More about initial management

Management of patients at risk of MRONJ is not onerous or difficult.

The overall aim is to manage these patients in a way that maximises preventive regimes and minimises the need for subsequent extractions and bone trauma.

For some patients this may require a change in behaviour in terms of brushing, interdental cleaning and other oral hygiene techniques, as well as other lifestyle behaviours such as diet and tobacco use. There may also be a benefit in prescribing high fluoride toothpaste for those patients with increased caries risk.

However, if extractions or procedures that impact on bone are required, it is likely that these can be performed in the primary care setting.

There is no benefit in referring the patient to a specialist or to secondary care based purely on their exposure to anti-resorptive or anti-angiogenic drugs.

It is also likely to be in patients’ best interests to be treated wherever possible by their own GDP in familiar surroundings.