Medication-related osteonecrosis of the jaw after dental clearance: Prevalence in an oncology center

OBJECTIVE: Medication-related osteonecrosis of the jaw (MRONJ), a complication of bisphosphonate therapy, has significant morbidity. This study aimed to determine the prevalence of MRONJ and compare its risks among patients who received antiresorptive or antiangiogenic therapy in King Fahad Medical City. STUDY DESIGN: In this retrospective study, the sample comprised data of all patients referred for dental treatment before antiresorptive and antiangiogenic therapy between 2008 and 2018. All patients were classified as at risk or having stage 0, stage 1, stage 2, or stage 3 MRONJ. RESULTS: The sample comprised 622 patients, including 358 (249 IV route, 34 oral route, and 75 subcutaneous route) who fulfilled the inclusion criteria and 25 in stage ≥ 0. Greater risk was observed in the intravenous group (8.82%) than in the oral and subcutaneous groups (2.94% and 2.67%, respectively). The overall prevalence rate was 6%. Patients with no history of dentoalveolar surgery had an MRONJ rate of 1.03%, whereas patients who underwent dentoalveolar surgery > 3 weeks before a lower MRONJ rate of 0.96%. Patients who underwent dentoalveolar surgery < 3 weeks before starting medication, and those who underwent surgery after starting the medication had higher MRONJ rates (21.42%, and 35.85%, respectively). The risk of spontaneously developing MRONJ was low. CONCLUSION: Risk of developing MRONJ was found to be higher when dentoalveolar procedures performed within 3 week before starting antiresorptive medications.