Medication related osteonecrosis of the jaw (MRONJ) is a serious complication sequela from the treatment with drugs that are primarily used to prevent skeletal events associated with bony metastases or osteoporosis.

This patient has multiple myeloma, treated with weekly medication of bortezomib and history of intravenous bisphosphonate/zolcdronic acid, which are the drugs highly associated with MRONJ.

Dental check up before and after treatment are mandatory. Patients must be aware about the risk of this condition and report immediately if presence of any oral symptoms to physicians.

Imaging features for MRONJ are osteosclerosis, osteolysis, sequestration, periosteal proliferation or soft tissue inflammation.

Top differential diagnosis to be discerned from MRONJ is osteoradionecrosis, which are indistinguishable from imaging point of view. But those patients with osteroradionecrosis would have history of radiotherapy in the concerned area.