This electronically delivered self-instructional program is designated for 1.5 hours of CE credit by Farran Media.
AGD Code: 730.
The fee to view this course is $36. This cost includes the fee to take the exam and claim your CE credits.
Medication-related osteonecrosis of the jaw (MRONJ) can be difficult to treat and causes significant morbidity, but is largely preventable. Originally termed BONJ given the number of cases associated with bisphosphonate use, it is more commonly recognized as MRONJ today since the pathophysiology is due to two pharmacological classes of medications: antiresorptive (including bisphosphonates and receptor activator of nuclear factor kappa-B ligand inhibitors) and antiangiogenic drugs. Newly published guidelines strongly recommend dental assessment and necessary remedial treatment before such drugs are commenced.
MRONJ pathophysiology is still not completely elucidated. There are several suggested hypothesis that could explain its unique localization to the jaws: inflammation or infection, microtrauma, altered bone remodeling or over-suppression of bone resorption, angiogenesis inhibition, bisphosphonate toxicity, peculiar biofilm of the oral cavity, terminal vascularization of the mandible, suppression of immunity, or Vitamin D deficiency. Dental screening and adequate treatment are fundamental to reduce the risk of osteonecrosis in patients under antiresorptive or antiangiogenic therapy, or before initiating the administration.
The treatment of MRONJ is generally difficult and the optimal therapy strategy is still to be established. For this reason, prevention is even more important. It is suggested that a multidisciplinary team approach including a dentist, an oncologist, and a maxillofacial surgeon to evaluate and decide the best therapy for the patient. The choice between a conservative treatment and surgery is not easy, and it should be made on a case by case basis. However, the initial approach should be as conservative as possible. The most important goals of treatment for patients with established MRONJ are primarily the control of infection, bone necrosis progression, and pain. The aim of this program is to present the current knowledge about MRONJ, its preventive measures and management strategies.
Description of Speaker:
Dr. Mark Donaldson received his baccalaureate degree from the University of British Columbia and his Doctorate in Clinical Pharmacy from the University of Washington. He completed a residency at Vancouver General Hospital, and has practiced as a clinical pharmacy specialist, clinical coordinator and director of pharmacy services at many healthcare organizations in both Canada and the United States. He is currently the Associate Principal of Clinical Pharmacy for Vizient’s Advisory Solutions, and lives in Whitefish, Montana.
Dr. Donaldson is a Clinical Professor in the Department of Pharmacy at the University of Montana in Missoula, Clinical Associate Professor in the School of Dentistry at the Oregon Health & Sciences University in Portland, Oregon, and affiliate faculty in the School of Dentistry at UBC. He has a special interest in dental pharmacology and has lectured internationally to both dental and medical practitioners. He has spent the last 22 years focusing on dental pharmacology and dental therapeutics, and is a leader in the field.
Dr. Donaldson has published numerous peer-reviewed works and textbook chapters. He currently serves on the Editorial Board for the Journal Healthcare Executive and the Journal of the American Dental Association and is a reviewer for over ten other different journals. He is board certified in healthcare management and is the Past-President and current Regent of the American College of Healthcare Executives’ Montana Chapter. Dr. Donaldson was named as the 2014 recipient of the Bowl of Hygeia for the state of Montana and is the 2016 recipient of the Dr. Thaddeus V. Weclew Award. This award is conferred by the Academy of General Dentistry upon an individual who has made outstanding contributions to the medical, dental and pharmacy literature. This year, Dr. Donaldson was conferred by the Canadian Dental Association (CDA) in Ottawa with the, “Special Friend of Canadian Dentistry Award for 2019.” This award is given to an individual outside of the dental profession in appreciation for exemplary support or service to Canadian dentistry and/or to the profession as a whole.
Upon completion of this course, participants should be able to achieve the following:
- Describe the risk factors for osteoporosis to include the normal bone remodeling process
- Explain the mechanisms of action of the bisphosphonates which may account for their association with ONJ
- Discuss preventative measures in management of suspected ONJ patients
- Identify commonly used medications associated with causing MRONJ
- Discuss current treatment strategies to include an individualized, yet multimodal and evidence-based approach to success in managing these patients
In the past 12 months, the lecturer/author declares that neither he/she nor any member of his/her family have a financial interest/arrangement or affiliation with any commercial entities nor have been paid directly by dentists and other health professionals within the field of dentistry or health care. The speaker discloses that he has a financial interest in consulting dental professionals in the subject matter that he is lecturing on.
Farran Media is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association
to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not
approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards
of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at
For any questions, please contact Howard Goldstein, DMD, Director of Continuing Education at
Farran Media is a nationally approved PACE Program Provider by the Academy of General Dentistry.
Approval does not imply acceptance by any regulatory authority or AGD endorsement. The current term of approval extends from 1/1/2019 to 12/31/2022.
Provider ID# 304396
This activity meets the educational criteria required for verifiable Continuing Professional Development under the General Dental Council Lifelong Learning scheme and represents 1.5 hours of verifiable CPD.
The CE provider (Farran Media) uses reasonable care in selecting and
providing content that is accurate. The CE provider, however, does not
independently verify the content or materials. The CE provider does not
represent that the instructional materials are error-free or that the content
or materials are comprehensive. Any opinions expressed in the materials are
those of the author of the materials and not the CE provider. Completing one or
more continuing education courses does not provide sufficient information to
qualify the participant as an expert in the field related to the course topic
or in any specific technique or procedure. The instructional materials are
intended to supplement, but are not a substitute for, the knowledge, expertise,
skill and judgment of a trained health care professional.
Continuing education credits issued for completion of online CE courses may not apply toward
license renewal in all licensing jurisdictions. It is the responsibility of each registrant
to verify the CE requirements of his/her licensing or regulatory agency.
State CE Requirements:
for CE requirements by state. Please note that this information is current as of the time of listing. This information is subject to change at any time from the state boards. For the most up-to-date information, please contact your state board directly.
There are no refunds for Online CE courses. Please contact technical support if you run into technical difficulty.
For any questions, please contact Howard Goldstein, DMD, Director of Continuing Education