Baghalipour Nasimeh, Moztarzadeh Omid, Samar Walla, Gencur Jiri, Volf Vaclav, Hauer Lukas
Oral Health Prev Dent. 2025 Aug 5;23:403-417. doi: 10.3290/j.ohpd.c_2169.
To assess and classify the strategies employed in various dental specialities for the prevention and management of medication-related osteonecrosis of the jaw (MRONJ).
A comprehensive literature review was conducted, acquiring studies sourced from Google Scholar and PubMed. The emphasis was on studies published in recent years, focusing on successful MRONJ prevention techniques across various dental specialties.
Four types of prevention were identified. Primary prevention strategies include optimizing oral hygiene, managing dental caries, and extraction of hopeless teeth in patients before starting antiresorptive or antiangiogenic medications, to reduce MRONJ risk. Secondary prevention techniques involve tailored approaches during procedures employed during different dental specialties aimed at reducing complications in susceptible patients. Tertiary prevention focuses on managing established MRONJ, aiming to relieve symptoms and prevent further deterioration. Quaternary prevention seeks to limit overmedicalisation and reduce risks associated with medications that contribute to MRONJ development.
Primary prevention remains the prevention of choice in terms of minimising the possible incidence of MRONJ, while secondary and tertiary prevention strategies are vital for managing risks and improving outcomes in susceptible patients. Quaternary prevention requires more research focusing on reducing the incidence of underlying conditions such as osteoporosis and cancer, which are associated with MRONJ development.
评估和分类不同牙科专业用于预防和管理药物相关性颌骨坏死（MRONJ）所采用的策略。
进行了全面的文献综述，获取了来自谷歌学术和PubMed的研究。重点是近年来发表的研究，聚焦于不同牙科专业成功的MRONJ预防技术。
确定了四种预防类型。一级预防策略包括在开始抗吸收或抗血管生成药物治疗前，优化口腔卫生、治疗龋齿以及拔除患者的无保留价值牙齿，以降低MRONJ风险。二级预防技术涉及在不同牙科专业的操作过程中采用针对性方法，旨在减少易感患者的并发症。三级预防侧重于管理已确诊的MRONJ，旨在缓解症状并防止病情进一步恶化。四级预防旨在限制过度医疗，并降低与导致MRONJ发生的药物相关的风险。
就将MRONJ的可能发生率降至最低而言，一级预防仍是首选的预防措施，而二级和三级预防策略对于管理易感患者的风险和改善预后至关重要。四级预防需要更多研究聚焦于降低与MRONJ发生相关的潜在疾病如骨质疏松症和癌症的发病率。
