Declining Incidence of Medication-Related Osteonecrosis of the Jaw in Patients With Cancer

Context: Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but severely debilitating condition. Given the significant morbidity attributable to MRONJ and the challenges associated with its management, prevention is crucial. Objective: We sought to evaluate the effectiveness of an active dental intervention in reducing MRONJ incidence. Design and Setting: We identified all patients who received antiresorptive drug therapy at a specialized cancer center between January 2003 and December 2013 through hospital pharmacy records, whereas confirmed cases of MRONJ were identified through a hospital database. Main Outcome Measures: The incidence of MRONJ before and after the implementation of active dental intervention in July 2008 was quantified and compared. Results: A total of 1243 patients received antiresorptive drug therapy, with 34 confirmed cases of MRONJ(crude overall incidence, 2.7%). The incidence of MRONJ was significantly lower in patients who received antiresorptive therapy after the implementation of guidelines that emphasized active dental input (0.8 vs 4.6%; chi(2) = 16.2; P = .00006). Using a binominal logistic regression model that adjusted for the number of doses of antiresorptive drug received, patients who received active dental input had an odds ratio of developing MRONJ of 0.24 (95% confidence interval, 0.09, 0.61; P = .004). Conclusion: The likelihood of developing MRONJ can be minimized through the implementation of prophylactic dental assessment and active dental intervention. This reinforces the importance of increased dental awareness and enhanced dental intervention in the prevention of MRONJ.