A survey of consultant members of the British Association of Oral and Maxillofacial Surgeons regarding bisphosphonate-induced osteonecrosis of the jaws

Abstract

The aims of this survey of consultants in the British Association of Oral and Maxillofacial Surgeons were threefold. Firstly, to estimate the number of patients screened for oral health before starting intravenous bisphosphonate medication, secondly, to indicate the use of antibiotics in patients on bisphosphonates who need routine extraction of a lower first molar tooth, and finally to estimate the number of new and currently managed cases of bisphosphonate-induced osteonecrosis of the jaw (BONJ) in the last year, and approximately how many of those currently being managed had healed. A questionnaire was mailed to 322 consultants working at 154 hospitals in the summer of 2008. There were responses from 184 consultants (57%) and from 111 hospitals (72%). Screening patients before starting intravenous bisphosphonates was uncommon (15%). Almost all consultants would prescribe antibiotics for molar extraction and in about two-thirds this was both before and after extraction. Relatively few would stop bisphosphonates. Nearly two-thirds of consultants had seen new cases of BONJ from intravenous treatment in the last year, and a quarter had seen three or more. A similar proportion had patients on intravenous bisphosphonates under review for BONJ, and it was estimated that in a fifth of patients the lesion had healed. This survey indicates current practice among oral and maxillofacial surgeons in the UK. A national project for the registration of new patients will provide a stronger evidence base with respect to incidence, risk factors, and management of BONJ.