Article
We are writing in response to the letter from Martin Kelleher and Mark McGurk, received 20 June 2016 in response to our article.
On reflection, the title to the paper should not have included the comment ‘no cause for alarm in dentistry’.
The purpose of the paper was to explain to the dental team the main indications for prescription of anti-resorptive bone therapies and understand the potential risk to the patient of not taking medication prescribed. We chose this subject to educate dentists following reports from the Helpline Manager/Senior Osteoporosis Nurse for the National Osteoporosis Society1 that many dentists are advising their patients to avoid anti-resorptive medication, causing stress and confusion to patients.
Whilst there are many articles, position papers and guidance notes available on the dental treatment of patients prescribed anti-resorptive medications, further analysis of that topic was not the purpose of our article.
Nowhere in the paper was it suggested that there is ‘no problem with MRONJ’, nor was it implied that MRONJ was not a potentially serious and problematic condition. Oral surgery was listed as one of several important risk factors; a detailed list of risk factors was not the remit of the paper.
We agree that the medicolegal issues are indeed complex and were not intended to be covered by this paper. The question as to ‘Whose responsibility is it for MRONJ occurring in patients on intravenous bisphosphonates or in those patients who have had multiple years of oral bisphosphonate as well as steroids, who get osteonecrosis of the jaw after oral surgical procedure?’ is important and we would suggest should be covered in a separate article.
Mr Kelleher and Professor McGurk raise important points with regard to the need for dental assessment and necessary preventive treatment, prior to starting and/or changes to anti-resorptive medication. We agree that this is particularly important for cancer patients who will face significantly higher doses of intravenous bisphosphonates and RANK-L inhibitors.
We trust that our article, together with their response, will allow dental teams to understand the treatment of patients prescribed anti-resorptive medications better and welcome further articles addressing these many issues which were not intended to be covered by our paper.