Are you confident in managing patients on bisphosphonates or biologics?

Which medications increase the risk of medication-related osteonecrosis of the jaw (MRONJ)?

How do you decide when to extract a tooth and when to refer to a specialist?

In this episode, Jaz is joined by oral surgery consultant Dr. Pippa Cullingham to explore the complexities of MRONJ. They break down the key risk factors, share expert advice on when to proceed with extractions, and discuss the latest guidelines for managing patients at risk.

They also discuss the importance of early assessment – by identifying at-risk teeth early, you can help prevent serious complications and ensure the best outcome for your patients.

Protrusive Dental Pearl: it is so important to assess patients before they start taking high-risk medications like bisphosphonates or biologics, using radiographs to identify potential issues. Extractions should ideally be done before medication starts to avoid complications, as MRONJ risk increases once treatment begins.

Key Takeaways:

• 
  
• Medication-related osteonecrosis of the jaw concerns medications other than bisphosphonates.
  
• Risk assessment is crucial when considering dental extractions for patients on certain medications.
  
• Guidelines from the Scottish Dental Clinical Effectiveness Partnership are valuable resources for dentists.
  
• Higher-risk patients require careful management and communication with their medical teams.
  
• Denosumab has a different risk profile compared to bisphosphonates.
  
• Patients on long-term bisphosphonates may still have risks even after stopping the medication.
  
• Dentists should feel empowered to manage certain extractions in primary care with proper guidance.
  
• The decision to extract a tooth should weigh the risks and benefits for the patient.
  
• Always assess the patient’s risk before extraction.
  
• Eight weeks is a critical time for assessing healing.
  
• Antibiotics are not recommended for preventing MRONJ in the UK.
  
• Radiotherapy history significantly impacts extraction risk.
  
• Referral to specialists may be necessary for high-risk patients.
  

Highlights of this episode:

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• 02:15 Protrusive Dental Pearl
  
• 03:52  Interview with Dr. Pippa Cullingham: Insights and Experiences
  
• 06:40 Medications and Their Risks
  
• 10:02 MRONJ: Incidence and Prevalence
  
• 13:13 Biologics and other medications
  
• 14:19 Guidelines and Best Practices
  
• 17:22 Managing High-Risk Patients
  
• 25:03 Prophylactic Antibiotics 
  
• 26:55 Risk Assessment
  
• 28:47 Radiotherapy & ORN Risk
  
• 31:49 Tips and Key Takeaways
  
• 33:32 New Medications & Prevention Strategies
  

For the best approach to managing MRONJ, check the SDCEP Guidelines and the American White Paper.

This episode is eligible for 0.5 CE credits via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes B and C.

AGD Subject Code: 730 ORAL MEDICINE, ORAL DIAGNOSIS, ORAL PATHOLOGY (Diagnosis, management and treatment of oral pathologies)

Dentists will be able to –

1. Be aware of the medications that increase the risk of MRONJ.

2. Learn how to assess the risk of MRONJ in patients, particularly before starting high-risk medications.

3. Understand when to proceed with extractions and when to refer patients to specialists for management.

If you liked this episode, check out PDP206 – White Patches