Medication-related osteonecrosis of the jaw (MRONJ) is considered a serious complication for patients receiving long-term treatment for breast cancer or osteoporosis.
Medications such as bisphosphonates, denosumab, and bevacizumab are used to strengthen bones and limit tumor spread. However, one of their side effects is the progressive destruction of the jawbone, which can affect chewing, speech, and overall health.
This condition may develop even if the cancer has not spread to the jaw and even without prior radiation or chemotherapy to the head and neck area—although such treatments can increase the risk of MRONJ.
Symptoms may include persistent pain and gum swelling, accompanied by areas of exposed, necrotic bone in the mouth that can develop into an abscess. In some cases, a fistula may form an abnormal opening in the gum or skin. If the condition progresses, it can lead to serious complications such as pathologic jaw fractures or even sepsis.
Tooth extractions or chronic oral infections are among the major risk factors, as demonstrated by recent studies in Malaysia and Austria.
The reassuring fact is that prevention is possible and effective through comprehensive dental examination and treatment before starting cancer therapy.
This includes performing necessary tooth extractions, treating dental caries and root canals, managing existing infections, conducting professional dental cleanings with the use of antiseptic mouth rinses, and adjusting dentures to prevent any oral injuries.
Patients are strongly advised to inform their dentist about any medications they are taking before undergoing any dental procedure, since certain interventions like extractions or implants require special planning in these cases.
In conclusion, there is no need to fear these essential medications used to treat serious diseases. Awareness and collaboration between the patient, dentist, and treating physician is the safest way to prevent complications and maintain both oral and bone health.
References:
- Alblazi K, Syed Nabil, Tumian NR, Mohd Yunus SS, Ramli R, et al. Potential role of comprehensive dental care in preventing medication-related osteonecrosis of the jaw (MRONJ): a single centre study. BMC Oral Health. 2024;24:1291.
- Incidence of medication-related osteonecrosis of the jaw in patients receiving antiresorptive therapy. Journal of Clinical Oncology. 2024;42(15_suppl):e18745.