MRONJ: topic review - AAOMS update

Welcome to our Resident Series, where we’ll be discussing relevant topics and updates from the leaders in our field. Today, Drs. Grant and Jake Stucki delve into the recent AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaw (MRONJ), published in May 2022. We’ve discussed MRONJ in previous episodes, but today we’re taking a closer look at the changes observed by the leaders of our specialty. In this episode, we cover all the bases of what MRONJ is, what causes it, its risks, and the various treatment options. We discuss the medications associated with causing MRONJ, and what constitutes a high-risk candidate for developing the condition. We break down the three critical diagnostic criteria and the four stages of MRONJ and explain why it’s crucial to know these back to front. Tune in to find out the degrees of risk when it comes to extraction and implants, and how to reduce the risk of MRONJ before, during, and after oral surgery. And be sure to join us for the next installment of the Resident Series!

Key Points From This Episode:

• Defining MRONJ: Medication-Related Osteonecrosis of the Jaw.
• The medications associated with causing MRONJ and what they’re used for.
• Which patients are at high risk for developing MRONJ.
• The various terms used for MRONJ in the recently updated AAOMS Position Paper.
• How bisphosphonates impair osteoclast function causing MRONJ.
• Why osteoclast function is intentionally inhibited in certain cancer patients.
• How long bisphosphonates can remain in the body, beyond treatment.
• The pathogenesis of MRONJ.
• The diagnostic criteria for MRONJ.
• The four stages of MRONJ: inexplicable pain (no exposed bone), asymptomatic exposed bone, exposed bone with pain, and pain with exposed bone and radiographic changes.
• The importance of knowing the stages and the diagnostic criteria for MRONJ!
• Factors to consider when determining a patient’s risk for developing MRONJ.
• Reasons for using antiresorptive medication.
• The risk of MRONJ following tooth extraction.
• How to reduce the risk of MRONJ before, during, and after oral surgery.
• The role of existing inflammation in causing MRONJ.
• Non-surgical and surgical treatment for MRONJ.
• Clinical scenarios: how to decide whether to extract a tooth from a patient who’s on antiresorptive medication.
• How Drs. Grant and Jake Stucki communicate the risk to patients.
• The low risk of implants causing MRONJ.
• The importance of informing your patients of the risk.
• Look out for our next Resident Series episode!

Links Mentioned in Today’s Episode:

AAOMS Position Paper on MRONJ 2022 Update — https://pubmed.ncbi.nlm.nih.gov/35300956/

Dr. Thomas Schlieve: Changing the way you think about MRONJ — https://www.everydayoralsurgery.com/podcast/

Everyday Oral Surgery — https://www.everydayoralsurgery.com/

Dr. Grant Stucki Email — grantstucki@gmail.com

Dr. Grant Stucki Phone — 720-441-6059

Dr. Grant Stucki on Instagram — https://www.instagram.com/everydayoralsurgery

Dr. Jake Stucki — https://www.linkedin.com/in/jake-stucki-ab19a593/