Authors' objectives: Background: Medication-related osteonecrosis of the jaw is a rare side effect of bisphosphonate medication, in this report used for treatment of early-stage breast cancer. Medication-related osteonecrosis leads to a progressive necrosis of the jawbone, which can be triggered by invasive dental procedures that traumatise the jawbone, such as tooth extraction. Evidence-based guidelines are absent, and to avoid invasive dental procedures during or after bisphosphonate treatment, prophylactic dental assessment with remedial dental procedures is often conducted prior to commencement of bisphosphonate treatment. Question at issue: Does prophylactic dental assessment, with remedial dental procedures when necessary, prior to commencement of adjuvant bisphosphonate treatment, affect the risk of medication-related osteonecrosis of the jaw, other complications, and quality of life in adults with early-stage breast cancer?

Authors' results and conclusions: Results: Only one publication fulfilled the inclusion criteria, reporting data from a randomised controlled trial, in form of three case series. The patients, with early-stage breast cancer, had undergone a dental assessment prior to treatment with different bisphosphonates; Clodronate (tablets), Ibandronate (tablets), or Zoledronic acid (intravenous) during 3-years. During the 7.5-8 years follow-up, 48 of the 6,018 patients, prevalence rate 0.80 (95% CI: 0.59 to 1.06)%, developed 57 medication-related osteonecrosis lesions. Twenty-two (dental extractions, n=20; other dental surgery, n=2, 39%) of the osteonecrosis lesions were related to dental treatments. In Sweden, only Zoledronate is used and in a lower dose than in the included study. Conclusion: There were no controlled studies assessing the effect of prophylactic dental assessment, with remedial dental procedures if deemed necessary, prior to commencement of adjuvant bisphosphonate treatment, on the risk of development of medication- related osteonecrosis of the jaw, other complications, or quality of life, in adults with early-stage breast cancer. Based on very low certainty of evidence (GRADE ⊕), the risk of developing medication related osteonecrosis of the jaw was very low. About one third of the osteonecroses occurred after dental treatment during bisphosphonate medication.

Authors' methods: Methods: Systematic literature searches were conducted in Medline, Embase, the Cochrane Library, and at websites of Scandinavian national and regional HTA organisations. The titles, abstracts, and subsequently full-text articles were independently screened by at least two authors. Final inclusion was decided in consensus. The included study was critically appraised using a checklist. The certainty of evidence was assessed according to GRADE. A protocol for this report was preregistered with PROSPERO (CRD420251047664).

Project Status: Completed

Year Published: 2025

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-2081313122-162/native/2025_146%20HTA-rapport%20Dental%20prevention%20of%20MRONJ.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se