12
Treatment
• Patients referred from the oncologist should be seen by the
dentist within 2 weeks of referral date and be on a 6 month
follow-up schedule with the dentist.
• Evaluate modifiable risk factors: invasive dental procedure,
diabetes, periodontal disease, denture use, smoking
• Before antiresorptive therapy:
▶ Conduct complete dental examination with
orthopantomography and intraoral radiographs
▶ Perform necessary dental extractions
▶ Conduct conservative dental and periodontal
interventions
▶ Adjust prosthetics if necessary
▶ Education the patient on need for lifelong daily
commitment to oral care
▶ Encourage the correction of risk factors ( smoking,
uncontrolled diabetes)
• During antiresorptive therapy:
▶ Conduct complete dental examination with
orthopantomography and intraoral radiographs
▶ Encourage follow-up visits every 6 months
▶ Evaluate oral mucosa integrity
▶ Orthopantomagraphy annually
▶ Reinforce ongoing education on the importance of
maintaining good oral hygiene
▶ Continue to reinforce modifiable risk factors (smoking,
uncontrolled diabetes)
• Confirm patients to follow-up appointments
Dentist
Oncologist
Dentist
Dental
Specialist
• When a suspected MRONJ is seen by a dentist
or in oncolog y, the dentist or oncologist should
refer the patient to a dental specialist for further
treatment management
• Potential differential diagnoses include:
▶ Necrotic dental pulp with apical abscess
▶ Periodontal abscess
▶ Reversible or irreversible pulpitis (could be
secondary to bruxism)
▶ Maxillary sinus pain (acute or chronic sinusitis)
▶ Myofascial pain
▶ Dental caries
▶ Neoplastic process in the jaw
▶ Any soft tissue lesion of the alveolar mucosa
such as an ulceration causing regional pain
MRONJ Management Flow Diagram (cont'd)
