Guidance: Oral health management of patients prescribed bisphosphonates

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Patients taking bisphosphonates are at increased risk of oral health complications (Bisphosphonate-related Osteonecrosis of the Jaw – BONJ).

BONJ is defined as exposed, necrotic bone in the maxilla or mandible that has persisted for more than eight weeks in patients taking bisphosphonates and where there has been no history of radiation therapy to the jaw.

Symptoms include:

  • delayed healing following a dental extraction or other oral surgery
  • pain
  • soft tissue infection and swelling
  • numbness
  • paraesthesia
  • exposed bone.

Dentists are increasingly likely to see patients taking bisphosphonates because these drugs are being prescribed more often to prevent as well as to treat a wider variety of medical conditions.

This guidance has been developed by a mulidisciplinary team working with the Scottish Dental Clinical Effectiveness Programme.

The guidance document and patient advice leaflet can be downloaded from the Bisphosphonate page of the SDCEP ( Scottish Clinical Effectiveness Programme) website.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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