Dental assessment pro forma for adult patients at risk of medication-related osteonecrosis of the jaw

Abstract

This paper introduces a dental screening pro forma designed for the dental assessment of adult patients who are starting or currently taking medications that pose them at risk of medication-related osteonecrosis of the jaw (MRONJ). Medications considered are those with current Drug Safety Update alerts for MRONJ from the Medications and Healthcare products Regulatory Agency. These include anti-resorptive drugs and some anti-angiogenic drugs. Patients taking these medications face a risk of osteonecrosis from certain dental procedures, dental pathology or chronic trauma. Although rare, MRONJ is difficult to manage once it occurs and can significantly affect a patient's quality of life. The pro forma aligns with national guidance from the Scottish Dental Clinical Effectiveness Programme and The National Institute for Health and Care Excellence, emphasising prevention, risk assessment and tailored oral health management. The pro forma captures information led by the guidance and presents it in a format to enable ongoing auditing and quality improvement. In addition to its diagnostic and monitoring functions, it also has a prevention focus. This aims to help reduce the future need for dental treatment and therefore the likelihood of medication-related osteonecrosis, due to the long-lasting effects of some anti-resorptive drugs. The pro forma is currently implemented in University Hospital Bristol and Weston Primary Care Dental Service, Bristol Dental Hospital and Wiltshire Primary Care Dental Service. It could also be adapted for use in general dental practice or used as a template for referrals.