Medication-related osteonecrosis
Identify antiresorptive or antiangiogenic exposure, indication and dose context. Prevention, consent and specialist input vary with risk.
Understand
MRONJ risk depends on drug, indication, dose, route, duration and other factors. Exposed bone or a probeable fistula in the right context needs careful differential assessment.
Assess
Record antiresorptive or antiangiogenic history and oncology status, examine for infection and exposed bone, and check prior procedures and radiographs.
Apply
Prioritise prevention and low-trauma care with informed consent. Use current SDCEP guidance and specialist input for higher-risk cases; avoid unplanned drug interruption without the prescribing team.
Key distinctions
MRONJ diagnosis and risk stratification depend on exposure history and clinical findings, with alternative causes such as radiotherapy-related necrosis or malignancy considered. Oncology-dose antiresorptives generally carry a different risk context from osteoporosis treatment. The best strategy is often prevention and coordinated dental care before and during therapy. Use current guidance for extraction planning and avoid blanket drug cessation advice.
Think through a case
A patient receiving high-dose antiresorptive therapy for malignancy needs an extraction. Clarify the regimen, discuss risk and coordinate an appropriate plan rather than applying a low-risk osteoporosis pathway.
The distinction to remember
Do not advise stopping a potent systemic therapy unilaterally or imply a single “drug holiday” rule fits everyone.
Test your recall
Is every patient taking a bisphosphonate at the same risk?
Show answer
No; drug, route, indication, duration and other factors matter.