Maintaining optimal oral health

Ensuring optimal oral health by implementing early dental assessment and initiation of appropriate dental care reduces the incidence of medication-related osteonecrosis of the jaw.

If a medical practitioner refers a patient for dental assessment before or shortly after starting an antiresorptive drug or romosozumab, the dentist should undertake a comprehensive oral examination including pulp tests and radiographs. The dentist should ensure that the patient is dentally fit and unlikely to require extractions in the foreseeable future. The dentist should eliminate dental caries (eg extractions, restorations), establish a healthy periodontium (eg debridement, extractions), and encourage good oral hygiene.

If possible, any necessary bone-invasive dental treatment should be completed before or shortly after starting antiresorptive therapy for osteoporosis (eg within 6 months)—the risk of medication-related osteonecrosis of the jaw in patients with osteoporosis remains low in the early stage of treatment. Patients with cancer who are prescribed high doses of antiresorptive drugs are at greater risk of medication-related osteonecrosis of the jaw, so ideally dental procedures should be completed before starting treatment.

For patients treated with romosozumab, there is insufficient evidence to inform the optimal approach to bone-invasive dental treatment; however, consider that patients using romosozumab will have a history of antiresorptive drug use.

Regular dental review is essential to monitor oral health (eg clinical oral examinations, radiographs), particularly if the patient has a history of periodontal disease. Advise patients to seek early management of oral or dental symptoms and, if worn, ensure optimal fit for dentures.

Effective communication between treating dentists and medical practitioners is essential. Inform and involve the patient in treatment decisions.