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Dental extractions in primary care for patients at risk of MRONJ

British Dental Journal (2021)Cite this article

Abstract

Aims This study aims to understand the experiences of general dental practitioners (GDPs) performing dental extractions for patients at risk of developing medication-related osteonecrosis of the jaw (MRONJ) and to identify the key features of the patients who are referred to secondary care for their extractions.

Materials and methods A mixed-method study consisting of quantitative analysis of anonymised electronic referrals and thematic analysis of in-depth telephone interviews with GDPs.

Results In total, 122 electronic referrals for patients at risk of MRONJ were identified. The majority of the referrals contained insufficient information to categorise the patient's risk of developing MRONJ. In-depth telephone interviews with six GDPs were analysed and the themes identified were consequences, difficult decisions, patient awareness and bridging the gap.

Conclusion Our results show that fewer than half of the referrals to secondary care investigated in this study showed a clear indication for secondary care involvement and the quality of the patient information provided was often insufficient to determine the patients' risk of developing MRONJ. Improved local guidance for the management of these patients and a dedicated pathway for their post-operative complications may encourage GDPs to perform more of these dental extractions in practice.

Key points

  • Identifies the key features of patients at risk of MRONJ who are referred to secondary care for dental extractions.

  • Discusses some of the barriers to performing dental extractions for these patients in primary care, including the risks to the patient, the dentist and the difficulties of onward referral if patients develop post-operative complications.

  • Highlights changes to the clinical pathways for patients at risk of MRONJ that could be implemented by the Oral Surgery Managed Clinical Networks.

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Authors and Affiliations

  1. Speciality Dentist in Oral and Maxillofacial Surgery, Leeds Teaching Hospitals Trust, Leeds, UK

    Sheryl Wilmott

  2. Professor of Oral and Maxillofacial Surgery/Honorary Consultant in Oral Surgery, University of Manchester Dental School, Manchester, UK

    Julian Yates

  3. Specialist in Dental Public Health, University of Manchester, Manchester, UK

    Iain A. Pretty

Authors
  1. Sheryl Wilmott
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  2. Julian Yates
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  3. Iain A. Pretty
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Contributions

Sheryl Wilmott: research conception and design, data acquisition, analysis and interpretation and initial draft of manuscript. Julian Yates: research design, analysis and interpretation and critical revision of manuscript. Iain A. Pretty: research design, analysis and interpretation and critical revision of manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work.

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Correspondence to Sheryl Wilmott.

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The authors declare no conflicts of interest.

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Cite this article

Wilmott, S., Yates, J. & Pretty, I. Dental extractions in primary care for patients at risk of MRONJ. Br Dent J (2021). https://doi.org/10.1038/s41415-021-3674-8

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