MRONJ Linked to Higher Risk of Acute Periapical Abscesses: Study
A new large-scale study published in the American Journal of Dentistry found that patients with medication-related osteonecrosis of the jaw face an increased risk of acute periapical abscesses (PAs). Therefore regular dental visits and improved oral hygiene are essential for early diagnosis and management of dental pathology in this population.
This research examined electronic health data from 1,799,122 patients who visited a major U.S. medical facility. Using diagnostic codes, they identified cases of MRONJ and acute PAs, and then conducted statistical analyses to determine the likelihood of MRONJ occurring in patients presenting with these dental infections. Odds ratios (ORs) were calculated, with adjustments made for co-morbidities such as diabetes and smoking.
The study revealed that patients suffering from acute periapical abscesses were far more likely to also develop MRONJ when compared to the broader hospital population. Overall, patients taking any type of bisphosphonate which are commonly prescribed to strengthen bones, were over 6-times more likely (OR 6.21, P<0.0001) to develop MRONJ when presenting with a PA.
Among specific medications, alendronate users showed a particularly strong association, with a more than five-fold increased risk (OR 5.33, P=0.0001). After controlling for diabetes, the odds remained significantly elevated at OR 5.33, while adjusting for smoking still yielded a strong association of OR 4.44. Both findings remained statistically significant.
The consistent strength of the association, regardless of other health factors, underscores that PAs may play a direct role in triggering or exacerbating MRONJ in susceptible patients. For oral healthcare providers, the message is clear: patients who are on bisphosphonates and present with acute PAs should be considered at higher risk for MRONJ. Prompt diagnosis and management of dental infections may reduce the likelihood of serious jaw complications.
Overall, the findings of this study stress that preventive strategies are key. Enhanced oral hygiene routines, regular dental check-ups, and early treatment of dental pathoses could substantially lower the incidence of MRONJ in vulnerable groups.
MRONJ is a painful and often debilitating condition where the jawbone fails to heal properly after minor trauma or infection, leading to bone exposure and necrosis. With bisphosphonate prescriptions remaining common for osteoporosis and cancer-related bone conditions, understanding the dental risk factors is vital for patient safety.
Source:
Katz, J., & Rotstein, I. (2025). Acute periapical abscesses may be a risk factor for medication-related osteonecrosis of the jaw. American Journal of Dentistry, 38(4), 169-172.
