Clinical decision-support only. For use by licensed dental professionals. Not a substitute for professional judgment or a complete drug reference. Always verify with primary sources.
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Medication

Denosumab

Antiresorptive (RANKL inhibitor monoclonal antibody)

Brand names: Prolia, Xgeva

Oral health effects

  • Medication-related osteonecrosis of the jaw (MRONJ)

    Exposed necrotic jawbone failing to heal within 8 weeks in a patient on antiresorptive/antiangiogenic therapy without head/neck radiation. Comparable MRONJ risk to bisphosphonates (higher with the oncologic Xgeva dosing). Unlike bisphosphonates its effect is NOT retained in bone, so risk may decline between doses: timing matters; consult the prescriber.

    Mechanism: Suppressed bone turnover (and/or reduced angiogenesis) impairs healing and remodeling of the jaws after trauma or extraction.

    Clinical management: Optimize oral health and complete invasive work before/early in therapy where possible; prefer non-surgical options and atraumatic technique; refer suspected MRONJ to oral surgery; coordinate with the prescriber.

Sources

  1. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws: 2022 Update. Ruggiero SL, Dodson TB, et al.. Journal of Oral and Maxillofacial Surgery, 2022.