Urgent Extraction IV Bisphosphonate — ORE Part 1 MCQ

Correct answer: B — Proceed with extraction as clinically indicated, after discussing MRONJ risk and providing antibiotics for the systemic infection.

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

The patient is higher risk for MRONJ because anti-resorptive treatment is being given for cancer. However, SDCEP does not make extraction absolutely contraindicated. In higher-risk patients, alternatives should be considered only where a tooth can potentially be retained; retained roots are specifically suggested only in the absence of infection. Here, an unrestorable tooth with acute apical infection and systemic features requires source control, so extraction should proceed as clinically indicated after informed discussion of MRONJ risk. Antibiotics are appropriate because there is systemic infection, but they do not replace operative source control. B and E wrongly use antibiotics as a substitute for definitive treatment and imply MRONJ prophylaxis. C is inappropriate because infection is present. D is too absolute: SDCEP advises specialist consultation for medically complex cases when it would otherwise be appropriate, not mandatory oncologist approval or universal secondary-care extraction.

Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw, section 4.2: Continuing Management of 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