Medication-Related Osteonecrosis of the Jaw (MRONJ)

Antiresorptive medication is a risk factor for MRONJ. Risk may relate to cumulative medication exposure, which reflects dose, medicine type, dosing schedule, and duration over time.

Stage 2 MRONJ includes exposed necrotic bone with pain and signs of infection. Stage 0 is used as a marker of increased risk even though visible exposed bone may be absent.

People using antiresorptive medicines have an increased risk. Longer treatment duration and systemic corticosteroid use have been associated with higher risk in some studies, while evidence about implants is mixed.

Diagnosis requires exposed bone, or bone that can be probed through a mouth or facial fistula, that has not healed within eight weeks. There must be a history of a bone-modifying or angiogenic medicine and no history of head and neck radiation.

Management is matched to disease stage. Nonoperative therapy is documented as an option, and treatment plans take account of symptoms, infection, medicine exposure, and the amount of bone involved.

MRONJ care can include assessment of medicine exposure, clinical staging, and nonoperative treatment. The treatment approach is selected according to stage, symptoms, infection, and bone involvement.

Inflammation or infection contributes to MRONJ severity and resolution. Bacteria on exposed necrotic bone can add to disease severity, and pain with signs of infection defines stage 2.

MRONJ prevention and management strategies are based on disease stage. Good control of oral inflammation and infection matters because inflammation and bacteria on exposed bone contribute to disease severity.