Table 2 Guide to clinicians for monitoring patients requiring antiresorptive therapy

From: Mitigating osteonecrosis of the jaw (ONJ) through preventive dental care and understanding of risk factors

Management

Overall dental health:

 • Assess and manage current disease state: teeth present, oral-dental infections, e.g., caries, periodontal disease, and xerostomia (multiple causes)

 • Assess quality of existing restorations, including dentures, bridges, and implants

 • Identify and address restorative needs prior to, during, and after therapy and removal of nonsalvageable teeth prior to therapy

 • Monitor for normal oral hard and soft tissue healing after dental procedures and extractions, and for resolution of oral pain

Risk factors

General:

 • Increasing age

 • Female gender

Overall systemic conditions that may exacerbate ONJ development:

 • Compromised immune system

 • Autoimmune diseases

 • Diabetes

 • Mineralized tissue disorders/diseases, especially those known to affect bone homeostasis

 • Genetic factors with suggested increased risk of ONJ (i.e., specific polymorphism in FDPS gene or SIRT1/HERC4 locus)

Medications that exacerbate ONJ risk:

 • Concomitant steroids or chemotherapeutic agents

 • Concomitant antiangiogenic agents

Antiresorptive regimens that increase the risk of ONJ:

 • Treatment for skeletal-related events in cancer have greater risk than osteoporosis/osteopenia

 • Intravenous formulations have greater risk than oral forms of bisphosphonates, with risk plateaus at 2–3 years and >4 years, respectively

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