Dental interventions in patients taking anti-resorptive medication for the treatment of osteoporosis and other bone disease: an audit of current practice in the Dublin Dental University Hospital

Medication-related osteonecrosis of the jaws (MRONJ) is a well-established complication of anti-resorptive and, more recently, anti-angiogenic therapy. The dental profession has a pivotal role to play in the prevention and management of this debilitating condition, and all dentists have a responsibility to remain cognisant of national and international best practice guidelines in the prevention of this disease process. The management of patients in the Dublin Dental University Hospital at risk of MRONJ when carrying out dental interventions was audited against nationally- and internationally-published guidelines.
The results of the audit showed compliance with the national and international guidance in 5% and 0% of cases, respectively. The most common measures implemented in the management of patients at risk of MRONJ were: preoperative antibiotics in 49% of cases; preoperative chlorhexidine mouthwash in 76%; plain local anaesthetic in 51%; and, post-operative antibiotics in 80%.
In conclusion, we found a low level of absolute compliance to both guidelines included in this audit. This highlights a need to re-examine the evidence underpinning these guidelines to ensure best practice patient care. Early recommendations have been made based on the findings of this audit, which will help to maximise its impact on clinical care delivery and generate discussion to stimulate and support action planning. Guidelines that are not followed are indicative of differing clinical opinions, highlighting the need for clarification and guidance as our understanding of this pathological entity broadens.

Journal of the Irish Dental Association 2017; 63 (5): 263-268

Dr Cían J. Henry
BA BDentSc(Hons) MFD RCSI
Senior House Officer, NCHD Department, Dublin Dental University Hospital.

Dr Rory O’Reilly

BA BDentSc(Hons) DipPCD RCSI
Junior House Officer, NCHD Department, Dublin Dental University Hospital.

Prof. Leo F.A. Stassen
FRCSI FDS RCS MA FTCD FFSEM FFD RCSI FICD
Professor/Chair Oral and Maxillofacial Surgery, Trinity College Dublin, National Maxillofacial Unit, St James’s Hospital

Corresponding author: Cían J. Henry, NCHD Department, Dublin Dental University Hospital, Lincoln Place, Dublin 2.
E: henryci@tcd.ie