Medication-related osteonecrosis of the jaw: A survey of knowledge, practices and opinions of dentists

Aim: The aim of this study was to evaluate dentists on their knowledge on biphosphonates, medication related osteonecrosis of the jaw (MRONJ), and on the treatment approaches towards patients using bisphosphonates in the Faculty of Dentistry at İzmir Katip Çelebi University.Material and Methods: This was a questionnaire-based cross-sectional study conducted on 97 dentists. The surveys consists of a total of 20 questions and four sections, with statistical analysis being used on the collected data. The Chi-square and Student-t tests were utilized to compare between the groups. The significance level was set at p < 0.05.Result: There was no significant difference in terms of correct answers to the questions between the dentists with professional experience in surgical procedures (Group A), and the dentists without professional experience in surgical procedures (Group B) (p> 0.05). In the second part of the questionnaire, the dentists were asked various questions in order to measure their general knowledge regarding bisphosphonates and MRONJ. There was no significant difference between the groups in terms of correct answers (p> 0.05). In the third part of the questionnaire, surgical scenarios were presented to the dentists and generally, they preferred the option in which no procedure should be performed in patients who take intravenous (IV) bisphosphonates, regardless of the duration of use.Conclusions: Increasing the awareness of medical practitioners, dentists, and patients in the use and side effects of bisphosphonates is important for preventing MRONJ. For this purpose, training strategies related to MRONJ should be established.

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1. Migliorati CA, Woo SB, Hewson I, et al. A systematic review of bisphosphonate osteonecrosis (bon) in cancer. Support Care Cancer 2010;18:1099-106.
2. Diel IJ, Bergner R, Grötz KA. Adverse effects of bisphosphonates: current issues. J Support Oncol 2007;5:475-82.
3. Holtmann H, Lommen J, Kübler NR, et al. Pathogenesis of medication-related osteonecrosis of the jaw: a comparative study of in vivo and in vitro trials. J Int Med Res 2018;46:4277-96.
4. Gutta R, Louis P. Bisphosphonates and osteonecrosis of the jaws: Science and rationale. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:186-93.
5. Assael LA. Oral bisphosphonates as a cause of bisphosphonate-related osteonecrosis of the jaws: clinical findings, assessment of risks and preventive strategies. J Oral Maxillofac Surg 2009;67:35-43.
6. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-7.
7. Ruggiero SL, Dodson TB, Assael LA, et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw-2009 update. Aust Endod J 2009;35:119-30.
8. Ruggiero SL, Dodson TB, Fantasia J, et al. MedicationRelated Osteonecrosis of the Jaw–2014 Update. J Oral Maxillofac Surg 2014;72:1938-56.
9. Sahin O, Odabasi O, Aliyev T, et al. Risk factors of medication-related osteonecrosis of the jaw: a retrospective study in a Turkish subpopulation. J Korean Assoc Oral Maxillofac Surg 2019;45:108-15.
10. Filleul O, Crompot E, Saussez S. Bisphosphonateinduced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 2010;136:1117-24.
11. Otto S, Tröltzsch M, Jambrovic V, et al. Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: a trigger for BRONJ development? J Craniomaxillofac Surg 2015;43:847- 54.
12. Yamazaki T, Yamori M, Ishizaki T, et al. Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg 2012;41:1397- 403.
13. Alhussain A, Peel S, Dempster L, et al. Knowledge, practices, and opinions of ontario dentists when treating patients receiving bisphosponates. J Oral Maxillofac Surg 2015;73:1095-105.
14. El-Rabbany M, Sgro A, Lam DK, et al. Effectiveness of treatments for medication-related osteonecrosis of the jaw: A systematic review and meta-analysis. J Am Dent Assoc 2017;148:584-94.
15. Dereci O, Orhan EO, Irmak O, et al. The effect of the duration of intravenous zolendronate medication on the success of non-surgical endodontic therapy: a retrospective study. BMC Oral Health 2016;16:9.
16. Vescovi P, Campisi G, Fusco V, et al. Surgery-triggered and non surgery-triggered Bisphosphonate-related Osteonecrosis of the Jaws (BRONJ): a retrospective analysis of 567 cases in an Italian multicenter study. Oral Oncol 2011;47:191-4.
17. Hajmohammadi E, Sattarzadeh S, Amani F. Knowledge rate of dentists regarding dental consideration of bisphosphonate drug user patients. J Res Med Den Sci 2015;3:194-8.
18. de Lima PB, Brasil VL, de Castro JF, et al. Knowledge and attitudes of Brazilian dental students and dentists regarding bisphosponate-related osteonecrosis of the jaw. Support Care Cancer 2015;23:3421-6.
19. Gonzales CB, Young V, Ketchum NS, et al. How concerns for bisphosphonate- induced osteonecrosis of the jaw affect clinical practice among dentists: a study from the South Texas Oral Health Network. Gen Dent 2015;63:61-7.
20. Escobedo M, García-Consuegra L, Junquera S, et al. Medication-related osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain). J Stomatol Oral Maxillofac Surg 2018;119:395-400.
21. Al-Samman AA, Al-Ani RS. Across-sectional survey on medication-related osteonecrosis of the jaws' knowledge and awareness in a sample of dental society. J Craniomaxillofac Surg 2019;47:926-31.
22. Sturrock A, Preshaw PM, Hayes C, et al. General dental practitioners’ perceptions of, and attitudes towards, improving patient safety through a multidisciplinary approach to the prevention of medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in the North East of England. BMJ Open 2019;9:e029951.