MEDICATION-RELATED OSTEONECROSIS OF THE JAWS IN ONCOLOGICAL PATIENTS: PREVENTIVE AND THERAPEUTIC STRATEGIES THROUGH AN INTEGRATIVE LITERATURE REVIEW

Authors

DOI:

https://doi.org/10.61164/rmnm.v1i3.3520

Keywords:

Oncology, Osteonecrosis, Quality of life

Abstract

Abstract

Introduction: In cancer patients, the use of Bone Modifying Agents (BMA) is part of the treatment protocol for osteolytic disease related to breast cancer, multiple myeloma, among others. Among the medications that can cause the development of MRONJ, bisphosphonates (BFs) and denosumab (DMAB) stand out. Such drugs may be related to the development of MRONJ, which can negatively affect the quality of life of cancer patients. Objective: To identify, through an integrative review, preventive and therapeutic approaches for MRONJ. Methodology: A bibliographic search was carried out in the electronic database PubMed, between July and October 2023, using descriptors defined according to the theme. The articles were selected according to previously established inclusion and exclusion criteria. Results: 354 articles were found in the databases. After analyzing the titles and abstracts, 107 articles were pre-selected and read in full. Then, 16 articles were included in the present review. Conclusion: Oral adjustment prior to starting BMA should always be encouraged. Given the need to perform invasive procedures in patients undergoing BMA, alternatives such as antibiotic therapy and pentoxifylline and tocopherol (PENTO) should be considered to try to minimize the chance of their occurrence. In cases of MRONJ development, treatments will depend on its staging and the literature provides alternatives such as antibiotic therapy, surgery, PENTO, Er,Cr:YSGG Laser, Low Intensity Laser Therapy (LLLT), Antimicrobial Photodynamic Therapy (aPDT) , Platelet and Leukocyte Rich Fibrin (L-PRF), Fibrin Rich Plasma (PRF) and Platelet Rich Plasma (PRP).

Keywords: Oncology; Osteonecrosis; Quality of life.

Author Biographies

  • Jackeline Mayara Inácio Magalhães , Doutoranda em Odontologia, Universidade Federal de Pernambuco (UFPE), Brasil

    Cirurgiã-Dentista graduada pela Universidade Federal de Pernambuco (UFPE), Doutoranda em Odontologia pela UFPE e Mestra em Cuidados Intensivos pelo Instituto de Medicina Integral Professor Fernando Figueira (IMIP). É especialista em Endodontia pelo Centro Odontológico de Estudos e Pesquisas (COESP) e em Estomatologia pela Unyleya, além de possuir residência em Odontologia Hospitalar (IMIP), habilitação em Laserterapia pela Associação Brasileira de Odontologia da Paraíba (ABO-PB) e aperfeiçoamento em Cirurgia-Buco-Maxilo-Facial pela Associação Brasileira de Odontologia de Pernambuco (ABO-PE). Atualmente, é coordenadora do curso de Odontologia e professora dos componentes curriculares de Odontologia Hospitalar, Endodontia I e Clínica de Atenção ao Idoso e ao Paciente com Necessidades Especiais no Centro Universitário FIS (UNIFIS). Suas principais áreas de atuação incluem Endodontia, Odontologia Hospitalar e Oncológica, Câncer Bucal, Laserterapia e Cirurgia Oral.

  • Pina Godoy Pina Godoy, Professor Adjunto de Patologia, Universidade Federal de Pernambuco (UFPE), Brasil

    Cirurgião-dentista graduado pela Universidade Federal de Pernambuco (1997), Mestre em Patologia Oral pela Universidade Federal do Rio Grande do Norte (2001) e Doutor em Patologia Oral pela Universidade Federal do Rio Grande do Norte (2005). É professor adjunto da Universidade Federal de Pernambuco, onde leciona o componente curricular de "Processos Patológicos Gerais" (PPG) para os cursos de Odontologia e Biomedicina. É professor permanente e vice coordenador do Programa de Pós-Graduação em Odontologia da UFPE, e professor permanente do Programa de Pós-Graduação em Saúde Translacional da UFPE. Atualmente é Vice Presidente da Associação Brasileira de Ensino Odontológico (ABENO), é presidente da comissão de ensino do Conselho Regional de Odontologia de Pernambuco (CRO-PE), e é membro da comissão de ensino da Sociedade Brasileira de Estomatologia e Patologia Oral (SOBEP). Integra o Banco de Avaliadores de Cursos e de Instituições de Ensino Superior (BASis) do INEP/ Ministério da Educação e o Sistema de Acreditação dos cursos de Odontologia no ARCOSUL. É habilitado em Laserterapia pela Liga de Laser na Odontologia Clínica (LLOC). Tem experiência na área de Odontologia, com ênfase em Patologia Oral, atuando principalmente nos seguintes temas: patologia oral, cistos odontogênicos, cisto dentígero, epidemiologia, câncer oral e ensino odontológico.

References

ALMEIDA, M. V. DA C. et al. Photodynamic therapy as an adjunct in the treatment of medication-related osteonecrosis of the jaw: A case report. Journal of lasers in medical sciences, v. 12, p. e12, 2021. DOI: https://doi.org/10.34172/jlms.2021.12

BLATT, S. et al. Non-interventional prospective observational study of platelet rich fibrin as a therapy adjunctive in patients with medication-related osteonecrosis of the jaw. Journal of clinical medicine, v. 11, n. 3, p. 682, 2022. DOI: https://doi.org/10.3390/jcm11030682

BROOME, M. E. Integrative literature reviews for the development of concepts. In: RODGERS, B. L.; KNAFL, K. A. (orgs.). Concept development in nursing: foundations, techniques and applications. Philadelphia: W.B. Saunders Company, 2000. p. 231-250.

CAMPISI, G. et al. Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020. International journal of environmental research and public health, v. 17, n. 16, 2020.

CAPOCCI, M. et al. Medication-related osteonecrosis of the jaws (MRONJ) and quality of life evaluation: a pilot study. La Clinica terapeutica, v. 168, n. 4, p. e253–e257, 2017.

CHALEM, M. et al. Therapeutic approach and management algorithms in medication-related osteonecrosis of the jaw (MONJ): recommendations of a multidisciplinary group of experts. Archives of osteoporosis, v. 15, n. 1, p. 101, 2020. DOI: https://doi.org/10.1007/s11657-020-00761-0

COROPCIUC, R. et al. Risk of medication-related osteonecrosis of the jaw after dental extractions in patients receiving antiresorptive agents - A retrospective study of 240 patients. Bone, v. 170, n. 116722, p. 116722, 2023. DOI: https://doi.org/10.1016/j.bone.2023.116722

DI FEDE, O. et al. The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention. BioMed research international, v. 2018, 2018. DOI: https://doi.org/10.1155/2018/2684924

EPSTEIN, M. S. et al. Management of bisphosphonate-associated osteonecrosis: pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, v. 110, n. 5, p. 593–596, 2010. DOI: https://doi.org/10.1016/j.tripleo.2010.05.067

FLEISHER, Kenneth E.; KONTIO, Risto; OTTO, Sven. Antiresorptive Drug-related Osteonecrosis of the Jaw (ARONJ)—a Guide to Research. Davos, Switzerland: AO Foundation, 2016. ISBN 978-3-905363-10-4.

GOKER, F. et al. Treatment of medication-related osteonecrosis of the jaw (MRONJ). A systematic review. European review for medical and pharmacological sciences, v. 25, n. 6, p. 2662–2673, 2021.

HASEGAWA, T. et al. Denosumab-related osteonecrosis of the jaw after tooth extraction and the effects of a short drug holiday in cancer patients: a multicenter retrospective study. Osteoporosis international, v. 32, n. 11, p. 2323–2333, 2021. DOI: https://doi.org/10.1007/s00198-021-05995-3

HE, L. et al. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw. International journal of oral science, v. 12, n. 1, p. 30, 2020. DOI: https://doi.org/10.1038/s41368-020-00093-2

KEMP, A. P. T. et al. Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients. Brazilian journal of otorhinolaryngology, v. 88, n. 5, p. 683–690, 2022. DOI: https://doi.org/10.1016/j.bjorl.2020.09.010

LEONARDI, N. et al. Alternativas terapéuticas de osteonecrosis maxilar asociada a medicamentos (ONMAM): Reportes de dos casos clínicos y revisión de la literatura. Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina), v. 79, n. 4, p. 379–382, 2022. DOI: https://doi.org/10.31053/1853.0605.v79.n4.37289

MAGALHÃES, J. M. I. et al. Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted to tooth extraction: a case series. Supportive care in cancer, v. 31, n. 8, p. 462, 2023. DOI: https://doi.org/10.1007/s00520-023-07906-0

MARTINS, M. A. T. et al. Osteonecrose dos maxilares associada ao uso de bisfosfonatos: importante complicação do tratamento oncológico. Revista brasileira de hematologia e hemoterapia, v. 31, n. 1, p. 41–46, 2009. DOI: https://doi.org/10.1590/S1516-84842009005000008

MAUCERI, R. et al. Conservative surgical treatment of bisphosphonate-related osteonecrosis of the jaw with Er,Cr:YSGG laser and platelet-rich plasma: A longitudinal study. BioMed research international, v. 2018, p. 3982540, 2018. DOI: https://doi.org/10.1155/2018/3982540

MENDES, K. D. S.; SILVEIRA, R. C. DE C. P.; GALVÃO, C. M. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & contexto enfermagem, v. 17, n. 4, p. 758–764, 2008. DOI: https://doi.org/10.1590/S0104-07072008000400018

MORENO-RABIÉ, C. et al. Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction. Scientific reports, v. 12, n. 1, p. 11280, 2022. DOI: https://doi.org/10.1038/s41598-022-15254-y

NIECKULA, P.; STEMPNIEWICZ, A.; TUBAJA, M. Prophylaxis of osteonecrosis in the case of patients treated with bisphosphonates: A review paper. Dental and medical problems, v. 55, n. 4, p. 425–429, 2018. DOI: https://doi.org/10.17219/dmp/99021

AMADOR SALOMÃO, P. E. .; TEIXEIRA OLIVEIRA SANTOS, A. . EVOLUÇÃO E DESAFIOS NA AVALIAÇÃO CIENTÍFICA: DA CLASSIFICAÇÃO DE PERIÓDICOS À QUALIDADE INTRÍNSECA DOS ARTIGOS. Revista Multidisciplinar do Nordeste Mineiro, [S. l.], v. 1, n. 1, p. 1–18, 2025. DOI: 10.61164/rmnm.v1i1.3481. DOI: https://doi.org/10.61164/rmnm.v1i1.3481

OTTO, S. et al. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer treatment reviews, v. 69, p. 177–187, 2018. DOI: https://doi.org/10.1016/j.ctrv.2018.06.007

PARISE, G. K. et al. Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid-case-control study. Oral and maxillofacial surgery, v. 27, n. 3, p. 507–512, 2023. DOI: https://doi.org/10.1007/s10006-022-01094-7

PASSERI, L. A.; BÉRTOLO, M. B.; ABUABARA, A. Osteonecrose dos maxilares associada ao uso de bisfosfonatos. Revista brasileira de reumatologia, v. 51, n. 4, p. 404–407, 2011. DOI: https://doi.org/10.1590/S0482-50042011000400012

RUGGIERO, S. L. et al. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws-2022 update. Journal of oral and maxillofacial surgery, v. 80, n. 5, p. 920–943, 2022. DOI: https://doi.org/10.1016/j.joms.2022.02.008

ŞAHIN, O. et al. Prevention of medication related osteonecrosis of the jaw after dentoalveolar surgery: An institution’s experience. Journal of clinical and experimental dentistry, v. 12, n. 8, p. e771–e776, 2020. DOI: https://doi.org/10.4317/jced.56837

SOUZA, S. L. X. et al. Terapia fotodinâmia como coadjuvante no tratamento da osteonecrose dos maxilares associada ao uso de medicamentos (OMAM). SALUSVITA, v. 38, n. 4, p. 1093-1105, 2019.

TENORE, G. et al. Management of medication-related osteonecrosis of the jaw (MRONJ) using leukocyte- and platelet-rich fibrin (L-PRF) and photobiomodulation: A retrospective study. Journal of clinical medicine, v. 9, n. 11, p. 3505, 2020. DOI: https://doi.org/10.3390/jcm9113505

TORRES, A. A. et al. Medication-related osteonecrosis of the jaw and low-level laser therapy as adjuvant treatment: A case report. Journal of lasers in medical sciences, v. 11, n. 4, p. 497–499, 2020. DOI: https://doi.org/10.34172/jlms.2020.78

UEDA, N. et al. Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer. Journal of bone and mineral metabolism, v. 39, n. 4, p. 623–630, 2021. DOI: https://doi.org/10.1007/s00774-020-01195-x

WILCOCK, A. et al. Denosumab: AHFS 92:24. Journal of pain and symptom management, v. 56, n. 2, p. 295–301, 2018. DOI: https://doi.org/10.1016/j.jpainsymman.2018.05.021

YAROM, N. et al. Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, v. 37, n. 25, p. 2270–2290, 2019. DOI: https://doi.org/10.1200/JCO.19.01186

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2025-02-14

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Vol. 3 No. 1 (2025): Revista Multidisciplinar do Nordeste Mineiro - REMUNOM

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MEDICATION-RELATED OSTEONECROSIS OF THE JAWS IN ONCOLOGICAL PATIENTS: PREVENTIVE AND THERAPEUTIC STRATEGIES THROUGH AN INTEGRATIVE LITERATURE REVIEW. (2025). Revista Multidisciplinar Do Nordeste Mineiro, 3(1), 1-14. https://doi.org/10.61164/rmnm.v1i3.3520