How can the “MRONJ” syndrome be prevented after tooth extraction in oncology or osteoporosis patients using antiresorptive drugs (bisphosphonates)?

Bisphosphonate drugs (such as Zometa, Fosamax) or targeted therapies containing denosumab completely block bone-destroying cells (osteoclasts) to prevent bone loss or stop cancer metastasis to the bone. When a tooth is extracted in a patient using these drugs, the extraction socket does not close for months because the bone’s self-renewal and healing mechanism stops, and the bone decays and dies in the mouth; this condition is called MRONJ (Drug-Induced Necrosis of the Jaw). To prevent this, if the patient is taking these drugs intravenously (IV) in high doses, tooth extraction should never be performed unless absolutely necessary, and the tooth should be kept in the mouth with root canal treatment. For oral ingestion, it is essential to interrupt the medication under the supervision of a physician (drug holiday), minimize bone trauma during extraction, completely close the wound with sutures, and use strong antibiotic and chlorhexidine mouthwashes after the procedure.