Prevention, Diagnosis and Management of Medication Related Osteonecrosis of the Jaw: Interdisciplinary Systematic Review of Dentists, Radiologists and Pharmacists Contributions

Ziad Nasser Almutawa ¹*, Nawaf Mansour Almutairi ², Saleh Mohammed Alegayel ³, Saeed Jalal Albaqami ⁴, Anas Ibrahim Alhuzaimi ², Ibrahim Mesfer Alqahtani ⁵, Khaled Hashim Alolimi ⁶, Faisal Ghaithan Alamri ⁶, Zainab Saad Alotaibi ⁷ and Samaher Mohammed Alhomaidhi⁸

¹Restorative Dentist, Medical Services in Ministry of Interior, Saudi Arabia
²Periodontist, Medical Services in Ministry of Interior, Saudi Arabia
³General Dentist, Medical Services in Ministry of Interior, Saudi Arabia
⁴Endodontist, Alkharj Military Industries Corporation Hospital, Saudi Arabia
⁵Endodontist, Medical Services in Ministry of Interior, Saudi Arabia
⁶Radiology Specialists, Ministry of Interior, Public Security, Medical Services, Riyadh, Saudi Arabia
⁷Pharmacist, King Khalid University Hospital, Saudi Arabia
⁸Dentist, Security Forces, Albaha, Saudi Arabia

*Corresponding Author: Ziad Nasser Almutawa, Restorative Dentist, Medical Services in Ministry of Interior, Saudi Arabia.

Received: November 25, 2025; Published: December 20, 2025

Abstract

Introduction: Medication related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive and antiangiogenic therapy. Effective prevention and management depend on coordinated care between dentists, radiologists and pharmacists, we aimed to review the roles of dentists, radiologists and pharmacists in the prevention, diagnosis and management of MRONJ, and summarize their knowledge, clinical practices and interdisciplinary collaboration.

Methods: A systematic search of electronic databases identified original studies reporting MRONJ related knowledge, attitudes, clinical practice, risk factors or outcomes in dentists, radiologists, pharmacists or mixed professional groups. Eligible designs included cross sectional surveys, qualitative studies and observational cohorts. Data were extracted on study characteristics, professional groups, MRONJ focus and main findings, and synthesised in line with PRISMA guidance.

Results: Eleven studies were included: eight cross sectional surveys of dental professionals or pharmacists, one qualitative interview study of general dental practitioners and two retrospective patient cohorts from Europe, the Middle East and Asia. Dental surveys showed high awareness of MRONJ and a gaps in recognising risk factors, clinical features and guideline-based management, as well as inconsistent documentation of antiresorptive therapy and communication with physicians. Cohort data indicated that absence of comprehensive dental care before antiresorptive or antiangiogenic therapy increased MRONJ risk and systemic factors such as chemotherapy, smoking and immunosuppression amplified risk.

Conclusions: Included studies support pre treatment dental clearance, systematic medical and medication history taking, and structured pharmacist dentist collaboration, and future research should integrate radiologists into coordinated MRONJ care pathways.

Keywords: Medication Related Osteonecrosis of the Jaw; Bisphosphonates; Dentists; Radiologists; Pharmacists; Interdisciplinary Care

References

1. Khan AA., et al. “Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus”. Journal of Bone and Mineral Research1 (2015): 3-23.
2. Fliefel R., et al. “Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review”. International Journal of Oral and Maxillofacial Surgery5 (2015): 568-585.
3. Guo Z., et al. “Pharmacogenetics of medication-related osteonecrosis of the jaw: a systematic review and meta-analysis”. International Journal of Oral and Maxillofacial Surgery3 (2020): 298-309.
4. dos Santos Ferreira L., et al. “Is teriparatide therapy effective for medication-related osteonecrosis of the jaw? A systematic review and meta-analysis”. Osteoporosis International12 (2021): 2449-2459.
5. Jamalpour MR., et al. “Complementarity of surgical therapy, photobiomodulation, A-PRF and L-PRF for management of medication-related osteonecrosis of the jaw (MRONJ): an animal study”. BMC Oral Health 1 (2022): 241.
6. Karna H., et al. “Risk-reductive dental strategies for medication related osteonecrosis of the jaw among cancer patients: A systematic review with meta-analyses”. Oral Oncology 85 (2018): 15-23.
7. Gaudin E., et al. “Occurrence and risk indicators of medication‐related osteonecrosis of the jaw after dental extraction: a systematic review and meta‐analysis”. Journal of Clinical Periodontology10 (2022): 922-932.
8. Mirelli C., et al. “Medication-Related Osteonecrosis of the Jaw in Dental Practice: A Retrospective Analysis of Data from the Milan Cohort”. Dentistry Journal5 (2022): 89.
9. Bival S., et al. “Dentists’ Awareness of Medication-Related Osteonecrosis of the Jaw (Risk Factors, Drugs, and Prevention) in the Republic of Croatia”. Acta Stomatologica Croatica2 (2023): 121-132.
10. Teślak M., et al. “Awareness of Medication-Related Osteonecrosis of the Jaws amongst Dental Professionals in Poland”. Applied Science11 (2021): 4821.
11. Escobedo M., et al. “Medication-related osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain)”. Journal of Stomatology Oral and Maxillofacial Surgery 5 (2018): 395-400.
12. López‐Jornet P., et al. “Bisphosphonate‐associated osteonecrosis of the jaw. Knowledge and attitudes of dentists and dental students: a preliminary study”. Journal of Evaluation in Clinical Practice5 (2010): 878-882.
13. Alblazi K., et al. “Potential role of comprehensive dental care in preventing medication related osteonecrosis of the jaw (MRONJ): a single centre study”. BMC Oral Health1 (2024): 1291.
14. Watanabe S., et al. “Effectiveness of Pharmacists’ Recommendations for Dental Examinations for Prevention of Medication-Related Osteonecrosis of the Jaw”. Biological and Pharmaceutical Bulletin9 (2025): b25-00371.
15. Sano M., et al. “Pharmacist Awareness, Knowledge, and Clinical Engagement of Medication-Related Osteonecrosis of the Jaw: A Survey From a Designated Community Cancer Care Hospital”. Cureus (2025).
16. Sturrock A., et al. “General dental practitioners’ perceptions of, and attitudes towards, improving patient safety through a multidisciplinary approach to the prevention of medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in the North East of England”. BMJ Open6 (2019): e029951.
17. Al-Maweri SA., et al. “Knowledge and Opinions of Saudi Dentists Regarding Dental Treatment of Patients Undergoing Bisphosphonates”. European Journal of Dentistry1 (2021): 144-151.
18. Han AL. “The awareness and practice of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey”. BMC Oral Health1 (2021): 155.
19. Ruksakiet K., et al. “Effects of discontinuing different antiresorptive regimens on medication-related osteonecrosis of the jaw in patients undergoing dental procedures: a systematic review and network meta-analysis”. EFORT Open Review5 (2025): 258-266.

Citation

Citation: Ziad Nasser Almutawa., et al. “Prevention, Diagnosis and Management of Medication Related Osteonecrosis of the Jaw: Interdisciplinary Systematic Review of Dentists, Radiologists and Pharmacists Contributions".Acta Scientific Paediatrics 9.1 (2026): 15-21.

Copyright

Copyright: © 2026 Ziad Nasser Almutawa., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.