PDF(Pubmed)
Abstract：
Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon complication of antiresorptive therapy (ART) in patients receiving higher and more frequent doses of osteoclast inhibitors. The jaws are the most common site, as they have high bone turnover. The oral structures are exposed to various types of stresses, like mastication and dental diseases, which lead to microtrauma and increased bone remodeling. The hallmark feature of MRONJ is the area of exposed, necrotic, nonhealing, asymptomatic bone for more than eight weeks. Objective signs are pain in the jaw and oral cavity, loose teeth, gingival swelling, ulceration, soft tissue infection, and paresthesia in the trigeminal nerve branches\' territory. Clinically, the MRONJ has been defined in four stages, from stage 0 to stage 3. Close coordination between the dentist and oncologist is critical for optimal treatment. Conservative management should be preferred over surgical management. There is significant underreporting and misdiagnosis of MRONJ cases in regular clinical practice. There needs to be more awareness among treating physicians about this sporadic complication of bisphosphonate therapy. This narrative review has given a detailed insight into the subject, starting with etiology, pathogenesis, incidence, clinical presentation, workup, staging, and various management strategies. The review article focuses mainly on practical aspects of MRONJ, which every clinician dealing with the disease must know. With a better awareness of this potential complication, healthcare practitioners dealing with at-risk patients can better diagnose, prevent, address, and provide necessary care.
摘要：
在接受更高剂量和更频繁剂量的破骨细胞抑制剂的患者中，药物相关的颌骨坏死（MRONJ）是抗吸收治疗（ART）的罕见并发症。颌骨是最常见的部位，因为他们有很高的骨转换。口腔结构暴露于各种类型的压力，比如咀嚼和牙齿疾病，导致微创伤和骨重建增加。MRONJ的标志特征是暴露的区域，坏死,不愈合，无症状骨超过八周。客观症状是颌骨和口腔疼痛，牙齿松动,牙龈肿胀，溃疡,软组织感染,三叉神经分支区域的感觉异常。临床上,MRONJ被定义为四个阶段，从阶段0到阶段3。牙医和肿瘤学家之间的密切协调对于最佳治疗至关重要。保守管理应优先于手术管理。在常规临床实践中，MRONJ病例存在明显的漏报和误诊。治疗医生需要更多地了解双膦酸盐治疗的这种零星并发症。这篇叙述性评论对这个主题有了详细的见解，从病因学开始，发病机制，发病率,临床表现,workup,分期,以及各种管理策略。评论文章主要关注MRONJ的实践方面，这是每个治疗这种疾病的临床医生都必须知道的。随着对这种潜在并发症的更好认识，与风险患者打交道的医疗保健从业者可以更好地诊断，防止，地址,并提供必要的护理。
