A primary prevention strategy: oral hygiene and correct lifestyles among patients at risk of developing drug-related osteonecrosis of the Jaw

Skeletal complications caused by osteoporosis or bone metastases are associated with considerable pain, increased mortality and reduced quality of life. Agents that prevent bone resorption, such as bisphosphonates or denosumab, can reduce the risk of fractures and are widely used in patients with osteoporosis or bone cancer metastases. Drug-related osteonecrosis of the jaw (MRONJ) is a rare but potentially serious adverse event associated with cumulative high doses of bisphosphonates or denosumab. MRONJ is a known potential side effect of long-term bisphosphonate therapy. Other risk factors for osteonecrosis of the jaw (ONJ) ​​include the use of glucocorticoids, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, dental prostheses, and other medications, including antiangiogenic agents. Prevention strategies for elimination and stabilization of oral disease include completion of necessary oral surgery prior to initiation of antiresorptive drug therapy, use of antibiotics before and / or after the procedure, and rinsing of the mouth with chlorhexidine antimicrobial, adequate wound healing after tooth extraction and maintenance of good oral hygiene. The primary goal of treatment should be to improve the patient's quality of life by managing pain and infections, preventing the development of new lesions and slowing the progression of the disease. As a multi-professional team, dentists and dental hygienists play a key role in the primary prevention of MRONJ. However, the need for a standardized multidisciplinary approach, with a sustained dialogue between the  specialists involved, should always be adopted in order to improve the effectiveness of preventive strategies and improve the patient's quality of life.  This treatise describes the preventive treatment and management of patients with this condition.