Abstract
BackgroundAccurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. I aimed to determine the awareness of Korean dentists regarding medication-related osteonecrosis of the jaw and the duration of drug holidays they prescribe to patients who need to undergo various dental procedures.MethodsAn online, questionnaire-based survey was conducted among 1000 dentists registered in an online community in Korea. The following were determined: general characteristics; type of practice; recordkeeping regarding patients’ use of bone-modifying agents; requirement of a doctor’s referral letter; advice given regarding drug holidays of bone-modifying agents before dental surgery procedures; and experience with medication-related osteonecrosis of the jaw. Differences between dentists with and without experience in treating patients with medication-related osteonecrosis of the jaw were evaluated using the χ2 test.ResultsAlthough a relatively high proportion (293/1000, 29.3%) of dentists had experienced cases of medication-related osteonecrosis of the jaw, only 650/1000 (65.0%) routinely documented the type of bone-modifying agent used by patients and the duration of its use. Moreover, only 591/1000 (59.1%) dentists routinely requested referral letters from doctors before performing dental surgery on patients. Although the recommended period for a drug holiday differs for each drug, 533/1000 (53.3%) dentists did not make such a distinction. There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in medication-related osteonecrosis of the jaw (707/1000) and those who had such experience (P = 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and without prior experience with the condition (P = 0.001).ConclusionsThese results suggest that dentists do not respond consistently to patients' drug history prior to performing dental procedures. This implies the need for increased cooperation between dentists and physicians, as well as the development of targeted educational interventions for the dental profession, to reduce the risk of medication-related osteonecrosis of the jaw.Trial registrationNot applicable.
Highlights
Accurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw
One of the updated recommendations was to replace the term “bisphosphonate-related osteonecrosis of the jaw” (BRONJ) with “medication-related osteonecrosis of the jaw (MRONJ).” This was done following many reports of MRONJ that were associated with the use of bone-resorption inhibitors, such as denosumab (e.g., Prolia and Xgeva [Amgen Inc., Thousand Oaks, CA, USA]), and angiogenesis inhibitors, since the publication of their first position paper [2]
Dentists engaged in private practice accounted for 85.3% of survey respondents, with the remainder being engaged in non-private practice
Summary
Accurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. Patients on bone-modifying medications should be treated with caution by dentists because of the possibility of medication-related osteonecrosis of the jaw (MRONJ). One of the updated recommendations was to replace the term “bisphosphonate-related osteonecrosis of the jaw” (BRONJ) with “MRONJ.” This was done following many reports of MRONJ that were associated with the use of bone-resorption inhibitors, such as denosumab (e.g., Prolia and Xgeva [Amgen Inc., Thousand Oaks, CA, USA]), and angiogenesis inhibitors, since the publication of their first position paper [2]. A low prevalence of BRONJ (0.004%) was identified among patients on oral therapy than among those on intravenous therapy [5]. The prevalence of MRONJ varies across countries, its general prevalence appears to be relatively low
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