Both non-surgical dental treatment and extractions increase the risk of medication-related osteonecrosis of the jaw: case-control study

  • Kelly McGowanEmail author
  • Robert S. Ware
  • Caroline Acton
  • Saso Ivanovski
  • Newell W. Johnson
Original Article



Medication-related osteonecrosis of the jaws (MRONJ) is a serious condition whose risk factors remain unclear. The aim of this study is to investigate the role of oral health and of dental treatment in the development of MRONJ.

Materials and methods

A case-control study was conducted in Brisbane, Australia. Hospital records were used to identify incident cases of MRONJ between January 2010 and March 2017. Cases were individually matched to up to 3 controls according to age, sex, primary disease, and type of antiresorptive therapy. Demographic data, medical histories and public dental records were collected. Associations between oral health, dental treatment, and MRONJ were investigated using conditional logistic regression.


Overall, 44 cases were identified and matched to 115 controls (total sample = 159). Only one-third of patients received a dental examination in the year prior to commencing antiresorptive therapy (27% of cases and 34% of controls). After adjusting for potentially confounding variables, non-surgical dental treatment (OR = 6.3; 95% CI = 2.1, 19.1; p < 0.001) and dental extractions (OR = 8.0; 95% CI = 3.0, 21.0, p < 0.001) were significantly associated with development of MRONJ.


Current levels of preventative dental care are insufficient to eliminate the need for dental treatment and extractions during antiresorptive therapy, and the consequent increase in risk of MRONJ.

Clinical relevance

Optimizing the health of the oral cavity and ongoing preventative dental care must be a priority for patients prior to the initiation of antiresorptive medications.


Risk assessment Bone density conservation agents Cancer Osteoporosis Dental procedure Preventative dentistry 


Compliance with ethical standards

Conflict of interest

K McGowan has received a speaker honorarium from Eli Lilly. RS Ware declares that he has no conflict of interest. C Acton declares that she has no conflict of interest. S Ivanovski declares that he has no conflict of interest. NW Johnson declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

784_2019_2828_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 23.0 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Dentistry and Oral HealthGriffith UniversitySouthportAustralia
  2. 2.School of DentistryUniversity of QueenslandHerstonAustralia
  3. 3.Menzies Health Institute QueenslandGriffith UniversitySouthportAustralia
  4. 4.Oral and Maxillofacial Surgery DepartmentRoyal Brisbane and Women’s HospitalHerstonAustralia
  5. 5.Dental InstituteKing’s College LondonLondonUK

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