Page 60 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Management and maintenance of oral health

protocols. This approach is consistently directed toward significant role of the patient in maintaining effective
the patients’ health and underscores the importance oral hygiene at home, including self-screening [45,46] .
of a multidisciplinary manner (Figure 2). Maintaining If MRONJ is suspected, it is imperative to refer the
healthy lifestyles in MRONJ patients includes several key patient promptly to an oral and maxillofacial surgeon or
elements: a specialized cancer center. In the meantime, the dentist
• Blood sugar control; may consider prescribing a mouthwash containing
• Elimination of risk factors such as smoking and 0.12% chlorhexidine and/or a course of amoxicillin with
alcohol consumption; [47-50]
• Adherence to proper nutrition rich in vitamins and clavulanic acid to treat any related infections .
avoiding excessively sour, spicy, crunchy and hot food; 4.2. Limitations
• Vigilance toward possible injuries or pains in the oral
cavity; MRONJ remains a condition marked by uncertain and
• Control of bacterial biofilm through oral hygiene controversial aspects among the most recently studied
practice, including brushing of teeth, gums, and oral diseases. Numerous questions persist, particularly
tongue, conducted twice a day. concerning the diagnosis, the optimal frequency of checks,
and the formulation of effective professional and home
4.1. Professional oral hygiene in cancer patients at oral hygiene protocols. The objective of this review is to
risk of MRONJ shed light on the management of primary prevention and

Professional oral hygiene is increasingly indicated in the provide guidance to oral health professionals for patients
recent literature for cancer patients at risk of MRONJ. at risk. The limited number of studies available for analysis
However, a clear and unequivocal operating protocol for is a notable constraint, indicative of the scarcity of studies
oral professionals caring for these patients is currently conducted on this specific topic. Future studies will be
lacking . essential to validate the preliminary findings and establish
[43]
a more comprehensive understanding of MRONJ.
Minimally invasive non-surgical periodontal therapy
must be carefully planned to ensure regular removal 5. Conclusion
of plaque and tartar, together with periodic clinical
screening of the oral and periodontal health status of The number of patients, both with cancer and without,
undergoing treatment with MRONJ-related drugs and,
patients undergoing treatment. For the management of therefore, the potential occurrence of adverse events appears
acute gum disease, chlorhexidine rinses at concentrations to be steadily increasing. Recent confirmation highlights
between 0.12% and 0.2% are recommended, administered that effective prevention of MRONJ necessitates the
2 to 4 times a day, depending on the severity. Nonsurgical
periodontal therapy can be performed when there are application of appropriate protocols for primary prevention
no significant oral lesions that limit mouth opening in both pre-treatment and treatment phases for patients
and when the neutrophil count is >2,000/ml and the receiving antiresorptive drugs. The Consensus Conference
platelet count is >40,000/ml. The professional oral emphasizes the importance of adherence to these principles
hygiene program includes the compilation and updating by key figures such as physicians, drug prescribers, dentists,
of the periodontal record, including recording the and oral hygienists. To improve the efficacy of therapeutic
probing depth, clinical level of attachment, recessions, strategies and enhance the quality of life for patients, a
mobility, and furcation involvement. Furthermore, the standardized multidisciplinary approach is recommended.
evaluation of periodontal health includes the evaluation Central to the prevention strategy is periodontal therapy,
of the quality of oral hygiene, including plaque and personalized oral hygiene education, and motivation for
bleeding indices. Professional oral hygiene procedures adopting healthy lifestyles. Periodontal screening remains
encompass deplaquing and tartar removal utilizing indispensable for clinicians, facilitating the establishment of
low-frequency mechanical instruments. Moreover, the a correct multidisciplinary approach to managing MRONJ.
program emphasizes the strengthening and education The examination of the posterior aspect of the tongue
of home oral hygiene practices, covering both the oral emerges as a valid indicator of the patient’s microbiota
cavity and dentures, to mitigate the risk of periodontal status, offering the possibility of conducting minimally
infections [42,44] . Therefore, it is essential to plan a invasive bacteriological tests to monitor bacterial load.
follow-up period of 3 – 4 months for cancer patients Acknowledgments
undergoing treatment and 6 months for patients at low
risk of MRONJ. This planning should not overlook the None.

Volume 7 Issue 1 (2024) 5 https://doi.org/10.36922/itps.1419