Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
Jaw pain / Swelling / Loosening of teeth / Exposed bone in the jaw (oral fistula) / Numbness in the jaw (depending on nerve involvement)
History of Present Illness:
Onset, duration, location, and severity of jaw pain.
Dental problems or recent dental procedures (e.g., tooth extraction).
Exposure to medications associated with MRONJ (bisphosphonates, denosumab).
Duration of medication use and reason for taking the medication.
Past Medical History:
Underlying medical conditions for which the patient is taking medications associated with MRONJ (e.g., osteoporosis, Paget’s disease of bone).
Previous history of jaw problems or surgeries.
Medical conditions that may affect jaw healing (e.g., diabetes, malnutrition).
Medications:
List all current medications, with particular emphasis on:
Bisphosphonates (e.g., alendronate, zoledronic acid)
Denosumab
Duration of use for these medications
Social History:
Inquire about smoking history (increases risk of MRONJ).
Dental hygiene practices.
Family History:
Not typically relevant for MRONJ.
Physical Exam:
Oral examination:
Look for signs of inflammation, erythema (redness), edema (swelling), exposed bone, and loosening of teeth.
Assess for purulence (pus) drainage from any openings in the jaw.
Extraoral examination: Evaluate for facial swelling and lymphadenopathy (swollen lymph nodes).
Imaging Studies:
Panoramic X-ray: Initial imaging study to assess for bone loss in the jaw.
Cone beam CT scan: Provides detailed 3D images of the jaw bones to evaluate the extent of bone involvement.
Laboratory Tests:
Not routinely required for diagnosis of MRONJ.
May be performed to rule out other conditions or assess for underlying medical issues.
Bone Biopsy (may be indicated in some cases):
Confirms the diagnosis of osteonecrosis and helps differentiate it from other infections or inflammatory conditions.
Assessment:
Medication-related osteonecrosis of the jaw (MRONJ): Based on clinical presentation, medication history, and imaging findings, suspect or confirm MRONJ.
Stage of MRONJ (if applicable): Depending on the extent and severity of bone involvement, stage the MRONJ using established criteria (e.g., AAOS staging system).
Plan:
Management approach depends on the stage of MRONJ:
Early stage: Discontinue the offending medication (if possible).
Conservative management with oral hygiene optimization, antibiotics for infection control, pain medications, and dental care to address loose teeth.
Advanced stage: May require surgical debridement of necrotic bone by an oral surgeon in collaboration with a maxillofacial surgeon.
Consideration of alternative medications for the underlying condition if possible.
Dental care: Referral to a dentist for dental hygiene education, management of existing dental problems, and avoidance of elective dental procedures that may worsen MRONJ.
Pain management: Prescribe medications to manage jaw pain.
Education:
Educate the patient about MRONJ, risk factors, symptoms, and the importance of maintaining good oral hygiene.
Discuss the need for regular dental follow-up and avoidance of elective dental procedures.
Provide information about potential long-term effects of MRONJ on jaw function and prosthetic dentistry options.
Disclaimer: This template is for informational purposes only and should be adapted to the specific needs of each patient. Medication-related osteonecrosis of the jaw is a serious complication of bisphosphonate and denosumab therapy. Early diagnosis and prompt management are crucial to prevent further bone loss and improve patient outcomes. It is recommended to consult with relevant medical resources and MRONJ management guidelines for comprehensive care planning, especially regarding medication discontinuation decisions for osteoporosis or Paget’s disease of bone.