Re-appraisal of dental clearance protocol before anti-resorptive agents for osteoporosis using the modified Delphi technique.

BACKGROUND: Patients undergoing anti-resorptive agent (ARA) therapy are at risk of medication-related osteonecrosis of the jaw (MRONJ). Although existing guidelines encourage dental clearance prior to the initiation of ARA therapy, details on risk-appropriate treatment planning are insufficient. METHODS: This mixed-method study established a 13-person multidisciplinary expert panel to generate consensus statements through a modified Delphi process. Seven domains and 29 statements were identified through a comprehensive literature review and inputs from the expert panel. After two rounds of anonymous voting, 23 out of 29 statements achieved consensus. DISCUSSION: Domain 1 recommended the tailoring of treatment plans to the patients' medical history, dental history, social history, urgency of care, and life expectancy. Domain 2 recommended the removal of non-functional and misaligned teeth only if they are symptomatic. Domains 3 and 4 recommended that the management of caries and pulpal and periapical diseases in asymptomatic teeth does not have to precede the initiation of ARA therapy. Domain 5 recommended the removal of teeth with advanced periodontal disease but did not support the necessity of complete resolution of deep periodontal pockets prior to the initiation of ARA therapy. Domain 6 identified indications for the removal of dental implants prior to the initiation of ARA therapy and recommended the deferral of the management of most prosthesis-associated issues. Domain 7 which concerned the management of paediatric patients, failed to achieve consensus for any statements. This is congruent with the lack of evidence in the management of paediatric patients planned for ARA therapy. CONCLUSION: The consensus statements encourage clinicians to customise a risk-appropriate dental clearance protocol for each patient referred for dental clearance prior to ARA therapy for osteoporosis.