Recommendations

Continuing Management

Refer to Section 4.2 of the full guidance.

This covers the management of patients who have an established anti-resorptive or anti-angiogenic drug regimen and, for most patients, describes the care required following initial management.

Key recommendation

Carry out all routine dental treatment as normal and continue to provide personalised preventive advice in primary care.

  • Perform straightforward extractions and other bone-impacting treatments in low risk patients in primary care.
  • Adopt a more conservative approach in higher risk patients, giving greater consideration to other, less invasive alternative treatment options before performing extractions and other bone-impacting treatments in primary care.
  • Do not prescribe antibiotic or antiseptic prophylaxis following extractions or other bone-impacting treatments specifically to reduce the risk of MRONJ.
    (Strong recommendation; low quality evidence)

Flowchart which summarisies the oral health management of patients at risk of MRONJ

  • Treat routinely for scale and polish, simple restorations, recall and radiological review.
  • If an extraction or any oral surgery or procedure that impacts on bone is necessary, discuss the risk of the procedure with the patient (or carer, where appropriate) to ensure valid consent and follow the recommended management strategy based on their allocated risk group below.
    Low risk Higher risk
    Perform straightforward extractions and procedures that may impact on bone in primary care. Explore all possible alternatives to extraction where teeth could potentially be retained e.g. retaining roots in absence of infection.
      If extraction remains the most appropriate treatment, proceed as for low risk patients.
  • Do not prescribe antibiotic or antiseptic prophylaxis unless required for other clinical reasons. 
  • Advise the patient to contact the practice if they have any concerns, such as unexpected pain, tingling, numbness, altered sensation or swelling in the extraction area.
  • Review healing. If the extraction socket is not healed at 8 weeks and you suspect that the patient has MRONJ, refer to an oral surgery/special care dentistry specialist as per local protocols.
  • If you suspect a patient has spontaneous MRONJ, refer to an oral surgery/special care dentistry specialist as per local protocols.