Medication:  Coumadin   Plavix   Pradaxa Xarelto Eliquis  Aspirin  Antineoplastics     any blood thinners including garlic

Diseases:    Liver diseases

Conditions:  Clotting issues

Smoker?          Dry Mouth?         Birth control?

Diseases:     Diabetes      Renal Disease     COPD     Congestive heart failure     HIV

Connective Tissue Diseases like     RA    Sjogren’s Syndrome

History of:  Multiple myeloma, Bone metastasist, osteoporosis, radiation therapy in head or neck, chemotherapy, organ transplant.

Antiangiogenic agent? Cancer or macular degeneration drugs like Sunitinib (Sutent) Bevacizumab (Avastin) Aflibercept (Zaltrap, Eylea) JADA 2022 Aminoshariae

Examples of these therapies include anti-angiogenics such as monoclonal antibodies (mAbs), tyrosine kinase inhibitors (TKIs),⁵ mammalian target of rapamycin (mTOR) inhibitors,⁶ radiopharmaceuticals⁷ and demethylation agents.⁸

Immunomodulators have also been linked to the development of MRONJ, including TNF-α inhibitors, IL-17 inhibitors and IL-23 inhibitors, and IL-6 inhibitors. These medications play a crucial role in treating a wide range of autoimmune and inflammatory disorders by dampening excessive immune activity that leads to inflammation and tissue damage in conditions such as rheumatoid arthritis (RA), psoriatic arthritis, Crohn’s disease, ulcerative colitis, and psoriasis.⁹ Medications used to manage bone density and inflammation in osteoporosis, such as selective oestrogen receptor modulators (SORMs) and corticosteroids, have also been linked to the development of MRONJ. Medications related to osteonecrosis of the jaw independent of bisphosphonates and denosumab

Immunosuppressive drugs? Enbrel Humira, cyclosporine, methotrexate (Rheumatrex, Trexall, Otrexup (PF), Xatmep)

Steroids? cortisone, hydrocortisone, prednisone, other

SSRI or antidepressants? circle all citalopram Celexa, escitalopram Lexapro, fluoxetine Prozac, fluvoxamine Luvox,    paroxetine Paxil, sertraline Zoloft, Desvenlafaxine Pristiq, Duloxetine Cymbalta, Levomilnacipran Fetzima, Milnacipran Savella, Venlafaxine Effexor

Proton pump inhibitors omeprazole (Prilosec, Yosprala, Zegerid ) lansoprazole (Prevacid), dexlansoprazole (Dexilent), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Vimovo, Nexium)

Bone healing or strengthening pills or shots = Bisphosphates? taken for osteoporosis, Paget’s disease, multiple myeloma, hypercalcemia, and metastatic breast cancer and prostate cancer
Oral

• Alendronate (Fosamax, Alendro)
• Risedronate (Actonel)
• Ibandronate (Boniva)
• Atelvia Skelid (tiludronate) This one OK
• Tiludronate (Skelid) This one OK

Intravenous

• Pamidronate (Aredia, Pamisol) worst
• Zolendronic acid (Zometa, Reclast) worst
• Ibandronate (Boniva IV)
• Clodronate (Bonefos) This one OK

Subcutaneous

•  Denosumab monoclonal Ig Ab (Prolia, XGEVA=like IV). Prolia patients should be treated the way we treat ORAL Bisphosphonate patients as their risk is very low, likely less than .5% Watts 2019 JCEM. Xgeva patients should be treated the way we treat IV Bisphosphonate Patients. The effects do reverse with time from Denosumab.

History of cancer?  What type?  Do you know what treatments you were given?

Synthetic joints?

Shunts?

Congential heart defects?

History of C. diff. infection?

Allergic to any Medication?  Penicillin? 

FYI  Bisphosphonates can be classified into 2 categories: non-nitrogen containing and nitrogen containing bisphosphonates. Nitrogen-containing bisphosphonates are the only compounds that cause BP-related osteonecrosis. Reference

Treatment of BP patient OS and implant