Guidance for prescribers and dispensers

You will be aware that anti-resorptive or anti-angiogenic therapy involves a small increased risk of medication-related osteonecrosis of the jaw (MRONJ) and that patients should maintain good oral health to minimise this risk.

Patients who are being prescribed anti-resorptive or anti-angiogenic drugs for the management of cancer should preferably undergo a thorough dental assessment, with remedial dental treatment where required, prior to commencement of the drug therapy.

In addition, the bisphosphonates can cause damage to the oral mucosa therefore it is important that patients (or carers where appropriate) are aware of the need to follow the instructions for administration of these drugs.

  • At the commencement of treatment with anti-resorptive or anti-angiogenic drugs, advise the patient (or carer where appropriate):
    • That the medication they have just been given is associated with a small risk of MRONJ
    • To make an appointment with a dentist as soon as possible to ensure they are dentally fit (this includes patients who have dentures)
    • To tell their dentist that they are taking the medication
  • Due to the risk of damage to the oral mucosa, advise patients who are prescribed an oral bisphosphonate not to hold the tablet in the mouth and to follow the instructions for administration included in the drug information leaflet.
    • Consider prescribing alternatives to oral bisphosphonates for patients with a poor swallow reflex or swallowing difficulties

If needed, information about how to find a dentist can be found at, or by phoning the local NHS Health Board.