary dialog among specialists involved in visit should include a complete clinical and radiographic
both primary and secondary prevention of MRONJ. examination, along with precise mapping of the oral
While systemic risk factors, such as oncological disease mucosa through accurate photographic documentation.
and comorbidities associated with hyperthyroidism, For individuals utilizing prosthetic devices, meticulous

Previous studies Identification of new studies via databases and registers

Records identified from Records removed before
Identification PubMed (n=310) Records identified from Duplicate records removed
Databases:
screening:
other resources (n=0)
(n=312)
Cochrane (n=1)
Records marked as ineligible by
Google Scholar
(n=1,424)
automation tools (n=100)
Screening Records screened Records excluded
(n=1,315)
(n=1,323)

Reports assessed for
eligibility
(n=8)
Included Total studies included in

review
(n=8)
Figure 1. PRISMA flowchart assessment of the included studies.

Volume 7 Issue 1 (2024) 3 https://doi.org/10.36922/itps.1419