# Endodontic Consequences of Early Stage of Medication‐Related Osteonecrosis of the Jaw: A Case Report

## TL;DR

This case report shows how a medication used in cancer treatment can lead to jawbone issues that affect teeth and dental health.

## Contribution

The paper highlights the previously under-recognized endodontic consequences of early-stage medication-related osteonecrosis of the jaw.

## Key findings

- A patient on antiresorptive drugs developed dental issues linked to early-stage MRONJ.
- Extraction and surgical treatment resolved the MRONJ-related dental complications.
- Early-stage MRONJ lacks clear radiographic signs, making diagnosis challenging.

## Abstract

Osteonecrosis of the jaws (MRONJ) is a frequent side effect of antiresorptive (AR) drugs used in oncology. MRONJ may have endodontic consequences, as reported in this clinical case.

A 64‐year‐old woman being treated with antiresorptive (AR) drugs targeting bone metastasis of a primitive breast cancer consulted at the dental service of Pitié‐Salpêtrière Hospital. She first experienced symptomatic apical periodontitis followed by symptomatic irreversible pulpitis, which were initially explained as resulting from occlusal trauma. Despite endodontic treatment, exacerbation of the symptomatology was noted. MRONJ was suspected, and the affected tooth was extracted.

The presence of necrotic bone during the surgery confirmed the diagnosis. Surgical treatment led to complete healing and total disappearance of clinical and radiological signs at 4 months.

MRONJ can induce alterations in adjacent tooth vascularization and secondary pulpal disease. Early diagnosis is difficult because early‐stage MRONJ occurs without clear radiographic signs.

MRONJ is a side effect of antiresorptive (AR) drugs used in oncology. MRONJ may have endodontic consequences, as reported in this clinical case.Endodontists should be aware of the side effects of AR drugs and their possible consequences on dental pulp to avoid delayed diagnosis and invasive interventions.

MRONJ is a side effect of antiresorptive (AR) drugs used in oncology. MRONJ may have endodontic consequences, as reported in this clinical case.

Endodontists should be aware of the side effects of AR drugs and their possible consequences on dental pulp to avoid delayed diagnosis and invasive interventions.