# Oral Health Management of Patients at Risk of MRONJ
> Clinical guidelines for dental management of patients at risk of Medication-Related Osteonecrosis of the Jaw (MRONJ), covering risk factors and protocols.

Tags: dental-guidelines, mronj, bisphosphonates, oral-surgery, dentistry, osteonecrosis, patient-safety
## Oral Health Management of Patients at Risk of MRONJ
Clinical management guidelines and patient risk classification for Medication-Related Osteonecrosis of the Jaw (MRONJ).

## MRONJ Risk Factors
*   **Medical Condition:** Cancer patients have a higher risk than osteoporosis patients.
*   **Drug Therapy Duration:** Risk increases with cumulative doses; higher risk after 4+ years of bisphosphonates.
*   **Surgery:** Tooth extraction is the leading trigger, occurring in 2.9% of cancer patients.
*   **Concurrent Meds:** Glucocorticoids increase risk.
*   **Dental Factors:** Ill-fitting dentures and periodontal disease are risk contributors.

## Assessing Patient Risk
*   **Low Risk:** Osteoporosis patients on oral bisphosphonates or denosumab for < 5 years without glucocorticoid use.
*   **Higher Risk:** Patients on bisphosphonates for > 5 years, those on concurrent glucocorticoids, cancer patients on anti-resorptive/anti-angiogenic drugs, or those with a history of MRONJ.

## Initial Management: Patient Readiness
*   Prioritize preventive care before starting drug therapy.
*   Obtain radiographs to identify hidden pathology.
*   Extract teeth with poor prognosis immediately.
*   Discuss risk with the patient without discouraging medication use.

## Continuing Management Protocols
*   **Low Risk:** Routine treatment as normal; review extractions at 8 weeks; no antibiotic prophylaxis required for MRONJ prevention.
*   **Higher Risk:** Explore all alternatives before extraction (e.g., retaining roots); refer to specialists for complex cases or if healing is delayed beyond 8 weeks.
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