# Comprehensive Review of Prevention and Management Strategies for Medication-related Osteonecrosis of the Jaw (MRONJ)

## TL;DR

This paper reviews strategies across dental specialties to prevent and manage medication-related jawbone death, emphasizing primary prevention and the need for further research.

## Contribution

The paper introduces a classification of four prevention types for MRONJ, including quaternary prevention as a novel concept.

## Key findings

- Primary prevention includes optimizing oral hygiene and managing dental issues before starting certain medications.
- Secondary prevention involves tailored approaches during dental procedures to reduce complications.
- Quaternary prevention aims to limit overmedicalisation and reduce risks from medications linked to MRONJ.

## Abstract

To assess and classify the strategies employed in various dental specialities for the prevention and management of medication-related osteonecrosis of the jaw (MRONJ).

A comprehensive literature review was conducted, acquiring studies sourced from Google Scholar and PubMed. The emphasis was on studies published in recent years, focusing on successful MRONJ prevention techniques across various dental specialties.

Four types of prevention were identified. Primary prevention strategies include optimizing oral hygiene, managing dental caries, and extraction of hopeless teeth in patients before starting antiresorptive or antiangiogenic medications, to reduce MRONJ risk. Secondary prevention techniques involve tailored approaches during procedures employed during different dental specialties aimed at reducing complications in susceptible patients. Tertiary prevention focuses on managing established MRONJ, aiming to relieve symptoms and prevent further deterioration. Quaternary prevention seeks to limit overmedicalisation and reduce risks associated with medications that contribute to MRONJ development.

Primary prevention remains the prevention of choice in terms of minimising the possible incidence of MRONJ, while secondary and tertiary prevention strategies are vital for managing risks and improving outcomes in susceptible patients. Quaternary prevention requires more research focusing on reducing the incidence of underlying conditions such as osteoporosis and cancer, which are associated with MRONJ development.