“Medication Related Osteonecrosis of the Jaw (MRONJ): Dental Atraumatic Treatment: Antiseptic Mouthwashes”.

Abstract

The American Surgery of Bone Mineral Research (ASBMR) in 2007 defined MRONJ as “necrotic bone area exposed to the oral environment with more than eight weeks of permanence, in the presence of chronic treatment with Bisphosphonates (BP), in the absence of radiation therapy to the head and neck”. Historically, the first drugs associated with the condition were BP, which led to coining of the term MRONJ. However, scientist need to include other drugs in the etiopathogenesis of osteonecrosis, such as other antiresorptive: Denosumab (DS) and antiangiogenic agents. MRONJ treatment is controversial nowadays and depend on Stages of the illness. Some authors recommend high toilettes and resection bone so other, prefer atraumatic therapies focused in antiseptic agents and interdisciplinary (dentist-physician) control. The most common antiseptic agents used are Povidone Iodine, Rifamycin, Cetyl pyridinium chlorid and Chlorhexidine. Alcohol preparations have the fastest onset of action, followed by chlorhexidine and then povidone iodine. However, residual antimicrobial activity is greatest with chlorhexidine. Formulations that contain both chlorhexidine and alcohol combine the rapid onset of alcohol with the persisting effects of chlorhexidine.