Do you recommend routine dental evaluation for all patients before starting bisphosponates in patients with bone metastases?

Yes. The purpose of a dental exam prior to starting IV bisphosphonates or SC denosumab is to survey the mouth and fix any root canals, extractions, or other dental pathology prior to starting of drugs. Why? Because dental extractions during treatment with bisphosphonates or denosumab are one of biggest risk factors for developing medically related osteonecrosis (MONJ).

MONJ is defined as area of exposed bone while on bisphosphonates or denosumab, persisting for more than 6 weeks, and in the absence radiation therapy. MONJ causes pain and impacts quality of life, and their are no good treatment options. The key is prevent MONJ and the dental exam is part this prevention.

The other purpose of the dental exam is promote good oral hygiene, beca...