Antiresorptives (MRONJ)
Dental Considerations for Patients Taking Zoledronic acid — osteoporosis (5 mg yearly IV)
Important — second opinion only. DentiCision provides an evidence-based second opinion to assist the dentist. It does not replace the treating dentist's professional clinical judgment or consultation with the patient's physician. The treating dentist retains full clinical, scientific and legal responsibility. Always verify drugs and doses against current guidelines.
Treatment duration needed to finalise the decision (yearly zoledronic acid (osteoporosis))
AAOMS manages patients differently below and above 4 years of therapy, and when steroids are also taken.
Emergency vs routine management
If EMERGENCY — what to do
- • Treat pain/infection; extraction may proceed when needed using an atraumatic technique with primary closure where possible.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
- • Do not request a drug holiday for an emergency.Ref: Ruggiero SL et al. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws — 2022 Update. J Oral Maxillofac Surg 2022;80:920–943
If ROUTINE — what to do
- • Low-risk (< 4–5 years, no steroids): routine care including extractions with conservative technique.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
- • ≥ 4 years or with steroids: prefer endodontics over extraction; a 2-month drug holiday may be discussed with the prescriber for elective surgery.Ref: Ruggiero SL et al. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws — 2022 Update. J Oral Maxillofac Surg 2022;80:920–943
- • Review the socket 8 weeks after extraction.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
Clinical precautions
- • Informed consent regarding the (low) MRONJ risk
- • Atraumatic technique; primary closure where possible
- • Chlorhexidine 0.2% rinse before and for 1–2 weeks after; review healing at 2 and 8 weeks
Information & tests to request
- • How many years has the patient taken the yearly zoledronic acid (osteoporosis)? — AAOMS 2022: <4 years without risk factors = proceed without change; ≥4 years (or with steroids) = prescriber input before bony surgery.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | ROUTINE Low MRONJ risk — no bony procedure |
| Supragingival scaling / polish | ROUTINE Low MRONJ risk — no bony procedure |
| Deep scaling / subgingival RSD (subgingival calculus) | ROUTINE Low MRONJ risk — no bony procedure |
| Root canal treatment | ROUTINE Low MRONJ risk — no bony procedure |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Treatment duration needed to finalise the decision (yearly zoledronic acid (osteoporosis)) |
| Surgical / bony extraction | MODIFY / CAUTION Treatment duration needed to finalise the decision (yearly zoledronic acid (osteoporosis)) |
| Implant placement | MODIFY / CAUTION Treatment duration needed to finalise the decision (yearly zoledronic acid (osteoporosis)) |
References
- AAOMS 2022 — MRONJ Position Paper
- SDCEP — Oral health & antiresorptive drugs
- SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
- Ruggiero SL et al. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws — 2022 Update. J Oral Maxillofac Surg 2022;80:920–943
Related guides
Important — second opinion only. DentiCision provides an evidence-based second opinion to assist the dentist. It does not replace the treating dentist's professional clinical judgment or consultation with the patient's physician. The treating dentist retains full clinical, scientific and legal responsibility. Always verify drugs and doses against current guidelines.