3
Coordination of Care
➤ For cancer patients scheduled to receive a BMA in a non-urgent
setting, oral care assessment (including a comprehensive dental,
periodontal, and oral radiographic exam when feasible to do
so) should be undertaken prior to initiating therapy. Based on
the assessment, a dental care plan should be developed and
implemented. The care plan should be coordinated between the
dentist and the oncologist to ensure that medically necessary dental
procedures are undertaken prior to initiation of the BMA. Follow-
up by the dentist should then be performed on a routine schedule
(e.g., every six months) once therapy with a BMA has commenced.
(Moderate Recommendation; EB-L/I)
Modifiable Risk Factors
➤ Members of the multidisciplinary team should address modifiable
risk factors for MRONJ with the patient as early as possible. These
risk factors include poor oral health, invasive dental procedures,
ill-fitting dentures, uncontrolled diabetes mellitus, and tobacco use.
(Moderate Recommendation; FC-Ins)
Elective Dentoalveolar Surgery
➤ Elective dentoalveolar surgical procedures (e.g., non-medically
necessary extractions, alveoloplasties, and implants) should not be
performed during active therapy with a BMA at an oncologic dose.
Exceptions may be considered when a dental specialist with expertise
in prevention and treatment of MRONJ has reviewed the benefits and
risks of the proposed invasive procedure with the patient and the
oncology team. (Moderate Recommendation; EB-I)
Dentoalveolar Surgery Follow-Up
➤ If dentoalveolar surgery is performed, patients should be evaluated by
the dental specialist on a systematic and frequently scheduled basis
(e.g., every 6-8 weeks) until full mucosal coverage of the surgical site
has occurred. Communication with the oncologist regarding status
of healing is encouraged particularly when considering future use of
BMA (Table 2). (Moderate Recommendation; FC-Ins)
Temporary Discontinuation of BMAs Drior to Dentoalveolar Surgery
➤ For patients with cancer who are receiving a BMA at an oncologic
dose, there is insufficient evidence to support or refute the need
for discontinuation of the BMA prior to dentoalveolar surgery.
Administration of the BMA may be deferred at the discretion of the
treating physician, in conjunction with discussion with the patient and
the oral health provider. (Weak Recommendation; IC-Ins)
Risk Reduction
