We are still seeing patients with medication-related osteonecrosis of the jaw (MRONJ) although it is becoming much less common as the dosage regimens for the use of antiresorptive and antiangiogenic drugs have improved dramatically over the past 20 years. (J Oral Maxillofac Surg 78: 1986-1999, 2020). We do, however still see these patients in our practice with these types of bone problems. Most of our patients who are on these medications are taking them as part of a chemotherapy for neoplastic disease (cancer treatment), but we also still see patients who are on these drugs for osteoporosis (decreased bone density problems). The use of injectable forms of these drugs seem to be the most common cause of the jawbone problems, specifically the “dead bone disease” problem. There are multiple factors that seem to lead to these problems such as poor general health, nutrition, and immune status.

Early treatment of these bone problems with local debridement and flap closure have been very effective. I have only used other adjunctive treatments such as HBO therapy (hyperbaric oxygen) in rare cases. These are difficult cases as there are other problems (comorbidities) that we have to deal with at the same time. Also, it often takes several surgical procedures depending on the condition of the supporting tissues and bone. This additional time often negatively affects the psychological aspects of care. If you have these types of bone problems I would recommend addressing them early, and a team approach to care is the best. We would typically team up with the other treating doctors to work toward the best outcome.