Paget Plus Bisphosphonate Dental — ORE Part 1 MCQ
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Correct answer: A — Consider Paget-related extraction difficulty and bisphosphonate-related MRONJ risk
Explanation lettering: C = shown as B · E = shown as C · B = shown as D · D = shown as E
A is correct. Paget disease can itself complicate extraction: affected jaws may show altered bone and root changes such as hypercementosis, and patients have reported more difficult extractions and post-extraction complications. Oral bisphosphonates add a separate, usually low, risk of MRONJ. Under SDCEP guidance, Paget disease is managed within the non-malignant bone-disease MRONJ risk pathway; duration of bisphosphonate therapy and concurrent systemic glucocorticoids modify risk. B wrongly ignores the underlying disease. C and E incorrectly treat oral therapy as risk-free. D is unsupported: increased turnover in Paget disease does not make extraction safer.
Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw, 2024, Table 3.1 and Section 3.2. https://www.sdcep.org.uk/media/5cnbsel5/sdcep-mronj-guidance-extant-2024.pdf