World Workshop on Oral Medicine VI: Controversies regarding dental management of medically complex patients: assessment of current recommendations.
OBJECTIVE
Current recommendations for safe and effective dental management are less than optimal for some medical conditions because of limited evidence, conflicting conclusions, or both. This review (1) compiled and evaluated dental management recommendations for select medical conditions; (2) summarized recommendations and their assigned levels of evidence; (3) identified areas of conflict, ambiguity, or both; and (4) identified issues that warrant future research, enhanced consensus statements, or both.


METHODS
Systematic literature searches were performed for guideline publications, systematic and narrative reviews, and opinion documents containing recommendations for (1) medication-related osteonecrosis of the jaw (MRONJ); (2) cardiovascular diseases (CVDs); (3) prosthetic joints (PJs); and (4) systemic steroid therapy (SST).


RESULTS
The search yielded the following numbers of publications that met the inclusion criteria: MRONJ - 116; CVDs - 54; prosthetic joints - 39; and systemic steroids - 12.


CONCLUSIONS
Very few of the compiled recommendations were assigned or linked to levels of evidence by their authors. Key conclusions include the following: MRONJ-expert recommendations trend toward proceeding with dental treatment with little to no modification in osteoporotic patients on bisphosphonates; CVDs-current recommendations are primarily directed to general surgery and applied to dentistry; PJs-routine antibiotic prophylaxis is not indicated for dental treatment; and SST-steroid supplementation is not indicated for most patients undergoing dental procedures under local anesthesia.
Division of Oral Medicine and Radiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA. Electronic address: Joel.napenas@carolinas.org.
Joel J
JJ
Napeñas
Oral and Maxillofacial Sciences Department, Al-Farabi College for Dentistry and Nursing, Riyadh, Kingdom of Saudi Arabia; Oral Pathology and Medicine Department, Faculty of Dentistry, Hama University, Hama, Syria.
Omar
O
Kujan
University of Turin, Lingotto Dental School, Turin, Italy.
Paolo G
PG
Arduino
Department of Oral Pathology, Oral Medicine and Special Needs, Westmead Centre for Oral Health, Westmead, New South Wales, Australia.
Suma
S
Sukumar
Dublin Dental University Hospital, Dublin, Ireland.
Sheila
S
Galvin
Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Croatia.
Marinka
M
Baričević
Allyn and Betty Taylor Library, Western University, London, Ontario, Canada.
John
J
Costella
The Department of Oral Medicine, The Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
Rakefet
R
Czerninski
Oral Health and Diagnostic Services, School of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
Douglas E
DE
Peterson
Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
Peter B
PB
Lockhart
D003657:Decision Making; D017742:Dental Care for Chronically Ill / Q000379:methods*; D055094:Evidence-Based Dentistry; D006801:Humans