title: The Prevention of Medication-related Osteonecrosis of the Jaw.
abstract: BACKGROUND
  Medication-related osteonecrosis of the jaw (MRONJ) is a preventable complication of antiresorptive treatment. It arises in 1-20% of patients with bone metastases of solid tumors and hematologic malignancies and in 0.1-2% of patients being treated for osteoporosis with bisphosphonates. Depending on the underlying disease and medication dosage, the risk of MRONJ can be elevated even in the first year of antiresorptive treatment. The treatment of MRONJ is difficult and often involves surgery of the jaw.
  
  
  METHODS
  We systematically reviewed publications retrieved by a selective search for literature on the prevention of MRONJ in the PubMed and Cochrane Library databases and with the aid of the Google Scholar search engine.
  
  
  RESULTS
  15 of 559 retrieved publications were included in the analysis. The quality of the evidence in the studies was generally moderate to low, with most of them being case series. In one case series of over 1200 patients with multiple myeloma, the incidence of MRONJ was lowered from 4.6% to 0.8% through regular dental checkups and improved oral hygiene. Tooth extraction, in particular, is associated with a high risk of MRONJ. In a retrospective study, 57% of patients who underwent tooth extraction without antibiotic prophylaxis developed MRONJ, compared to 0% with antibiotic prophylaxis.
  
  
  CONCLUSIONS
  Before antiresorptive medication is begun, oral hygiene should be improved. Moreover, it seems that perioperative antibiotic prophylaxis and adequate plastic wound closure can often prevent MRONJ. In view of the fact that bisphosphonates can persist in bone for more than 15 years, patients should be thoroughly informed of the risk that antiresorptive treatment can cause MRONJ, and the measures discussed should be initiated.
authors.affiliation: Center for Dental Medicine, Department of Oral and Maxillofacial Surgery and Regional Plastic Surgery, Medical Center-University of Freiburg; Department of Medicine I: Hematology, Oncology, and Stem-Cell Transplantation, Medical Center-University of Freiburg.
authors.forename: Philipp
authors.initials: P
authors.lastname: Poxleitner
authors.forename: Monika
authors.initials: M
authors.lastname: Engelhardt
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzeisen
authors.forename: Pit
authors.initials: P
authors.lastname: Voss
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans; D010024:Osteoporosis; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates