Title: MRONJ and ORN: Referral or management in primary care? Navigating guidelines in the context of long waiting lists
Abstract:
Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are serious complications associated with antiresorptive or antiangiogenic medications and head and neck radiotherapy, respectively, and represent an increasing clinical challenge for dental practitioners. Improved survival rates among oncology patients, alongside wider prescribing of antiresorptive therapies for oncological and non-oncological indications, have contributed to a growing population of at-risk patients, resulting in increased referrals to oral and maxillofacial surgery services and prolonged waiting times within secondary care. Although national and international guidelines provide structured recommendations for prevention, risk stratification, and management, uncertainty remains among dental practitioners regarding appropriate referral thresholds and the extent to which patients can be safely managed within primary dental care. This presentation aims to explore current guidance on MRONJ and ORN and clarify when referral is indicated versus when treatment can be delivered in primary care in accordance with established protocols, particularly in the context of increasing service pressures. Within this project, a review of key guidance documents, including SDCEP and NICE recommendations, alongside relevant contemporary literature, will be undertaken to examine staging systems, referral criteria, and management pathways. Over-referral of low-risk or stable patients may place unnecessary strain on already pressured secondary care services without demonstrable benefit to patient outcomes, potentially delaying access for patients with more advanced disease. Improved understanding and confident application of MRONJ and ORN guidelines may support more effective clinical decision-making, enabling timely referral of complex or progressive cases while empowering dentists to manage appropriate patients safely in primary care, thereby reducing service pressures and promoting high-quality, patient-centred care.
