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Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw

Cover sheet of guidance of Medication-related Osteonecrosis of the Jaw Published March 2017


Three Smartphones using SDCEP Dental Companion AppAlso available via the SDCEP Dental Companion app.

NICE has accredited the process used by the Scottish Dental Clinical Effectiveness Programme to produce its Oral Health Management of Patients at Risk of NICE accredited logoMedication-related Osteonecrosis of the Jaw guidance. Accreditation is valid for 5 years from 15 March 2016. More information on accreditation can be viewed at www.nice.org.uk/accreditation. Further information about NICE accreditation of SDCEP guidance can be viewed at NICE Accreditation.

Supporting tools
A number of supporting tools are included with the full guidance to assist the dental team to implement the guidance recommendations. These are available for download and printing:


Printed copies of the Full Guidance and Guidance in Brief are available.

About this guidance

There is an increased risk of oral health complications for patients prescribed anti-resorptive or anti-angiogenic drugs (medication-related osteonecrosis of the jaw, MRONJ). This guidance provides recommendations, advice and information to help dental practitioners manage the routine dental care of patients prescribed these drugs and is an update to the previous SDCEP Oral Health Management of Patients Prescribed Bisphosphonates guidance.

The guidance is aimed primarily at dentists in primary care dental practice and will also be of relevance to the secondary care dental service, those involved in dental education and undergraduate trainees. The guidance is also of relevance to prescribers and dispensers of bisphosphonates and to patients.

Guidance development

The guidance is based on a review of available evidence and the opinion of dental and medical experts and experienced practitioners and has been subject to open consultation prior to finalising for publication. The methodology used for the development of this guidance, including details of the evidence search strategy, evidence appraisals and information about conflict of interests can be found in the Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw Guidance Development Methodology (PDF). Further information on the SDCEP guidance development process is available or contact the SDCEP office (scottishdental.cep@nes.scot.nhs.uk).

During the development process, potential barriers to the implementation of this guidance were identified. A Guidance Implementation Summary (PDF) of information about these is provided. For further details visit the TRiaDS website.

Guidance Development Group

A multidisciplinary Guidance Development Group, consisting of individuals from a range of branches of the dental and medical professions together with two patient representatives, was convened to develop and write this guidance, assisted by our Programme Development Team.

Name Position
Michaelina Macluskey (Co-Chair) Senior Lecturer/Honorary Consultant Oral Surgeon, Dundee Dental Hospital and School
Stephanie Sammut (Co-Chair) Consultant in Oral Surgery, Dundee Dental Hospital and School
Alexander Crighton Consultant in Oral Medicine, University of Glasgow Dental Hospital and School
Helen Devennie Specialist Practitioner (Medically Compromised and Oral Surgery), Inverness Dental Centre
Elizabeth Foster Patient Representative
Karen Gordon Consultant in Special Care Dentistry, Edinburgh
Duncan Gowans Consultant Haematologist, Ninewells Hospital, Dundee; Perth Royal Infirmary
Vicki Greig Specialty Registrar in Oral Surgery, NHS Greater Glasgow and Clyde
Doris Hunter Patient Representative
Douglas Kennedy Consultant in Oral & Maxillofacial Surgery, NHS Tayside
Pamela Kidd General Dental Practitioner, Glasgow
Penny Lockwood General Medical Practitioner, Dundee; Honorary Senior Clinical Lecturer, University of Dundee
Nick Malden Consultant in Oral Surgery, Edinburgh Dental Institute
Anna Macdonald Senior Dental Officer, Specialist in Special Care Dentistry, Perth
Gillian Nevin General Dental Practitioner, Coupar Angus; Assistant Director of Postgraduate GDP Education, NHS Education for Scotland
Terence O’Neill Professor of Rheumatology and Clinical Epidemiology, University of Manchester; Member of Clinical & Scientific Committee, National Osteoporosis Society
David Reid Emeritus Professor of Rheumatology, University of Aberdeen
Andrew Wight General Dental Practitioner, Dundee

Review and updating

A review of the context of this guidance (regulations, legislation, trends in working practices, experience and evidence) will take place five years after publication and, if this has changed significantly, the guidance will be updated accordingly.