MRONJ Treatment in Milwaukee, WI
If you're diagnosed with a serious oral health condition, such as MRONJ, or if you are about to be placed on medications that alter healing (and specifically bone healing), working with an experienced oral and maxillofacial surgeon can make all the difference in helping you feel at ease while ensuring your treatment goes as smoothly as possible. The experts at Community Oral and Maxillofacial Surgery in Milwaukee can help you navigate the complexity of MRONJ comfortably and effectively. Before scheduling your consultation with Dr. Khader, here's what you need to know about MRONJ.
Prevention of MRONJ requires a visit to your dentist prior to starting any of these medications if time permits. While on these medications, you should consult with your dentist and oral and maxillofacial surgeon if you require a surgical procedure (such as extractions or implant placement). Avoiding surgery while on these medications may be advised to prevent the possible development of MRONJ.
If MRONJ develops, you may develop sharp areas of the jaw bone that irritate your tongue or cheek. In advanced cases, you may develop pain, discomfort, infection, and jaw fractures. Treatment usually involves symptom control and methods of avoiding infection (oral hygiene measures, antibiotic mouthwashes, and antibiotics if needed). In rare situations, surgery may be indicated.
What is MRONJ?
Medication-related osteonecrosis of the jaw (MRONJ) is a rare condition that presents itself as a nonhealing wound in the jaw with exposed bone. MRONJ occurs due to an impaired wound healing capacity of the jaw seen in patients who are currently taking or previously had exposure to a number of medications. Some of these medications are used as adjuncts in chemotherapy care for cancer patients (such as Xgeva®, Prolia®, Zometa®). Other medications are used in patients with osteoporosis (such as: Boniva®, Fosamax®, Actonel®). Cases of MRONJ have also been seen in patients who had exposure to Avastin®, Sirolimus®, Humira®, Methotrexate®, and Infliximab®.
Another similar but unrelated condition arises when the jaw bone has received radiation (usually in the setting of cancer in the head and neck region). In this instance, and if bone exposure does occur, the condition is called: Osteoradionecrosis of the Jaw or ORN. The treatment and follow-up for MRONJ and ORN share some commonalities.
Symptoms of MRONJ
Some people with MRONJ don't experience any symptoms at all. Others may notice one or more of the following signs:
- Jaw pain
- Loose teeth
- Swollen gums
- Gum infections
- Jawbone fractures
Treatment for MRONJ
If MRONJ develops, you may develop sharp areas of the jaw bone that irritate your tongue or cheek. In advanced cases, you may develop pain, discomfort, infection, and jaw fractures. Treatment usually involves symptom control and methods of avoiding infection (oral hygiene measures, antibiotic mouthwashes, and antibiotics if needed). In rare situations, surgery may be indicated.
What are the stages of MRONJ, and how is each stage treated?
MRONJ progresses through three stages, with treatment varying based on the severity. Stage 0 represents the patients who have no clinical evidence of exposed bone, but have symptoms and signs that could be indicative of MRONJ (such as dull jaw pain, sinus pain, tooth loosening without evidence of periodontal disease). In Stage 1, there may be exposed bone without pain or infection, and treatment typically involves oral hygiene measures, the use of antiseptic mouthwashes, and monitoring. In Stage 2, infection is present alongside exposed bone, often accompanied by pain, and antibiotics are usually prescribed along with continued prevention methods and strict oral hygiene measures. In the most advanced stage (Stage 3), the disease may spread to deeper tissues, resulting in bone fractures, sinus infections, or severe pain. Surgery may be required at this stage to remove damaged bone and control the infection.
Are there risk-mitigating strategies that have been proven to minimize the incidence of MRONJ?
Yes! MRONJ is a multi-factorial disease that usually affects patients who have been exposed to medications that alter healing (specifically bone healing). Prior to starting specific medications (chemotherapy agents, antiresorptive medications used for osteoporosis or cancer, among multiple others), oncology teams, endocrinology teams, and primary care teams can request a thorough dental evaluation to be completed for the patient. Identifying future sources of dental disease and treating those prior to starting these medications, have been proven to mitigate risk of developing future MRONJ. Patients should be placed on a dental surveillance regimen that allows early disease detection with the goal of minimizing future need for extractions or surgical dental care (which in turn reduces the risk of developing MRONJ). Patients should undergo routine dental cleanings and be advised to work diligently on oral hygiene measures.
Can poor oral hygiene increase the risk of developing MRONJ?
Nutrition plays an essential role in both the prevention and management of MRONJ. A balanced diet rich in vitamins and minerals, particularly calcium and vitamin D, supports bone health and healing. Patients on medications that can lead to MRONJ may benefit from working with a healthcare provider to ensure they are getting proper nutrition, which can aid in reducing the risk of developing the condition. Adequate nutrition also promotes stronger immune function, which is critical for managing infection and enhancing the body’s ability to heal after treatment.
What role does nutrition play in the prevention or management of MRONJ?
Yes, poor oral hygiene can significantly increase the risk of developing MRONJ. Maintaining good oral health is crucial for patients on medications that affect bone healing, as untreated infections, gum disease, or tooth decay can contribute to the onset of MRONJ. Routine dental cleanings, proper brushing, and flossing, along with regular dental visits, help minimize the risk of complications and support overall oral health, which is especially important when undergoing treatments that impair bone healing.
Oral and Maxillofacial Surgeon for MRONJ Treatment
If you've been diagnosed with MRONJ, or about to start radiation therapy to the head and neck, or are about to be placed on medications that alter bone healing, please contact the experienced team at Community Oral and Maxillofacial Surgery to schedule your appointment with Dr. Khader. The team at Community Oral and Maxillofacial Surgery is available to talk about ways to prevent MRONJ and ONJ, prepare you for any future radiation or medications that alter the normal healing, and walk you through all treatment options for MRONJ.
Please get in touch with us if you have any questions or would like to schedule an appointment.
