Management of Medication-related Osteonecrosis of the Jaw (MRONJ) risk in patients due to commence anti-resorptive/anti-angiogenic drugs – how should pre-drug-treatment dental preventive care be organised?

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) can be difficult to treat and causes significant morbidity, but is largely preventable. Published guidelines strongly recommend dental assessment and necessary remedial treatment before such drugs are commenced. Specific guidance on who should provide or arrange this care is lacking, and it may often be delegated to the patient arranging it with their own dentist. However, numerous factors can make this difficult. Aims: To review published strategies for organising timely and effective dental preventive care in patients due to be prescribed MRONJ-associated drugs. Results: 13 studies were identified giving some detail of formal dental assessment setup. Two comprised a primary care dentist-led service, one a hospital assessment with most treatment in primary care and the remainder a hospital-based service from dental staff with or without dental specialists and input from medical and allied professionals. Follow-up varied from none to the period of drug use. Most studies reported the effectiveness of the service in reducing MRONJ incidence. Discussion: Details of the organisation of dental assessment/treatment are incomplete in most studies. Direct comparison is difficult. However, promising strategies to prevent MRONJ have been demonstrated. Conclusion: There exists a large and growing group at risk of MRONJ who have significant amounts of oral disease. However, the risk of the condition is largely preventable. Promise is shown in several methods to organise timely dental care before treatment.