Revisiting best practice guidelines and patient care workflow for managing the risk of medication-related osteonecrosis of the jaw: comparative summary and case studies

Jen Chen, Chia-Yu Wu, Kristina Gallagher, Chin-Wei Wang

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: Patients taking antiresorptive medications in dental clinics are at risk of medication-related osteonecrosis of the jaw (MRONJ), which poses daily challenges for their clinicians. This paper aimed to summarize and revisit the three most recognized practice guidelines for the management and prevention of MRONJ, which were proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), and presented by the Journal of Bone and Mineral Research (JBMR) and the Journal of Clinical Oncology (JCO). Results and case studies: The AAOMS position paper focused on risk stratification by different medications, management decision trees, risk factors, pathophysiology, and disease staging. The JBMR international consensus presented eight focused questions, which were addressed by systematic reviews. The JCO clinical practice guideline presented six clinical questions, and each concluded with practical recommendations. Practical information was summarized and converted into an adoptable patient care workflow for clinicians to follow and apply in daily practice. Three case studies presented were treated following these guidelines. Each patient underwent advanced surgeries including alveoloplasty, tooth extraction, implant placement, and particulate bone grafting. Some of the considerations not fully informed were discussed and illustrated in each step of the patient care workflow, which included specifics for risk communication, updates on the use of antibiotics, biomarkers, and drug holidays.

CONCLUSION AND PRACTICAL IMPLICATIONS: Structured risk communication with official informed consent documentation should be considered before initiating invasive treatments. Disease control phase with home care therapy should be provided prior to staged reconstructive therapy. Drug holidays and antibiotics coverage can be customized based on individual conditions and related procedures with interprofessional coordination.

Original languageEnglish
Pages (from-to)832-843
Number of pages12
JournalQuintessence international (Berlin, Germany : 1985)
Volume54
Issue number10
DOIs
Publication statusPublished - Nov 28 2023

Keywords

  • Humans
  • Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology
  • Workflow
  • Bone Density Conservation Agents/adverse effects
  • Patient Care/adverse effects
  • Anti-Bacterial Agents/therapeutic use
  • Diphosphonates/adverse effects

Fingerprint

Dive into the research topics of 'Revisiting best practice guidelines and patient care workflow for managing the risk of medication-related osteonecrosis of the jaw: comparative summary and case studies'. Together they form a unique fingerprint.

Cite this