Medication-related osteonecrosis of the jaw risk — ORE Part 1 MCQ
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Correct answer: C — Seek oral-surgery advice and coordinate definitive treatment with her oncology team
Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E
A is correct. She is at higher MRONJ risk because she receives denosumab for cancer; corticosteroid therapy, infection and extraction add further risk. However, absence of exposed bone means she does not currently have established MRONJ, and it is not a reason to leave a painful, infected, unrestorable tooth untreated. SDCEP advises considering less invasive alternatives first in higher-risk patients, but recognises that extraction may still be necessary; medically complex cancer patients warrant oral surgery/special care dentistry input for planning. Oncology liaison is needed because denosumab timing and any interruption are prescribing decisions. B is unsafe because it omits enhanced assessment and valid risk discussion. C permits recurrent infection. D is not definitive management and antibiotics are not a substitute for eliminating the source. E adds another bone-impacting procedure; implants should generally be avoided in patients receiving high-dose anti-resorptives for cancer.
Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw, sections 3–4 and Guidance in Brief, 2017 guidance extant 2024. https://www.sdcep.org.uk/media/xtlp2uqx/sdcep-mronj-guidance-extant-2024.pdf