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Watts D. Fac Dent J 2015; 6: 126–129

Medication-related osteonecrosis of the jaw (MRONJ) refers to a condition 1) that comprises exposed necrotic bone, 2) has been present for more than eight weeks, and 3) is not associated with radiotherapy or metastatic disease. This literature review describes the link between periodontal disease and MRONJ. The introduction of putative periodontal pathogens and their endotoxins in both mice and rat models have been shown to cause MRONJ-type lesions. Nevertheless, it is difficult to draw firm conclusions because 'high dose of zoledronic acid (per se) may have resulted in MRONJ-like lesions irrespective of the presence of the periodontal disease.' Several human studies have shown that those patients who have MRONJ have more severe periodontal disease. The author cites a paper that suggests the following mechanism for this association; nitrogen-containing bisphosphonates could enhance the release of interleukins from macrophages infected with the periodontal pathogens Porphyromonas gingivalis and Tannerella forsythia.