Introduction: Why MRONJ Awareness is Essential in Dental Care
In my years of dental practice, I have seen the positive transformations modern medicine can bring, particularly with treatments for conditions like osteoporosis and cancer. Medications like bisphosphonates and denosumab are critical for managing these conditions, providing immense benefits by strengthening bones and supporting patients’ quality of life. However, like any medical treatment, these medications come with certain considerations, particularly in dental care. One such consideration is the risk of medication-related osteonecrosis of the jaw (MRONJ), a condition that dentists and patients alike must be aware of.
Medication-related osteonecrosis of the jaw is rare, but understanding it helps us manage the risk effectively. My goal with this post is to demystify MRONJ, explain the role of certain medications in its development, and reassure you that, with the right dental guidance, the risk is minimal and manageable. Let’s dive into what MRONJ is, why it occurs, and how we approach it at Tracey Bell Clinic.
1. What is MRONJ?
MRONJ stands for medication-related osteonecrosis of the jaw, a rare but significant condition where the jawbone is exposed and fails to heal properly, leading to the potential for infection and bone deterioration. It’s most commonly associated with medications used to treat bone conditions like osteoporosis or to manage bone-relate

d complications in cancer patients.
Medications linked to MRONJ fall under two primary categories:
- Antiresorptive medications: These include bisphosphonates (like alendronate, risedronate) and denosumab, which help slow down bone loss.
- Antiangiogenic and immunomodulatory medications: Drugs like bevacizumab, sunitinib, and corticosteroids can also be linked to MRONJ, though the association is less clear and less common than with antiresorptives.
MRONJ typically occurs when the bone tissue in the jaw becomes exposed and fails to heal due to the effects of these medications on bone metabolism. The good news is that MRONJ is rare, particularly in patients taking these drugs for osteoporosis. However, the condition is more commonly seen in cancer patients who receive high doses of these medications.
2. The Importance of Bone Medications in Treating Osteoporosis and Cancer
Antiresorptive medications play a vital role in managing osteoporosis and certain cancers. These medications work by slowing the breakdown of bone, thereby reducing the risk of fractures and strengthening the skeleton. They’re especially important for patients with osteoporosis, who face increased fracture risks, and cancer patients, where bone metastasis can lead to severe complications.
At the Tracey Bell Clinic, we often treat patients who are on these medications and work closely with their healthcare providers to ensure they get the best of both worlds: effective medical treatment for their condition and safe dental care.
- Bisphosphonates: These drugs bind to the bone surface, slowing down bone turnover and preventing loss of bone density. They’re commonly prescribed for osteoporosis and are particularly beneficial for postmenopausal women.
- Denosumab: This is a newer type of antiresorptive medication that targets a protein involved in bone resorption, making it effective for both osteoporosis and cancer-related bone damage.
For patients undergoing these treatments, MRONJ is a rare but possible side effect. However, the risk is minimal in osteoporosis patients taking oral doses of antiresorptives and slightly higher for cancer patients on high-dose intravenous treatments.
3. What Causes MRONJ? Understanding the Risk Factors

MRONJ occurs when certain medications disrupt the natural healing process of the jawbone. Although the exact mechanism isn’t entirely understood, we know that antiresorptive and antiangiogenic drugs reduce blood supply to the jawbone and impair bone turnover. This is crucial in dentistry, as dental procedures like extractions can trigger MRONJ in at-risk patients.
Several factors increase the risk of MRONJ:
- Medication Dosage and Duration: The length of time a patient has been on antiresorptive therapy sign
ificantly impacts MRONJ risk. For instance, cancer patients on high doses of these medications face a higher risk than osteoporosis patients on lower doses. - Type of Drug and Delivery Method: Intravenous drugs are generally associated with a higher risk of MRONJ than oral medications, which is important when assessing a patient’s overall risk.
- Concurrent Health Conditions: Smoking, diabetes, immunosuppression, and other chronic conditions can increase susceptibility to MRONJ, particularly if they impact blood flow and bone health.
- InvasiveDental Procedures: Procedures like extractions, implants, or any surgery involving bone can elevate MRONJ risk for patients on these medications. Our approach at Tracey Bell Clinic is to evaluate each case carefully, consulting with your GP or specialist if necessary.
4. Preventing MRONJ: A Collaborative Approach
Prevention is a key focus when it comes to MRONJ, and it starts with open communication between patients, dentists, and healthcare providers. At Tracey Bell Clinic, we work to ensure that any dental treatment plan for patients on antiresorptive medications considers their entire medical history.
Dental Assessment and Hygiene
The foundation
of MRONJ prevention is excellent oral hygiene and regular dental assessments. If you are starting on bone medications, it’s a great idea to visit your dentist for a comprehensive examination, which can address any current issues before you begin treatment. Regular dental check-ups allow u
s to monitor your oral health closely, reducing the risk of MRONJ.
Informed Decision-Making and Treatment Timing
Timing dental procedures is critical for patients on these medications. Some sources suggest that it may be beneficial to pause or adjust medications before invasive procedures, although evidence on this remains inconclusive. In practice, we carefully evaluate whether treatment should proceed, consulting with your healthcare team if a “drug holiday” is necessary.
Preventive Measures During Treatment
For those already on antiresorptive drugs, we employ special care strategies if invasive procedures are necessary. Antibiotics may be prescribed to prevent infection, and gentle techniques are used during procedures to minimise trauma to the jawbone.
5. Common Questions About MRONJ
Here are some frequently asked questions from patients concerned about MRONJ:
- Is MRONJ very common?
No, MRONJ is relatively rare. It occurs in less than 1% of cancer patients and is even less common in osteoporosis patients taking oral antiresorptives. - Can MRONJ be treated?
Yes, MRONJ can be managed, especially if identified early. Treatment options vary from antibiotics to more complex surgical interventions, depending on the severity. - Do I need to stop my bone medication before dental work?
This depends on the nature of the dental work and your specific medical history. Consult your dentist and healthcare provider to determine the best approach. - What symptoms should I look out for?
Symptoms include jaw pain, swelling, and exposed bone. If you experience any unusual symptoms after dental work, let your dentist know immediately. - Is MRONJ preventable?
While MRONJ cannot be prevented in all cases, proper dental hygiene, regular check-ups, and avoiding unnecessary invasive procedures can significantly reduce the risk.
6. The Role of the Dentist in MRONJ Prevention and Management
As dentists, we are on the front lines of MRONJ prevention. At Tracey Bell Clinic, our team is trained to recognise risk factors and to work with patients in managing them. We also take time to educate patients about the importance of dental care in preventing MRONJ and the measures we take to minimise risk.
If you are on medications associated with MRONJ, your dentist will assess any dental procedure’s necessity carefully, opting for minimally invasive treatments whenever possible. This patient-focused approach ensures that dental work is performed safely, with MRONJ risks considered in every decision.

7. Why Patients Shouldn’t Be Afraid of Bone Medications
It’s essential to emphasise that the benefits of bone-strengthening medications for osteopor
osis and cancer outweigh the risks of MRONJ for most patients. These medications can prevent fractures, reduce bone pain, and manage cancer-related complications, making a huge difference in patients’ lives.
Although MRONJ is a potential side effect, the risk remains low, especially when dental professionals and healthcare providers work together to monitor and manage it. Patients should feel empowered to continue their medication as prescribed, knowing their dental care team is there to address any concerns.
Conclusion: Collaborating for Safe Dental Care
Medication-related osteonecrosis of the jaw is a rare condition, but it’s one we take seriously at Tracey Bell Clinic. By understanding MRONJ, being proactive with preventive care, and working closely with healthcare providers, we aim to support patients in receiving both effective medical treatment and safe dental care.
For patients on bone medications, it’s crucial to maintain open communication with both your dentist and your doctor. Regular dental check-ups, excellent oral hygiene, and tailored dental treatment plans are all part of managing MRONJ risk effectively. At Tracey Bell

For those that wish to read updated reports here ar some useful links
https://www.sdcep.org.uk/published-guidance/medication-related-osteonecrosis-of-the-jaw/#Review
https://www.sdcep.org.uk/media/a3unkohl/sdcep-mronj-surveillance-review-report_march-2024.pdf
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