Knowledge and clinical behavior on antiresorptive medications and osteonecrosis of the jaws: a cross-sectional study

Daniel Amaral Alves Marliére,Luciana Asprino,Tony Eduardo Costa,Saulo De Matos Barbosa,Rafael Binato Junqueira,Henrique Duque De Miranda Chaves Netto

doi:10.1590/1981-863720190005820190018

Abstract

ABSTRACT Objective: This present study assessed the knowledge and clinical behaviors of dentists on antiresorptive medications (AM) and osteonecrosis of the jaws (ONJ). Methods: A cross-sectional study was performed by a questionnaire applied to a sample of 101 dentists. It inquired about general information, knowledge on AM and ONJ, behaviors regarding clinical cases of patients, and knowledge acquisition sources. Kappa coefficient (ƙ) checked the questionnaire’s reliability. Descriptive statistics were computed, Fisher’s test assessed the association between behaviors and knowledge. Logistic regression analysis to estimate propensity score. Statistical significance was set at p ≤ 0.05. Results: The reliability showed good agreement (ƙ = 0.8). 59% of the dentists reporting to know AM, 83% believing it is important to know whether patients took AM during anamnesis and 53% indicating that they knew that ONJ was a side effect of AM. However, 5% of the dentists informed that they could fully recognize brand name of AM, and that 50% would not perform any dental invasive treatment, with 73% acquiring knowledge on AM and ONJ from scientific articles. Conclusion: dentists recognized AM, but they would not be comfortable treating patients who had taken AM or developed ONJ. Educational efforts might be made to promote the knowledge of dentists.

Highlights

Synthetic drugs for inhibition of osteoclastic action were developed 20 years ago in order to decrease bone resorption [1,2]
One can observe that the majority of the dentists (59%) learned about antiresorptive medications (AM) and believed it is important to know whether the patient takes or took such medications during anamnesis (83%)
As well as Alhussein et al, we suggest that a greater knowledge on ONJ would make dentists more comfortable treating patients properly [15].the results on clinical behavior and the imprecision on the resources of knowledge on this issue showed that dentists tend to feel uncomfortable treating patients who took or takes AM

Summary

Introduction

Synthetic drugs for inhibition of osteoclastic action were developed 20 years ago in order to decrease bone resorption [1,2]. Those medications were called bisphosphonates (BP) and became effective in preventing and treating bone metabolic diseases (i.e. osteoporosis, bone metastatic neoplasm, Paget’s disease, multiple myeloma) [3,4,5]. Malan et al [9], Pichardo et al [10] and Povoa et al [11] described cases of ONJ in patients treated with denosumab (i.e. antiresorptive drug) to prevent bone metastasis in prostatic neoplasms. Based on the reports on BP-related ONJ, the American Association of Oral and Maxillofacial Surgeons (AAOMS) recommended that the term “bisphosphonaterelated osteonecrosis of the jaws” (BRONJ) should be changed to “medication-related osteonecrosis of the jaws” (MRONJ) because there were an increasing number of cases involving other drugs rather than BP [12]

Methods

Results

Discussion

Conclusion