Potential Relationship between Poor Oral Hygiene and MRONJ: An Observational Retrospective Study

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related side effect linked but not limited to antiresorptive and antiangiogenic molecules. It recognizes several triggers in dental procedures, such as surgery, endodontic treatments, and root planing, but also prosthesis decubitus or with a spontaneous onset. Although there are many reports about the onset of this pathology, oral hygiene status is mainly described as a consequence of MRONJ. Not so much is known about the oral hygiene situation as a concurrent factor in the pathogenesis of severe stages and about non-surgical periodontal therapy in patients affected by MRONJ. Actually, clear instructions for non-surgical periodontal therapy are poor in the literature. The primary outcome of the present study is to evaluate the oral hygiene status in MRONJ patients. In addition, a secondary outcome is to review the factor of poor oral hygiene as a cause or worsening aspect for MRONJ. A total of 45 subjects (19 males and 26 females) with a mean age of 59 ± 12 were enrolled. The Pearson correlation coefficient showed no significant results for the variable of the Simplified Oral Hygiene Index (OHI-S) and the American Association of Oral and Maxillofacial Surgeons (AAOMS) stage, although the majority of patients showed poor oral hygiene with an OHI-S average of 3.39 ± 1.83. As stated by the last AAOMS position paper, poor plaque control is related to a worsened MRONJ stage. The relation between the lack of oral hygiene and MRONJ onset is still unclear.

Oral Health-Related Quality of Life and Mental Health Impairment in Patients Affected by Medication-Related Osteonecrosis of the Jaws: A Case–Control Pilot Study

“…Additionally, in the present study, MRONJ patients presented an overall poor oral health status compared to the control subjects, as demonstrated by the higher mean score of the DMFT and prevalence of periodontal disease, which could have further impaired their OHRQoL. These findings are in line with those from other studies suggesting that poor oral health may represent a pivotal risk factor for the development of MRONJ in predisposed patients or even a worsening of osteonecrosis [46,47].…”

Improvement of Quality of Life after Surgical Treatment of Patients with MRONJ: A Prospective Analysis Using the SF-12 and OHIP-14 Questionnaires

“…Studies have found bidirectional effects in the relationship between QOL and MRONJ. Specifically, low scores on Oral Health Impact Profile assessments may increase the risk of exacerbating osteonecrosis of the jaw or serve as a significant risk factor for its development [ 28 ].…”

Adjunctive Plasma Rich in Growth Factors in the Treatment of Osteomyelitis and Large Odontogenic Cysts Prior to Successful Implant Rehabilitation: Case Report

“…More recently, bisphosphonate therapy has been used to treat diffuse sclerosing osteomyelitis [ 4 , 5 ]. Unfortunately, bisphosphonates are well known to predispose patients to medication-related osteonecrosis of the jaw (MRONJ), particularly in the context of surgical, endodontic, or periodontal manipulation [ 6 , 7 , 8 , 9 ].…”