Medication Related Osteonecrosis of Jaw – A Systematic Review

Abstract

Background:

Osteonecrosis, sometimes called avascular necrosis of bone, is a degenerative disorder of bone that results from a decreased blood supply.  This happens because of direct tissue toxicity, which can be brought on by radiation, chemotherapy, heat damage, or smoking. Osteonecrosis of the jaw (ONJ) in labourers exposed to phosphorus fumes was referred to as "phossy jaw" in the seventeenth century. When bisphosphonates (BPs) became popular, ONJ—also known as bisphosphonate-related osteonecrosis of the jaw, or BRONJ—became more common among BP users. The American Association of Oral and Maxillofacial Surgeons (AAOMS) established a special committee to rename BRONJ as medication-related osteonecrosis of the jaw (MRONJ). Medication-related osteonecrosis of the jaws (MRONJ) is an uncommon side effect of antiresorptive or antiangiogenic drugs, such as bisphosphonates.  Since its first discovery in 2003, the term has changed from "bisphosphonate-related" to "antiresorptive-related" and ultimately to MRONJ as more medications, including steroids and biologicals, have been linked to its etiology.  A rare but dangerous condition that can impact a person's upper or lower jaw is medication-related osteonecrosis of the jaw (MRONJ). In the absence of prior radiation therapy, it is a progressive loss of the mandible in an individual exposed to a drug known to raise the risk of illness. It was first reported in 2002. These drugs are used to treat cancers such as multiple myeloma, as well as osteoporosis, which leads to brittle bones. Bisphosphonates are among the most used medications. Medication-related osteonecrosis of the jaw (MRONJ) includes conditions like osteonecrosis of the jaw caused by angiogenesis inhibitors, denosumab-related osteonecrosis of the jaw (DRONJ), and bisphosphonate-related osteonecrosis of the jaw (BRONJ). It is an uncommon yet incurable condition. Research has shown that MRONJ is one of the major adverse effects associated with antiresorptive medications like bisphosphonates, angiogenesis inhibitors, and denosumab, which inhibit the receptor activator of NF-kappa B ligand. The American Association of Oral and Maxillofacial Surgeons (AAOMS) defines MRONJ as the persistence of exposed necrotic bone or bone that can be probed through an intra-oral or extra-oral fistula in the maxillofacial region for more than eight weeks in patients receiving antiresorptive or anti-angiogenic agents without a history of radiation therapy or evident jaw-related metastatic disease.

Material and Methods: Major databases such as Medline were explored detailed literature search in resulting in a systematic review of medication related osteonecrosis of the jaw.

Results: Five original research scientific articles dated between 2020 – 2024 pertaining to mentioned topic were highlighted.

Conclusions: Before or during the administration of medications that could potentially lead to MRONJ, it is crucial for general dentists to deliver proactive and comprehensive dental care to effectively prevent this condition. Furthermore, oral surgeons are equipped with targeted MRONJ treatment plans tailored for every stage of the disease, ensuring the best possible outcomes for patients.