# MRONJ Clinical Guidance for Dental Management
> Essential clinical guidance for managing dental patients at risk of Medication-Related Osteonecrosis of the Jaw (MRONJ) based on SDCEP standards.

Tags: mronj, dentistry, bisphosphonates, oral-surgery, clinical-guidance, denosumab, patient-care
## What is MRONJ?
* **Definition:** Exposed bone or bone probeable through a fistula in the maxillofacial region persisting >8 weeks in patients on anti-resorptive/anti-angiogenic drugs.
* **Symptoms:** Pain, swelling, numbness, or delayed healing post-extraction.

## Causative Medications
* **Anti-resorptive:** Bisphosphonates (Alendronic acid, Zoledronic acid) and Denosumab.
* **Anti-angiogenic:** Bevacizumab, Sunitinib, Aflibercept.

## Risk Assessment and Classification
* **Low Risk:** Patients on bisphosphonates <5 years for osteoporosis with no glucocorticoids.
* **Higher Risk:** Cancer patients, bisphosphonates >5 years, or concurrent glucocorticoid use.

## Clinical Incidence
* **Cancer patients:** ~1% incidence (up to 2.9% post-extraction).
* **Osteoporosis patients:** 0.01–0.1% incidence (0.15% post-extraction).

## Management Protocols
* **Initial Care:** Optimize oral health, extract poor-prognosis teeth before drug therapy starts if possible.
* **Continuing Management:** Routine treatment proceeds normally. No evidence for routine antibiotic prophylaxis.
* **Review:** Mandatory 8-week review of healing post-extraction. Refer to specialists if socket is not healed.
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