NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Bisphosphonates: Oral Health

Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw– new guidance and the role of prescribers and dispensers

 

Patients who are taking anti-resorptive or anti-angiogenic drugs have a small risk of developing medication-related osteonecrosis of the jaw (MRONJ). This condition may be more prevalent in patients who have dental procedures which impact on bone, for example dental extractions.

The Scottish Dental Clinical Effectiveness Programme (SDCEP) has produced advice for doctors and pharmacists caring for patients who take bisphosphonates or other relevant medicines. They can play a key role in ensuring that patients are aware of the need to inform their dentist about their medical condition and the drugs they are taking. The full guidance includes patient information leaflets and an information sheet detailing the recommendations which are specific to prescribers and dispensers.

 

Key points for doctors and pharmacists

 Advise patients starting treatment with anti-resorptive or anti-angiogenic drugs that there is a risk of MRONJ.

  • Bisphosphonates: alendronic acid, ibandronic acid, pamidronate disodium, risedronate sodium, sodium clodronate, zoledronic acid
  • RANKL Inhibitor: denosumab
  • Anti-angiogenic: bevacizumab, sunitinib, aflibercept
  • Advise patients to make an appointment for a dental examination as soon as possible to ensure that they are dentally fit. The patient should tell their dentist about the medication they are taking. Patient information leaflets are available to assist in this communication.
  • Patients with cancer should preferably undergo a thorough dental assessment, with remedial dental treatment where required, before starting drug therapy. These patients are at a higher risk of MRONJ.
  • Dentists may in some cases need to seek clarification of a patient’s health condition or medications from the patient’s GP or medical specialist.

 

Key points for dentists

To help dentists provide appropriate dental care for this patient group, new guidance on the Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw was published in March 2017 by SDCEP. The guidance provides recommendations, advice and information to help dental practitioners manage the routine dental care of patients prescribed drugs associated with MRONJ. This guidance is an update to the previous SDCEP Oral Health Management of Patients Prescribed Bisphosphonates guidance.  

Dental practitioners should assess a patient’s risk of MRONJ based on their medical condition, type and duration of drug therapy and any other complicating factors. This requires the dental practitioner to be aware that the patient is taking one or more of these medications and to also know details of the patient’s medical condition, duration of drug treatment and any other medications that the patient may be taking. The guidance also recommends that before commencement of treatment with these drugs, or as soon as possible thereafter, the patient should undergo a thorough dental assessment, with remedial dental treatment where required.

 

 

 

Published 19/05/2017