Why have I been given this leaflet?
You have been given this leaflet because you have told your dentist/ doctor that you take certain medications.
These medications may be given for osteoporosis, bone diseases or as part of cancer treatment. The drugs can be taken as tablets or given as a drip/injection. You may only have it once a year.
One of the side-effects of these drugs is the way it affects jaw bone healing leading to a condition called Medication Related Osteonecrosis of the Jaw (MRONJ)
What is MRONJ?
MRONJ is a rare condition in which some bone in the jaw becomes exposed. This can occur randomly or following certain dental treatments. Most commonly it occurs after dental extractions, dental implants or as a result of poorly fitting dentures.
MRONJ can be painful and is difficult to manage. Currently there is no cure.
Am I likely to get MRONJ?
The risk of developing MRONJ is low, but can be affected by a few different things:
Why you are taking the medicine:
- If you are taking the medicine to treat or prevent osteoporosis then your risk is very low, between 1 in 1000 and 1 in 10,000.
- If you are taking the medicine to manage cancer your risk is higher, but still only around 1 in 100.
- If you are taking the medicine for myeloma there is evidence your risk is higher than other groups, around 3 in 100.
How long you have been taking the medicine for:
- If you take the medicine for osteoporosis and have been taking it for five years or more then your risk will increase but remains low.
Having a tooth removed, or having surgery in your mouth:
- Most cases of MRONJ occur after a dental extraction. This is why it is best to avoid unnecessary dental extractions and surgery if you are at risk of MRONJ. Sometimes if a tooth is painful or infected extraction is the only option
Other risk factors
These things can increase your risk of getting MRONJ:
Untreated: dental disease, gum disease and poor oral hygiene.
Loose dentures: dentures rubbing on your gum might make MRONJ more likely.
Smoking.
Diabetes: Poorly controlled diabetes may increase your risk of getting MRONJ.
Steroids: taking steroid medicines such as prednisolone or hydrocortisone may increase your risk of getting MRONJ.
What are the risks associated with dental treatment?
The risk is very low to non-existent for most ordinary treatments such as fillings. The risk is increased if you need treatment that affects bone (like a tooth extraction) but is still considered low.
You are at greater risk of problems if you do not treat dental disease. Smoking, sugar and excessive alcohol can all increase the risk of developing some dental diseases.
How can I reduce my risk?
Remember, MRONJ is uncommon.
Looking after your oral health will reduce your risk even more.
Should I stop taking the drug?
No, you should continue to take your medication as the medical benefits are likely to far outweigh the risks.
Remember, MRONJ is uncommon.
The benefits of taking the drugs you have been prescribed far outweigh the risks.
Are there signs and symptoms I should look out for?
It is particularly important to look out for these signs and symptoms if you have had recent dental treatment but remember MRONJ can occur without any dental treatment
- Exposed bone in your jaw.
- Feeling of tingling, numbness, heaviness or other unusual sensations around the jaw.
- Pain in your jaw or a bad taste.
- Swelling of your jaw.
- Pus or discharge in your mouth.
- Loose teeth
You should contact your dentist immediately if you notice any of the above symptoms.
After a dental extraction or surgery to the jaw
You will be reviewed after around eight weeks to check that healing is complete. If you are concerned something is not right with your healing contact us for an earlier appointment.
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Below is a list of the most commonly prescribed drugs known to be associated with MRONJ.
You may not be on any of the drugs below but your dentist or doctor will tell you which medications you are taking that carry a risk.
Where can I find out more information?
The information within this leaflet is based upon the Scottish Dental Clinical Effectiveness (SDCEP) Dental Clinical Guidance and Patient Information Leaflets regarding the Oral Health Management of Patients at Risk of MRONJ (March 2017).
Other resources:
National Osteoporosis Society www.nos.org.uk
Paget’s Association www.paget.org.uk
Cancer Research UK www.cancerresearchuk.org
Myeloma UK www.myeloma.org.uk
Prostate Cancer UK www.prostatecanceruk.org
Breast Cancer Care www.breastcancercare.org.uk
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