What Do Prescribers of Bone Modifying Agents Know about Medication-Related Osteonecrosis of the Jaw? Is Current Prevention Enough?

Abstract

Osteonecrosis of the jaw represents interference by external and internal factors in the natural bone remodeling system. Numerous bone remodeling agents (BMAs), such as bisphosphonates, denosumab, and tyrosine kinase inhibitors, can lead to medication-related osteonecrosis of the jaw (MRONJ). This is a serious condition that ocurs as a side-effect of treatment in patients with osteoporosis or malignancies. Antiresorptive drugs are medications that target osteoclasts with the aim of preventing bone resorption and are used to treat osteoporosis, osteopenia, and a variety of other conditions, such as Paget’s disease. They are also used in cancer patients with active bone metastases where antiresorptive treatment is used for the prevention of skeletal complications. Poor dental health, infections, and especially dental surgery are the primary causes of MRONJ, while other risk factors, such as smoking, alcohol abuse, and diabetes mellitus, can also influence its development. Prevention is the key component of management, and thus awareness of the risk factors among prescribers is very important. The aim of our study was to evaluate current knowledge about MRONJ among BMA prescribers in an academic hospital and their awareness about oral health and dental check-ups. By using a custom-designed questionnaire addressed to general and internal medical practitioners, endocrinologists, rheumatologists, and oncologists as an instrument for collecting data, we tried to identify trends in BMA prescription among different specialists and their recommended preventative measures, with the aim of creating new strategies to prevent the occurrence of MRONJ. The survey revealed a low awareness among physicians of the potential risk factors and underlined the need for a concerted effort to improve patient management. In this sense, a multidisciplinary team approach that includes the patient, the drug prescriber, the dentist, and the oral surgeon could significantly improve the quality of life of patients with MRONJ.

Evaluation of dental implant with hydroxyapatite coating by laser-induced hydrothermal synthesis: in vitro and in vivo experimental study

“…BIC percentage represent one of the most reliable parameters for dental implant osseointegration. BIC values > 50% are seemed to be optimal stability between bone and implant xtures [30]. However, a disadvantage of BIC is a bi-dimentional parameter obtained from only histologic image of specimen [31].…”

Resemblances and differences between osteoradionecrosis of the jaw and medication-related osteonecrosis of the jaw

“…BMA prescribers, like endocrinologists, oncologists, rheumatologists, and other specialties should inform their patients regarding the risk of developing ONJ, and dental check-ups should be recommended before initializing BMA treatment [ 25 ]. Also, patients should focus on preventive dental care and any oral disease should be treated and a good oral status must be obtained before initializing radiotherapy or BMA, while invasive dental surgery should only be reserved for teeth with no chance of salvaging.…”