American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws—2022 Update

Dental Evaluation Prior to Cancer Therapy

“…The first reports of osteonecrosis of the jaw associated with bisphosphonates emerged in the early 2000s and was termed Bisphosphonates-Related Osteonecrosis of the Jaw [ 44 ]. This term was changed in 2014 to Medication Related Osteonecrosis of the Jaw (MRONJ) when reports of osteonecrosis of the jaw associated with the use of other anti-resorptive agents (ARAs) and anti-angiogenic agents (AAAs) were published [ 45 ]. ARAs are used in cancer therapy to prevent skeletal related events (e.g., pathological fractures, hypercalcemia of malignancy), while AAAs disrupt (neo) angiogenesis which hampers tumor growth and development.…”

“…ARAs are used in cancer therapy to prevent skeletal related events (e.g., pathological fractures, hypercalcemia of malignancy), while AAAs disrupt (neo) angiogenesis which hampers tumor growth and development. MRONJ is defined clinically by 3 criteria: (1) current or previous treatment with ARAs or AAAs; (2) exposed bone or bone that can be probed through an intra-oral or extra-oral fistula(s) in the maxillofacial region that has persisted for more than 8 weeks; and (3) no history of radiation therapy or obvious metastatic disease to the jaws [ 45 ]. The prevalence of MRONJ in cancer patients on ARAs or AAAs ranges widely between 0 and 18% [ 45 , 46 ].…”

“…MRONJ is defined clinically by 3 criteria: (1) current or previous treatment with ARAs or AAAs; (2) exposed bone or bone that can be probed through an intra-oral or extra-oral fistula(s) in the maxillofacial region that has persisted for more than 8 weeks; and (3) no history of radiation therapy or obvious metastatic disease to the jaws [ 45 ]. The prevalence of MRONJ in cancer patients on ARAs or AAAs ranges widely between 0 and 18% [ 45 , 46 ]. Longer duration of therapy, pre-existing inflammatory dental disease (e.g., periodontal disease), ill-fitting dentures, invasive dental procedures, uncontrolled diabetes mellitus, immunocompromised states and tobacco use are associated with higher risk [ 45 – 48 ].…”

“…The prevalence of MRONJ in cancer patients on ARAs or AAAs ranges widely between 0 and 18% [ 45 , 46 ]. Longer duration of therapy, pre-existing inflammatory dental disease (e.g., periodontal disease), ill-fitting dentures, invasive dental procedures, uncontrolled diabetes mellitus, immunocompromised states and tobacco use are associated with higher risk [ 45 – 48 ]. Currently, there is no universally accepted treatment for MRONJ [ 46 , 49 , 50 ].…”

“…Treatment options include conservative symptomatic management, pharmacological interventions with pentoxifylline and tocopherol, hyperbaric oxygen therapy or surgical management [ 46 , 49 – 51 ]. With the increasing use of ARAs and AAAs for cancer treatment, dental evaluation prior to the initiation of AAA or ARA therapies to address and mitigate modifiable risk factors associated with MRONJ development is considered routine in many cancer centers [ 45 , 49 ].…”