MRONJ Loose Teeth Management — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementMRONJ Loose Teeth ManagementORE Part 1

A patient with established bisphosphonate-related medication-related osteonecrosis of the jaw presents with mobile teeth adjacent to an area of exposed bone. What is the most appropriate management in primary dental care?

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Correct answer: E — Arrange specialist assessment before deciding on tooth removal

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

The correct answer is A. Established MRONJ requires referral to an oral surgery or special care dentistry specialist under local protocols. Mobility next to exposed necrotic bone may reflect disease involvement; therefore, extraction should not be undertaken independently in primary care simply because the teeth are loose. Specialist assessment determines diagnosis, disease staging and whether conservative or surgical management is indicated. Removing the teeth (B) may itself involve bone trauma and is not an automatic means of improving MRONJ. Observation alone (C) fails to arrange the required specialist management. Splinting (D) and crowning (E) address mobility mechanically but do not assess or manage the underlying MRONJ and may delay appropriate referral.

Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw, section 4: Managing Patients at Risk of MRONJ. Published 2017; reviewed and extant March 2024. https://www.sdcep.org.uk/media/xtlp2uqx/sdcep-mronj-guidance-extant-2024.pdf