9
Table 4. MASCC/ISOO Daily Oral Care Plan for Patients
Intervention Basic Oral Care Plan
Moisturizing
the Oral
Cavity
• Moisturize the mouth with water or artificial saliva products or
other water-soluble lubricants for use inside the mouth.
• Avoid glycerin or lemon-glycerin swabs since they dry the mouth
and do not moisturize.
• Apply lubricant after each cleaning, at bedtime, and as needed.
• Water-based lubricant needs to be applied more frequently.
• Frequent rinsing as needed with basic mouth rinse.
Lip Care • To keep lips lubricated and moisturized, use only animal or
plant-based oils such as bees wax, cocoa butter, and lanolin. Avoid
petroleum-based products as these will cause drying and cracking.
You should be having follow-ups a minimum of every 6 months with your Dentist.
If you notice any signs or symptoms, please advise either your Dentist or Oncologist.
Table 5. Treatment Strategies by Stage of MRONJ
a
Staging of MRONJ
b
Treatment Strategies
c
At risk: No apparent necrotic bone in
patients who have been treated with oral or
intravenous BMAs
• No treatment indicated
• Patient education and reduction of
modifiable risk factors
Increased Risk: No clinical evidence of
necrotic bone but nonspecific clinical
findings, radiographic changes, and
symptoms
• Symptomatic management, including
use of pain medication and close
scrutiny and follow-up.
• Refer to dental specialist and follow-up
every 8 weeks with communication of
lesion status to oncologist
• Patient education and reduction of
modifiable risk factors
Stage 1: Exposed and necrotic bone or
fistulas that probes to bone in patients who
are asymptomatic and have no evidence of
infection
• Antibacterial mouth rinse
• Clinical follow-up on a q8week basis by
dental specialist with communication of
lesion status to oncologist
• Patient education and reduction of
modifiable risk factors
(cont'd)
