Knowledge, Attitude, and Practices of Physicians and Dentists on Medication-related Osteonecrosis of Jaw (MRONJ): A Cross-Sectional Survey

Abstract Background: Bisphosphonate medication can cause osteonecrosis of the jaw, which is an uncommon but serious complication. The exact mechanism for the development of MRONJ is not known clearly. Dentoalveolar surgery is considered the major risk factor as a local risk factor with pre-existing inflammatory dental diseases, such as periodontal disease or periapical pathology. Therefore, this survey aims to explore the cross-reference of the patients before prescribing anti-resorptive and related medicines to avoid medication-related osteonecrosis of the jaw (MRONJ) by evaluating and managing any potential dental issues and do the required surgeries and uplift their oral hygiene before the commencement of such medications. Methods: An observational cross-sectional study was conducted among physicians and dentists of secondary and tertiary care hospitals and clinics in Pakistan between March and June 2021. Data were collected through a web-based questionnaire distributed among the eligible sample of physicians and dentists in the departments involved in prescribing bisphosphonates and managing the Osteonecrosis. SPSS 23.0 was used for data analysis. Frequencies and percentages were reported for all variables while Chi-squares and Fischer’s exact test was used to see differences in responses among physicians and dentists. A p-value of <0.05 was taken as statistically significant. Results: A response rate of 29% was achieved. All dentists answered correctly when asked about the indications of bisphosphonates but only about half of them agreed that bisphosphonates can cause but have limited knowledge related to other medicines like anti-angiogenic and mTOR inhibitors. 50% of the physicians provide patient education regarding the potential adverse effect of bisphosphonate medicine and related drugs while others don’t educate the patient regularly. Conclusions: Our study revealed a deficient knowledge regarding bisphosphonate-related ONJ among physicians and dentists. Appropriate training measures are required to raise their awareness.