Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw
Published March 2017
Downloads
- Full Guidance – provides comprehensive background information, recommendations and practical advice. An accessible version (Word) is also available.
- Guidance in Brief – summarises the main recommendations from the full guidance. An accessible version (Word) is also available.
- Guidance for Prescribers and Dispensers – highlights the recommendations relevant to those who prescribe and dispense anti-resorptive and anti-angiogenic drugs. An accessible version (Word) is also available.
Also 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 
Medication-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:
- Information Leaflets for Patients – these may be used to provide information to patients prescribed anti-resorptive or anti-angiogenic drugs and as the basis for further discussion:
- Dental advice for patients prescribed anti-resorptive drugs for the treatment of osteoporosis or other non-malignant diseases of bone. An accessible version (Word) is also available;
- Dental advice for patients prescribed anti-resorptive or anti-angiogenic drugs for the treatment of cancer. An accessible version (Word) is also available;
- Risk Assessment Flowchart – a stand-alone, printable version of the flowchart from Section 3 of the guidance;
- Managing the Health of Patients at Risk of MRONJ – a stand-alone, printable version of the flowchart from Appendix 3 of the guidance;
- Powerpoint Slide Set – a summary of the key messages from the guidance.
- List of Drugs Associated with MRONJ – a current list of the drugs with an MHRA Drug Safety Update for MRONJ.
Printed copies of the Full Guidance and Guidance in Brief are available. Click here for order details.
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 document. For further information on the SDCEP guidance development process please click here 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 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.