# MRONJ Clinical Guidance for Dental Management
> Comprehensive clinical guidance on managing patients at risk of Medication-Related Osteonecrosis of the Jaw (MRONJ). Covers risk assessment and treatment.

Tags: mronj, dentistry, oral-surgery, bisphosphonates, clinical-guidance, oral-health, osteonecrosis
## MRONJ Overview
* **Definition:** Exposed bone in the maxillofacial region for >8 weeks in patients on anti-resorptive or anti-angiogenic drugs.
* **Key Fact:** MRONJ is an adverse drug effect; dental treatment does not cause it but can trigger it.

## Causative Medications
* **Anti-Resorptive:** Bisphosphonates (Alendronic acid, Zoledronic acid, etc.) and Denosumab.
* **Anti-Angiogenic:** Bevacizumab (Avastin®), Sunitinib, Aflibercept.

## Incidence and Epidemiology
* **Cancer Patients:** ~1% incidence (up to 2.9% post-extraction).
* **Osteoporosis Patients:** 0.01–0.1% incidence (0.15% post-extraction).
* ~60% of cases occur after a recent tooth extraction.

## Risk Classification
* **Low Risk:** Osteoporosis patients on bisphosphonates for <5 years without glucocorticoids.
* **Higher Risk:** Cancer patients, bisphosphonates for >5 years, or concurrent glucocorticoid use.

## Management Recommendations
* **Assess:** Record risk level in clinical notes.
* **Prevention:** Optimise oral health and extract poor-prognosis teeth before therapy starts when possible.
* **Low Risk Treatment:** Routine dental work and extractions can proceed in primary care.
* **Higher Risk Treatment:** Adopt conservative approaches; explore alternatives to extraction (e.g., endodontics).
* **Key Instruction:** Review healing at 8 weeks post-extraction. Refer to a specialist if not healed. Do not recommend 'drug holidays'.
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