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Medication-related osteonecrosis of the jaw: guidance for the oncology multidisciplinary team

This guidance has been produced by a multidisciplinary working party on behalf of the UK Chemotherapy Board which includes specialist representation from medical, dental and nursing teams across the UK.

It has been endorsed by the Clinical Standards Committee of the Faculty of Dental Surgery of the Royal College of Surgeons of England.

It is common practice in oncology to prescribe bone-modifying agents (BMAs) or anti-angiogenic drugs (AADs) for a range of cancers. The association of these drugs in medication-related osteonecrosis of the jaw (MRONJ) has led to a wealth of published guidance. However, much of this guidance is focused and weighted towards the dental specialty with minimal information to assist oncologists. As regular prescribers of these medications, it is essential that appropriate information in both preventing and managing MRONJ is available for responsible treatment planning. Hence, this guidance has been assembled to aid oncologists and the wider team in understanding the condition and subsequently provide optimum clinical care.

In summary, the guidance focuses on all aspects of MRONJ in relation to oncology patients. It aims to fulfil three functions:

  • Primarily, it is a single source of collective information for oncology teams focused around the prevention and management of MRONJ.
  • Secondly, it proposes protocols that oncology departments can adapt and amend accordingly to fit local delivery of services.
  • Thirdly, it provides a series of simple communication adjuncts that can be adapted to assist communication between the oncology multidisciplinary team, patients, dental practitioners and hospital dental specialists.

Collaboration between the cancer care team, dentists and dental specialists is repeatedly emphasised and encouraged throughout the guidance.

A number of proformas accompany the guidance – these are editable PDFs which can be completed electronically.