<p>Medication-related osteonecrosis of the jaw (MRONJ) is a complication of antiresorptive and anti-angiogenic therapies used in the management of malignancy and can cause significant functional and aesthetic morbidity for patients. Multiple myeloma (MM) is a plasma-cell haematological malignancy frequently associated with osteolytic bone disease. Antiresorptive therapy (ART) reduces skeletal-related events in MM and other malignancies with skeletal involvement but is associated with an increased risk of MRONJ. This paper presents the clinical features and management of four MRONJ cases, ranging from localised exposed bone to severe maxillary and mandibular destruction, in MM patients who presented to the Dublin Dental University Hospital between 2021 and 2023. MRONJ management is challenging due to its refractory nature. As prevention is paramount, dental practitioners play a key role in minimising risk through comprehensive dental assessments and management before, during and after ART. Multidisciplinary collaboration between dental practitioners and oncology teams, alongside timely diagnosis and risk reduction, is essential to improve outcomes and minimise MRONJ-related complications. These cases are contextualised within current evidence on MRONJ in malignancy, focusing on implicated medications, risk factors, prognostic factors and treatment outcomes.</p>