Medical and Dental Professions’ Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study
Marwan Hamed Aljohani, Abdulbari Saleh Aljohani, Riyadh Mohammed Aljohani, Wahab Khalifah Alsharif, Ibrahim Nourwali, Shadia A Elsayed
Keywords :
Bisphosphonate, BRONJ, General dental practitioner, Jaw necrosis, Medication-related osteonecrosis of the jaw
Citation Information :
Aljohani MH, Aljohani AS, Aljohani RM, Alsharif WK, Nourwali I, Elsayed SA. Medical and Dental Professions’ Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study. J Contemp Dent Pract 2024; 25 (1):62-67.
Aims: This study aimed to assess the awareness of the risk of medication-related osteonecrosis of the jaw (MRONJ) among general dental practitioners (GDPs) and primary care physicians (PCPs), focusing on the clinical implications and coordination of treating or identifying high-risk patients.
Materials and methods: Two Google Forms electronic questionnaires were distributed to 724 GDPs and 617 PCPs in primary care settings. One for PCPs with eight multiple choice questions and the other for GDPs with 10 multiple choice questions. A clinical case scenario and a section on open-ended comments were included in both questionnaires. The data obtained from each group were statistically analyzed and compared.
Results: A total of 239 GDPs and 220 PCPs participated in the study, with a response rate of 34.23%. The mean age of participants was 29.5 years and 54.35% were females (51.2% and 57.5% in the GDPs and PCPs group, respectively). Most participants had graduated from Saudi Arabia. Almost all dentists were aware of osteonecrosis of the jaw (95.1%), 68.3% of them were aware of the guidelines regarding bisphosphonate-related osteonecrosis of the jaw (BRONJ) and MRONJ, 60.5% rated their general knowledge about MRONJ as very poor to poor, and 91.8% did not know any guidelines regarding BRONJ or MRONJ. Among the participants, 75.3% did not know how MRONJ was present in the oral cavity. A total of 69.9% of participants were unaware of other factors associated with an increased risk of MRONJ.
Conclusion: MRONJ risk awareness varies greatly between dentists who diagnose and manage patients in dental clinics and physicians who write about medicines and therapies. Counseling sessions and greater coordination between dental and medical specialists are strongly suggested while prescribing antiresorptive drugs to prevent the consequent development of MRONJ.
Clinical significance: This study shows a significant lack of knowledge regarding MRONJ among GDPs and PCPs, which may affect the prevention and treatment of patients. Therefore, we urge GDPS and PCPs to take more information from scientific sources on this topic and more cooperation from specialties for the benefit of patients.
Wang J, Goodger NM, Pogrel MA. Osteonecrosis of the jaws associated with cancer chemotherapy. J Oral Maxillofac Surg 2003;61(9):1104–1107. 2003;61(9):1104–1107. DOI: 10.1016/s0278-2391(03)00328-8.
Tanna N, Steel C, Stagnell S, et al. Awareness of medication related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners. Br Dent J 2017;222(2):121–125. DOI: 10.1038/sj.bdj.2017.79.
Wooltorton E. Patients receiving intravenous bisphosphonates should avoid invasive dental procedures. CMAJ 2005;172(13):1684–1684. 2005;172(13):1684. DOI: 10.1503/cmaj.050640.
Baqain ZH, Sawair FA, Tamimi Z, et al. Osteonecrosis of jaws related to intravenous bisphosphonates: The experience of a Jordanian teaching hospital. Ann R Coll Surg Engl 2010;92(6):489–494. DOI: 10.1308/003588410X12699663903395.
Baron R, Ferrari S, Russell RGG. Denosumab and bisphosphonates: different mechanisms of action and effects. Bone 2011;48(4):677–692. DOI: 10.1016/j.bone.2010.11.020.
Russell RGG, Watts NB, Ebetino FH, et al. Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 2008;19(6):733–759. DOI: 10.1007/s00198-007-0540-8.
Yamashita J, McCauley LK. Antiresorptives and osteonecrosis of the jaw. J Evid Based Dent Pract 2012;12(3 Suppl):233–247. DOI: 10.1016/S1532-3382(12)70046-5.
Landesberg R, Woo V, Cremers S, et al. Potential pathophysiological mechanisms in osteonecrosis of the jaw. Ann N Y Acad Sci 2011;1218:62–79. DOI: 10.1111/j.1749-6632.2010.05835.x.
Lo JC, O'Ryan FS, Gordon NP, et al. Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg 2010;68(2):243–253. DOI: 10.1016/j.joms.2009.03.050.
Hajeri S, Alturkistany Y. Medication-related osteonecrosis of the jaw after dental clearance: prevalence in an oncology center. Saudi Dent J 2022;34(6):479–484. DOI: 10.1016/j.sdentj.2022.06.004.
Scagliotti GV, Hirsh V, Siena S, et al. Overall survival improvement in patients with lung cancer and bone metastases treated with denosumab versus zoledronic acid: subgroup analysis from a randomized phase 3 study. J Thorac Oncol 2012;7(12):1823–1829. DOI: 10.1097/JTO.0b013e31826aec2b.
Kün-Darbois JD, Fauvel F. Medication-related osteonecrosis and osteoradionecrosis of the jaws: Update and current management. Morphologie 2021;105(349):170–187. DOI: 10.1016/j.morpho.2020.11.008
Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate-related osteonecrosis of the jaw: Background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102(4):433–441. DOI: 10.1016/j.tripleo.2006. 06.004.
Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw–2014 update. J Oral Maxillofac Surg 2014;72(10):1938–1956. DOI: 10.1016/j.joms.2014.04.031.
Rahman Z, Nayani S, Anstey H, et al. A survey evaluating the awareness of MRONJ within the Birmingham GMP community. Oral Surg 2018;12(1):22–29. DOI: 10.1111/ors.12372.
Tenore G, Mohsen A, Rossi AF, et al. Does medication-related osteonecrosis of the jaw influence the quality of life of cancer patients? Biomedicines 2020;8(4):95. DOI: 10.3390/biomedicines8040095.
Vandone AM, Donadio M, Mozzati M, et al. Impact of dental care in the prevention of bisphosphonate-associated osteonecrosis of the jaw: A single-center clinical experience. Ann Oncol 2012;23(1):193–200. DOI: 10.1093/annonc/mdr039.
Kanwar N, Bakr MM, Meer M, et al. Emerging therapies with potential risks of medicine-related osteonecrosis of the jaw: A review of the literature. Br Dent J 2020;228(11):886–892. DOI: 10.1038/s41415-020-1642-3.
Campisi G, Mauceri R, Bertoldo F, et al. Medication-related osteonecrosis of jaws (mronj) prevention and diagnosis: Italian consensus update 2020. Int J Env Res Pub He 2020;17(16):5998. DOI: 10.3390/ijerph17165998.
Ruggiero SL, Dodson TB, Aghaloo T, et al. American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws—2022 Update. J Oral Maxillofac Surg 2022;80(5):920–943. DOI: 10.1016/j.joms.2022.02.008.
Medication-related Osteonecrosis of the Jaw. SDCEP. Published March 2017. Accessed December 13, 2021. https://www.sdcep.org.uk/published-guidance/medication-related-osteonecrosis-of-the-jaw/.
Wilmott S, Yates J, Pretty IA. Dental extractions in primary care for patients at risk of MRONJ. Br Dent J 2021;75(6):374–380. DOI: 10.1038/s41415-021-3674-8.
Cerrato A, Zanette G, Boccuto M, et al. Actinomyces and MRONJ: A retrospective study and a literature review. J Stomatol Oral Maxillofac Surg 2021;122(5):499–504. DOI: 10.1016/j.jormas.2020.07.012.
Otto S, Eva Maria Schnödt, Haidari S, et al. Autofluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw (MRONJ): A retrospective single-center study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131(5):519–526. DOI: 10.1016/j.oooo.2020.10.018.
Owosho AA, Liang STY, Sax AZ, et al. Medication-related osteonecrosis of the jaw: An update on the memorial sloan kettering cancer center experience and the role of premedication dental evaluation in prevention. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;125(5):440–445. DOI: 10.1016/j.oooo.2018.02.003.