From Volume 45, Issue 2, February 2018 | Pages 102-117
Considerable concern and confusion exists about Medication-Related OsteoNecrosis of the Jaw (MRONJ) which can be a painful, prolonged and debilitating condition caused by the death of jaw bone. The most common class of drugs causing this rare problem is the bisphosphonate group of drugs, which resulted in the term Bisphosphonate-Related OsteoNecrosis of the Jaw previously being given the acronym BRONJ.
If patients are on oral bisphosphonates, routine conservative dentistry is not a problem and, even if they need surgical treatment such as an extraction, osteonecrosis of the jaw afterwards is very rare (less than 1%).
Other drugs were developed to slow down bone resorption caused by many serious medical conditions and some are associated occasionally with OsteoNecrosis of the Jaw (ONJ), thereby giving rise to the term ARONJ (meaning Anti-Resorptive OsteoNecrosis of the Jaw). Subsequently, owing to the plethora of other drugs, sometimes used in combinations, which became implicated in developing this condition, the term Medication Related OsteoNecrosis of the Jaw (MRONJ) became the preferred term for this problem.
The range of anti-resorptive drugs available includes ones of varying potency and modes of action with differing risks of them being associated with osteonecrosis of the jaws. They are used either alone, or in combination with other drugs, to manage disorders such as severe osteoporosis, but increasingly for managing various bone complications of different types of cancers. MRONJ most commonly becomes apparent in patients who have been taking these drugs for very prolonged periods along with steroids, or those taking intravenous forms of the drugs, and who then undergo invasive surgical procedures, usually dental extractions.
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