Comment on Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline Summary

he article entitled “Medication-Related Osteonec- rosis of the Jaw: MASSC/ISOO/ASCO Clinical Practice Guideline” was recently published by Yarom et al 1 and was summarized by Shapiro et al. 2 The Multinational Association of Supportive Care in Cancer (MASSC), the International Society of Oral Oncology (ISOO), and ASCO are to be commended for their effort to establish a multidisciplinary expert panel and formulate shared guidelines, with the aim of ensuring best practices for prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients who receive bone-modifying agents (BMAs) for oncologic indications. A systematic review was conducted to select founding articles and assign level of evidence and grade rec- ommendations. The authors’ statement that “formal quality assessment of included studies was not con- ducted” makes it difficult for the reader to understand the process of article selection and increases the risk of biases. Despite the insufficient evidence, their effort to summarize and coordinate the roles of different health care professionals (oncologist/hematologist, dental practitioners, and dental specialists) involved with patients who have metastatic cancer before, during, and after treatment with BMAs is sound. But some conclusions seem controversial and are highly de- bated in the literature