Spontaneous medication-related osteonecrosis of the jaw: a bimodal treatment approach

While most incidences of medication-related osteonecrosis of the jaw (MRONJ) are associated with a history of oral trauma, tooth extraction, or prior oral surgical procedures, osteonecrosis and exposed bone can occur spontaneously in the oral cavity. This case report describes the successful treatment of spontaneous MRONJ in a patient who had a history of breast cancer, drug allergies, occasional respiratory insufficiency, heart murmur, untreated borderline hypertension, and gastroesophageal reflux disease. In addition, the patient was prescribed the antiresorptive drug denosumab for osteoporosis. A nonsurgical treatment regimen followed by a surgical approach was a safe and successful treatment method for this patient who had a complicated medical history and a number of medical considerations. The bimodal approach allowed the effects of the prescribed medication (denosumab) to dissipate and enhanced the local conditions for the surgical procedure to achieve optimal results. A careful and thorough oral evaluation combined with head and neck examination can uncover a previously undiagnosed necrotic condition. The patient is often unaware of the exposed bone, which is relatively painless. Patients with complicated medical histories, who often are treated by multiple medical practitioners and prescribed multiple medications for different conditions, may require a similar bimodal treatment approach.