By Dr. Héctor Sáenz de Viteri Tejeda
What is medication-related osteonecrosis of the jaw (MRONJ), and who is at risk? MRONJ can be a serious complication that could cause destruction to the jawbone, thus affecting quality of life and causing significant morbidity. Patients who are receiving medical treatment for osteoporosis or certain types of cancers are at risk.
Bisphosphonates are the most popular medications prescribed to treat skeletal disorders, along with other antiangiogenic medications, and they represent a risk for patients needing dental extractions or patients considering any kind of dental surgery (i.e., dental implants). These anti-resorptive medications work at the cellular level, decreasing bone resorption and affecting bone repair (interrupting healing). Some of the common commercial names of these anti-resorptive drugs are Fosamax, Actonel, Boniva, Aredia, Zometa, Reclast, Xgeva, and Prolia—drugs that can be administered orally, intravenously, or subcutaneously.
It is extremely important to update your dentist if you are currently taking bisphosphonates, if you have taken bisphosphonate drugs in the past, or if you have been diagnosed with a medical condition like osteoporosis and will be treated with these types of medications.
There is lack of strong evidence to determine the true risk of using these drugs, but researchers have estimated that 10 of 100 people with cancer who have taken these medications develop MRONJ. For those taking these medications for osteoporosis, the number drops to 1 in 10,000. These medications can also represent a higher risk when they are taken for long periods of time (years). Other risk factors include being over 65 years of age, diabetes, smoking, periodontal disease, and ill-fitting dentures.
How can you prevent a future MRONJ complication? First, if you are planning to start treatment with any of these medications, your dentist should perform a very detailed clinical and radiographic examination to propose a personalized treatment plan that will eliminate any active infection in your mouth, such as decay and periodontal disease, to assess your long-term oral health. If you are considering comprehensive dental treatment that requires extractions and implants, these should be performed prior to starting drug therapy. Last, but not least, preventive dentistry, more frequent visits to the dentist for hygiene maintenance, and preventive checkups to are helpful to ensure that any problems are caught early.
Dr. Héctor Sáenz de Viteri Tejeda, who specializes in prosthodontics and implant dentistry from the Universidad de la Salle Bajío and The University of North Carolina can be reached at Salida a Celaya 22, or at 415 152 2065 / 415 154 5152.
