The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
The bisphosphonates also can sometimes cause another rare but serious side effect, osteonecrosis of the jaw , a condition in which the cells in the jawbone start to die. Researchers think that osteonecrosis of the jaw may develop because bisphosphonates stop the body from repairing microscopic damage to the jawbone that can happen during routine dental procedures or from everyday wear and tear. But it's still not clear why this happens in some people and not in others. If you're taking a bisphosphonate, tell your dentist right away. Together, you and your dentist can work out a dental treatment schedule that keeps your teeth healthy and minimizes your risk of osteonecrosis of the jaw.
Treatment with bisphosphonates has not been demonstrated to prolong survival in any of these malignancies. 18 - 20 Thus, in the treatment of metastatic malignancy, the absolute benefit from treatment (NNT 4-10 depending on endpoint) is much closer to the absolute harm from treatment (NNH 10-120). In this situation, screening or preventative dental treatment prior to initiation of bisphosphonate treatment may be appropriate and guidelines for dentists seeing such patients have been published. 5 The efficacy of the recommended prevention strategies has not been evaluated.