December 2019

Volume 36, Issue 4

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?

Authors: Ben J Steel
doi: 10.1922/CDH_4582Steel11

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. Keywords: Oral health, older adults, prevention, osteonecrosis

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Other articles in this issue

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Geographic distribution of dental specialists permitted to advertise dental practices in Japan 241-244 Download
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? 245-255 Download
Differences between caregiver-perceived and dentist-assessed oral health status of patients among intellectual disabilities 256-262 Download
What is health economics? 263-275 Download
Oral function and vertical jump height among healthy older people in Japan 276-280 Download
Social gradients in dental attendance among older adults: Findings from the National Survey on Demographics and Health in Peru 281-286 Download
Child involvement in oral health education interventions - a systematic review of randomised controlled studies 287-293 Download
Association between psychological distress and chronic periodontitis in Sri Lankan adults 294-298 Download
Malocclusion, facial and psychological predictors of quality of life in adolescents 298-302 Download

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