Abstract: Medication-related osteonecrosis of the jaw (MRONJ) is a necrotic disease of the jaw induced by prolonged use of specific medications, primarily characterized by bone exposure, persistent pain, and non-healing wounds. Current evidence suggests that its pathogenesis may involve inhibition of bone remodeling, suppression of angiogenesis and microcirculation, disruption of the soft tissue barrier, and infection. Dysbiosis of the oral microbiota and complex polymicrobial infections play critical roles in the onset, progression, and chronicity of MRONJ. This review systematically summarizes the pathogenic mechanisms of microecological imbalance, the microbial profiles, detection methods, and microbe-related therapeutic strategies in MRONJ. It focuses on the complexity of microbe-drug interactions and outlines future research directions, aiming to provide a basis for precise clinical interventions.

Key words: medication-related osteonecrosis of the jaw, oral microbiome, biofilm, pathogenic microbiota, precision therapy