Managing the oral health of patients at risk of MRONJ

N.B. In the situation where a patient initially presents with an established history of anti-resorptive or anti-angiogenic drug use, follow the advice for extractions or other procedures which impact on bone in the lower section.

The upper section of this flowchart outlines the initial management of patients who are about to commence treatment with anti-resorptive or anti-angiogenic drugs, or those who have very recently started drug therapy.

The lower section outlines the management of patients who require an extraction or procedure which impacts on bone at a later stage in their drug treatment.