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Bisphosphonate-Related Osteonecrosis of the Jaw

Persistent exposed jaw bone in patients on antiresorptive therapy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ağız ve Diş Sağlığı department. Book Appointment →

What is Bisphosphonate-Related Osteonecrosis of the Jaw?

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), now broadened to medication-related osteonecrosis of the jaw (MRONJ), is defined as exposed necrotic bone in the maxillofacial region persisting more than 8 weeks in patients on antiresorptive (bisphosphonates, denosumab) or antiangiogenic therapy without prior head and neck radiation.

Pathogenesis involves suppressed bone turnover, impaired vascularity and disrupted soft tissue healing. Risk is higher with intravenous formulations and oncologic doses than oral osteoporosis dosing. Prevention strategies include comprehensive dental evaluation and treatment before initiating high-risk medications, optimal oral hygiene and avoidance of elective oral surgery during therapy.

Symptoms

Exposed necrotic bone visible in oral cavity
Persistent oral pain or paresthesia
Loose teeth without obvious periodontal cause
Non-healing extraction socket beyond 8 weeks
Soft tissue swelling and erythema
Sinus tract drainage with bone exposure
Pathologic mandibular fracture in advanced stage

Risk Factors

Intravenous bisphosphonate (zoledronate, pamidronate) for cancer
Oral bisphosphonate for osteoporosis (lower risk)
Denosumab (RANKL inhibitor)
Antiangiogenic agents (bevacizumab, sunitinib)
Recent dental extraction or oral surgery
Concurrent corticosteroids and chemotherapy
Diabetes and immunosuppression

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Exposed bone in oral cavity for over 8 weeks
  • Persistent oral pain on antiresorptive therapy
  • Non-healing tooth extraction site
  • Spontaneous tooth loosening
  • New oral mucosal swelling or fistula
  • Pre-treatment dental clearance for high-risk medications

Treatment Methods

01
AAOMS staging: stage 0 (no exposure), 1, 2, 3 (severe with fracture or fistula)
02
Conservative management for early stages: chlorhexidine rinses
03
Antibiotic therapy (penicillin, amoxicillin) for stage 2 with infection
04
Pain management with NSAIDs and topical anesthetics
05
Limited debridement of necrotic bone for symptomatic relief
06
Surgical resection for stage 3 with pathologic fracture
07
Drug holiday discussion with prescribing physician (limited evidence)
08
Optimal oral hygiene and regular dental follow-up
09
Pre-medication dental clearance for prevention

Which Department to Visit?

You can visit our Ağız ve Diş Sağlığı department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Ağız ve Diş Sağlığı Department

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A dental implant is a titanium screw placed in the jawbone that supports a crown, bridge or denture, providing the closest possible function and aesthetics to a natural tooth.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.