[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [Drugs in dentistry](https://durgical.com/en/dentistry/areas/drugs/) › Medication-related osteonecrosis of the jaw # Medication-related osteonecrosis of the jaw - Drugs Bone-strengthening drugs used in osteoporosis and cancer can, rarely, leave dead jaw bone exposed after an extraction. Prevention starts with a dental check. Updated Nov 12, 2026 **See it in 3D:** [Mandible](https://durgical.com/en/anatomy/mandible/) · [Maxillae](https://durgical.com/en/anatomy/maxilla/) ## Key points - Exposed jaw bone for more than eight weeks on antiresorptives = MRONJ. - Cancer doses carry far higher risk than osteoporosis doses. - Dental check before starting; do not stop denosumab abruptly. ## What it is Medication-related osteonecrosis of the jaw (MRONJ) is exposed bone, or bone that can be probed through a fistula, in the jaw for more than eight weeks in a person treated with antiresorptive drugs (bisphosphonates, denosumab) or some antiangiogenic cancer drugs, without previous radiotherapy to the jaw. The risk is much higher with the high, frequent doses used for bone metastases and myeloma (intravenous zoledronic acid, high-dose denosumab) than with osteoporosis treatment. Extractions and other bone-invasive procedures are the usual trigger; poor dentures, periodontitis, corticosteroids, smoking and diabetes add risk. It presents as exposed bone, pain, swelling, pus, loose teeth or lip numbness. ## What to know - Definition: exposed or probeable jaw bone for more than eight weeks, antiresorptive or antiangiogenic exposure, no jaw radiotherapy. - Highest risk: cancer doses of zoledronic acid or denosumab; low risk with oral bisphosphonates for osteoporosis. - Mandible more than maxilla; often after extraction. - Before starting high-dose therapy: dental assessment and necessary extractions with time to heal. - Denosumab must not be stopped abruptly without a plan, because of rebound vertebral fractures. ## Risks and precautions - Do not stop osteoporosis treatment on one's own before dental care; the decision is shared with the prescriber. - A non-healing socket on these drugs should not be curetted aggressively; refer. - Numbness of the lower lip can be the first sign («Vincent's symptom»). ## Next step / Initial management - Refer for a dental check before starting antiresorptive or antiangiogenic therapy, especially cancer doses. - Patients already on these drugs: preventive dental care, avoid unnecessary extractions, and tell the dentist about the drug. - Exposed bone, a non-healing socket or jaw pain with swelling: refer to oral and maxillofacial surgery; chlorhexidine rinses and antibiotics if infected, as directed by the specialist. ## Test yourself Think of the answer, then tap the question to see it. ## Which drug groups cause medication-related osteonecrosis of the jaw? Antiresorptives (bisphosphonates and denosumab) and some antiangiogenic cancer drugs. ## What is the usual trigger of MRONJ? Tooth extraction or another bone-invasive dental procedure. ## Why must denosumab not be stopped abruptly? Because stopping it causes rebound bone loss with a risk of multiple vertebral fractures. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/medication-related-osteonecrosis-of-the-jaw/) ## Connections ## See it in 3D 2 The structures of Durgical's 3D anatomy where it is found. - [Mandible](https://durgical.com/en/anatomy/mandible/) - [Maxillae](https://durgical.com/en/anatomy/maxilla/) ## Related 3 - [The mouth during cancer treatment: mucositis, dry mouth and osteonecrosis](https://durgical.com/en/dentistry/the-mouth-during-cancer-treatment-mucositis-dry-mouth-and-osteonecrosis/) - [Dry socket (alveolar osteitis)](https://durgical.com/en/dentistry/dry-socket/) - [Jaw cysts and odontogenic tumours](https://durgical.com/en/dentistry/jaw-cysts-and-odontogenic-tumours/) ## In Pharmacology 5 - [Bisphosphonates](https://durgical.com/en/pharmacology/classes/bisphosphonates/) - [Zoledronic acid](https://durgical.com/en/pharmacology/zoledronic-acid/) - [Alendronic acid (alendronate)](https://durgical.com/en/pharmacology/alendronic-acid/) - [Denosumab](https://durgical.com/en/pharmacology/denosumab/) - [Chlorhexidine](https://durgical.com/en/pharmacology/chlorhexidine/) [← All of dentistry](https://durgical.com/en/dentistry/) Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once. Sources: [Bisphosphonate-Related Jaw Osteonecrosis](https://www.ncbi.nlm.nih.gov/books/NBK534771/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Alendronate](https://medlineplus.gov/druginfo/meds/a601011.html) (MedlinePlus, US National Library of Medicine, 2026); [Denosumab Injection](https://medlineplus.gov/druginfo/meds/a610023.html) (MedlinePlus, US National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/dentistry/medication-related-osteonecrosis-of-the-jaw/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/medication-related-osteonecrosis-of-the-jaw/