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New guidance to help dental professionals manage medication-related osteonecrosis of the jaw


New guidance on the Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw is launched today by the Scottish Dental Clinical Effectiveness Programme (SDCEP). This is an update to the previous SDCEP Oral Health Management of Patients Prescribed Bisphosphonates guidance and considers the wider range of drugs that have been implicated in the development of medication-related osteonecrosis of the jaw (MRONJ).  The guidance provides recommendations, advice and other information to help dental practitioners to manage the routine dental care of patients prescribed these drugs.

Joint Chair of the SDCEP Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw guidance development group, Michaelina Macluskey, said:

"Medication-related osteonecrosis of the jaw (MRONJ) is a rare side-effect of treatment with certain drugs. This new guidance provides clear and practical advice on how to advise and care for patients prescribed these drugs, focused on the prevention of MRONJ. By following this guidance, practitioners can raise patient awareness of the potential health implications of taking these drugs and encourage measures to prevent dental disease, and therefore the need for dental treatment, at an early stage.”

Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw aims to help minimise the risk of MRONJ developing in patients taking anti-resorptive or anti-angiogenic drugs and to encourage a consistent approach to their oral health management. The guidance also aims to empower dental staff to provide routine dental care for this patient group within primary care thereby minimising the need for consultation and referral to secondary care. Copies of the Full Guidance and summary Guidance in Brief will be distributed to all dentists in Scotland. Both are also available via the SDCEP website ( along with tools to support the implementation of the guidance, including patient information leaflets. 

Fizz Thompson, Clinical Director of the National Osteoporosis Society said:

“We welcome this new guidance which makes it clear that, for people taking bisphosphonates and denosumab, the risk of medication-related osteonecrosis of the jaw (MRONJ) is very rare and dental treatments are safe for the vast majority of people. Both dentists and people with osteoporosis should feel reassured that there is no need to stop taking osteoporosis drugs or avoid dental treatment, even for those at higher risk who need to take these drugs for more than 5 years.”

SDCEP is a National Dental Advisory Committee (NDAC) initiative working within NHS Education for Scotland (NES). SDCEP supports improvements in the quality of dental care by providing user-friendly guidance on topics that are priorities for dental healthcare. For quality assurance and to ensure the guidance’s applicability to primary care, each guidance publication is subject to open consultation during which those affected by the guidance can provide feedback and inform its development.

Dr David Felix, Postgraduate Dental Dean for Scotland, said:

“NHS Education for Scotland welcomes the publication of Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw as a valuable resource for dental professionals in Scotland and beyond. The work of the Scottish Dental Clinical Effectiveness Programme (SDCEP) promotes the adoption of research evidence into clinical practice, thereby supporting the delivery of high quality healthcare which is safe, person-centred and effective.

Members of the development group involved in producing this guidance are to be congratulated on creating a useful addition to the suite of guidance produced by SDCEP."

Further information on the work of SDCEP is available at from where the new guidance can also be downloaded.




Further information from: Scottish Dental Clinical Effectiveness Programme, Dundee Dental Education Centre, Frankland Building, Small’s Wynd, Dundee, DD1 4HN (email: or telephone: 01382 425751)

Notes to Editors

NES is NHSScotland’s national education and training Board. We are responsible for supporting NHS services to the people of Scotland through the development and delivery of education and training for all those who work in NHSScotland. We work closely with a range of partners to deliver our vision of Quality Education for a Healthier Scotland

NES is responsible for the implementation of the workforce development aspects of the Scottish Government’s Dental Action Plan.

NICE has accredited the process used by the Scottish Dental Clinical Effectiveness Programme to produce its Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw guidance. Accreditation is valid for 5 years from 15 March 2016. More information on accreditation can be viewed at  

About the National Osteoporosis Society:

The National Osteoporosis Society is the only UK-wide charity dedicated to improving the prevention, diagnosis and treatment of osteoporosis and fragility fractures.

We offer free support and information to people affected by osteoporosis and fragility fractures, including a help-line that receives more than 13,000 enquiries a year. Anyone with questions about osteoporosis can call 0808 800 0035 or email

We are a charity, mainly funded by individual donations and legacies.  We do not receive money from the government.

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Ian Williamson on 0131 656 4367 or

Dom Hall on 01761 473148 or