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MRONJ — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementMRONJORE Part 1

A 72-year-old woman with metastatic breast cancer has been receiving intravenous zoledronic acid for 2 years. She presents with exposed bone in the left posterior mandible that has been present for 10 weeks. There is no history of dental extraction. What is the most appropriate management?

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Correct answer: E — Refer to oral surgery or special care dentistry for specialist management of MRONJ

The patient meets the clinical definition of established MRONJ: exposed bone persisting >8 weeks in a patient on long-term IV zoledronic acid. UK guidance (SDCEP, NICE-accredited) mandates specialist referral for staged management of confirmed MRONJ. Option E is correct. Option C is wrong because debridement in primary care is inappropriate; established MRONJ requires specialist assessment and conservative pharmacological management (antibiotics, antiseptic agents) before any surgical intervention. Option B (antibiotic monotherapy) is insufficient without specialist staging and imaging. Option A contradicts evidence: medication holidays offer limited efficacy and patients should continue anti-resorptive therapy as oncological benefits outweigh MRONJ risk. Option D is dangerous: further dentoalveolar trauma (extraction) is a documented precipitating factor for MRONJ and is contraindicated.

Reference: SDCEP Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw (2017, reviewed March 2024). https://www.sdcep.org.uk/published-guidance/medication-related-osteonecrosis-of-the-jaw/