Sir, there has been guidance for dentists on the prevention of medication-related osteonecrosis of the jaws (MRONJ) for several years.1 Although this guidance also included information for prescribers and dispensers, it does not appear to have been widely disseminated. Indeed, only 4% of general medical practitioners in a Birmingham study were aware of MRONJ guidelines.2 I therefore welcome the publication by the Royal College of Physicians for the multi-disciplinary team.3

MRONJ is defined as exposed bone, or bone that can be probed through a fistula, in the maxilla or mandible, that has been present for more than eight weeks.4 It is an adverse side effect of anti-angiogenic or anti-resorptive medication.1,3 The incidence of MRONJ in patients who take these medications is reported as 1% in cancer patients and 0.1% in patients with metabolic bone disease.1

There have been instances of MRONJ occurring spontaneously, but it is most common following a dental extraction.1,3,4 Prevention of MRONJ involves pre-treatment screening, extraction of teeth with poor prognosis, adjustment of prostheses and education, including oral hygiene instruction and controlling risk factors such as smoking and alcohol. This has been shown to reduce the incidence of MRONJ by up to 50%.5

Dentists have reported poor communication with other healthcare professionals and often rely on patient recall for their medical history.6 The new guidance introduces dental alert cards which are to be carried by patients and shown to their dentists.3 Referral and reply letters between oncology, dentists and maxillofacial/oral surgeons have also been produced.

We should welcome and familiarise ourselves with these new methods of communication and remember to report all cases of suspected MRONJ to the MHRA.7Reducing the incidence of MRONJ will have financial benefit for the NHS, as this is a difficult condition to manage, and for severe cases may require surgery for debridement or resection.4