Our Summary

This study aimed to find a way to predict the risk of a specific jaw disease (medication-related osteonecrosis of the jaw, or MRONJ) in patients who are undergoing a treatment that helps prevent bone loss (anti-resorptive therapy) before having oral surgery. The researchers looked at the levels of a specific substance in the blood (sCTX) that might indicate this risk.

They searched for and analyzed information from previous studies that looked at sCTX levels in patients who had taken anti-resorptive drugs and then had oral surgery. They used a specific method to analyze this data and find the sCTX level that was associated with the lowest risk of developing MRONJ.

The researchers included information from seven studies, which involved a total of 1281 patients. Most of these patients were being treated for a condition that causes bones to become weak and brittle (osteoporosis), and the majority were taking a specific type of anti-resorptive drug (oral bisphosphonates).

The researchers found that for patients taking oral bisphosphonates for osteoporosis, an sCTX level of 260 pg/mL was associated with a very low risk of developing MRONJ. However, for patients being treated for conditions related to cancer, sCTX levels did not reliably predict the risk of developing MRONJ.

In summary, this study suggests that for patients taking specific drugs for osteoporosis who are about to undergo oral surgery, testing for sCTX levels could help predict their risk of developing a specific jaw disease. However, this prediction may not be reliable for patients being treated for cancer-related conditions.

FAQs

  1. What is the specific substance in the blood that might indicate the risk of MRONJ?
  2. What sCTX level was found to be associated with a very low risk of developing MRONJ in patients taking oral bisphosphonates for osteoporosis?
  3. Can testing for sCTX levels reliably predict the risk of developing MRONJ in patients being treated for cancer-related conditions?

Doctor’s Tip

A helpful tip a doctor might give a patient about oral surgery is to inform them about the potential risk of developing MRONJ if they are taking anti-resorptive drugs for osteoporosis. Patients should discuss their medication history with their oral surgeon and consider getting their sCTX levels tested before oral surgery to assess their risk. Additionally, patients should follow all pre- and post-operative instructions provided by their oral surgeon to ensure a successful and safe recovery.

Suitable For

Patients who are typically recommended oral surgery include those who:

  1. Have impacted teeth that are causing pain or infection
  2. Have severe tooth decay or damage that cannot be treated with a filling or crown
  3. Have gum disease that has progressed to a point where surgery is necessary
  4. Need dental implants to replace missing teeth
  5. Require corrective jaw surgery for issues with bite alignment or jaw function
  6. Have oral cancer or precancerous lesions that need to be removed
  7. Have facial trauma that requires surgical repair
  8. Have chronic facial pain or TMJ disorders that require surgery for treatment
  9. Have cysts or tumors in the jaw that need to be removed
  10. Have other oral and maxillofacial conditions that cannot be treated with conservative methods.

Timeline

Before oral surgery:

  1. Patient is diagnosed with a condition that requires oral surgery, such as impacted wisdom teeth or gum disease.
  2. Patient consults with oral surgeon to discuss treatment options and risks.
  3. Patient may be prescribed antibiotics or other medications to prepare for surgery.
  4. Patient may undergo pre-operative testing such as blood work or imaging scans.
  5. Patient is advised to avoid eating or drinking for a certain period of time before surgery.

After oral surgery:

  1. Patient undergoes the oral surgery procedure, which may involve anesthesia and the removal of teeth or tissue.
  2. Patient may experience pain, swelling, and bleeding following surgery.
  3. Patient is given post-operative instructions for care, including pain management and diet restrictions.
  4. Patient may need to follow up with the oral surgeon for additional care or monitoring.
  5. Patient’s recovery process may vary depending on the type of surgery performed and individual healing factors.

What to Ask Your Doctor

  1. What is medication-related osteonecrosis of the jaw (MRONJ) and how does it relate to oral surgery?
  2. How does anti-resorptive therapy increase the risk of developing MRONJ?
  3. What specific anti-resorptive drugs increase the risk of MRONJ?
  4. How can testing for sCTX levels help predict the risk of developing MRONJ before oral surgery?
  5. What is the significance of an sCTX level of 260 pg/mL in predicting the risk of MRONJ for patients taking oral bisphosphonates?
  6. Are there any alternative methods for predicting the risk of MRONJ in patients undergoing oral surgery?
  7. How common is MRONJ in patients undergoing oral surgery while on anti-resorptive therapy?
  8. What are the symptoms of MRONJ and how is it typically treated?
  9. Are there any precautions or additional measures that should be taken for patients at high risk of developing MRONJ during oral surgery?
  10. Are there any specific guidelines or recommendations for managing patients on anti-resorptive therapy who require oral surgery?

Reference

Authors: Ghio C, Gravier-Dumonceau R, Lafforgue P, Giorgi R, Pham T. Journal: PLoS One. 2025 May 5;20(5):e0318260. doi: 10.1371/journal.pone.0318260. eCollection 2025. PMID: 40323917