(C) Avalon Dental Group
Long-term use of osteoporosis medication or anticancer drugs may cause "Medication-Related Osteonecrosis of the Jaw" (MRONJ). Experts urge elderly patients to report medical history before dental procedures.
If gum pain or inflammation persists for an extended period, it may not be a simple dental issue. Patients taking osteoporosis treatments or certain anticancer drugs should be alert to a condition known as Medication-Related Osteonecrosis of the Jaw (MRONJ).
What is MRONJ?
Professor Kim Ra-yeon from the Department of Oral and Maxillofacial Surgery at Kyung Hee University Hospital at Gangdong explained on the 19th, "MRONJ is a condition where the jawbone fails to heal for more than eight weeks after injury, leading to persistent inflammation or necrosis. It is particularly prevalent in cancer patients receiving high-dose injectable chemotherapy or patients who have taken osteoporosis medication for a long time."
Risk Factors and Common Medications
The condition is primarily linked to drugs that affect bone metabolism or blood flow, including:
- Bone resorption inhibitors: Bisphosphonates and Denosumab (commonly used for osteoporosis).
- Angiogenesis inhibitors: Certain types of anticancer drugs.
While these medications are essential for treating bone density loss or cancer, they can interfere with the bone remodeling process and blood supply, especially after dental trauma such as tooth extraction or implant surgery.
Symptoms and Progression
MRONJ often begins subtly, mimicking routine dental issues. Symptoms include:
- Initial gum swelling and pain.
- Pus formation and persistent discomfort.
- In advanced stages, exposed necrotic jawbone may become visible inside the mouth.
Because early symptoms resemble common gingivitis, many patients ignore them. However, if a wound in the mouth does not heal within 8 weeks while taking the aforementioned medications, immediate dental consultation is required.
Diagnosis and Treatment
Diagnosis relies heavily on a patient's medication history. Doctors assess the duration and dosage of the drugs, check for bone exposure, and use imaging tools like panorama X-rays or CT scans to determine the extent of necrosis.
Treatment strategies vary by stage:
- Conservative Treatment: For early stages, focus is on infection control through disinfection, antibiotics, and strict oral hygiene.
- Surgical Treatment: If the bone exposure is extensive or inflammation is severe, surgery to remove the necrotic bone may be necessary.
Special Caution for the Elderly
Elderly patients are at higher risk because aging naturally decreases bone regeneration and immune function. Chronic conditions like diabetes or cardiovascular disease can further complicate the healing process.
"Elderly patients should never ignore simple gum inflammation and must maintain regular dental check-ups," Professor Kim emphasized. "Most importantly, patients must inform their dentists about all medications they are taking before undergoing any procedure."
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