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Choi Y, Hong N, Rhee Y, Park W. Dentists' Intention to Use Teleconsultation for the Treatment of Patients With Osteoporosis: An Online Survey Study. Telemed J E Health 2024; 30:e1119-e1125. [PMID: 38016130 DOI: 10.1089/tmj.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Introduction: To properly combine osteoporosis treatment with dental treatment and to prevent medication-related osteonecrosis of the jaw (MRONJI), a system of communication between health providers can be smoothly made within a short time is required. With the recent increase in the possibility of telemedicine being introduced in Korea, it is expected that the introduction of teleconsultation between health providers treating osteoporosis will reduce the discomfort of patients and health providers and improve satisfaction. In this study, a survey was conducted on the knowledge and experience of MRONJ to find out the willingness of dentists treating osteoporosis patients for teleconsultation. Methods: An online questionnaire-based survey was conducted to investigate the intention for teleconsultation for MRONJ with a total of 516 dentists between September and October 2021. Results: Two-thirds of the respondents had experience of requesting consultation other dentists or doctors for the osteoporosis or MRONJ patients. They answered that the referral letter was the most used consultation request method and that it took a long time to get a reply. As for the intention of teleconsultation, 70% of the respondents answered that they were willing. The more experienced or the higher the educational level, the higher the intention for teleconsultation. Although the intention of dentists for teleconsultation was high, satisfaction with the cost of teleconsultation was low. Discussion: Although dentists' intention to use teleconsultation was high, satisfaction with the cost of medical care for teleconsultation was low, so it seems that this should be coordinated.
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Affiliation(s)
- Yiseul Choi
- Department of Advanced General Dentistry, Institute for Innovation in Digital Healthcare, Yonsei University College of Dentistry, Seoul, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Wonse Park
- Department of Advanced General Dentistry, Institute for Innovation in Digital Healthcare, Yonsei University College of Dentistry, Seoul, Korea
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Landi L, Oteri G, Barbato L, Discepoli N, Carrassi AM, Rigoni M, Cairo F, Cavalcanti R, Crea A, Gianserra R, Sforza NM. Anti-resorptive therapy and MRONJ. A survey of the Italian Society of Periodontology and Implantology. Oral Dis 2024. [PMID: 38424699 DOI: 10.1111/odi.14907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/14/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Anti-resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian Society of Periodontology and Implantology members in the management of patients treated with anti-resorptive agents and with the risk of developing MRONJ. MATERIALS AND METHODS An 18-item questionnaire was submitted by e-mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro-Wilk test. RESULTS Four hundred and fifty-one questionnaires were returned by e-mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti-resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti-resorptive therapy for osteometabolic disorders. One or more MRONJ-affected patients were encountered by 63.2% of the respondents. CONCLUSIONS This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti-resorptive agents.
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Affiliation(s)
- L Landi
- Private Practice, Verona and Roma, Italy
| | - G Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - L Barbato
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - N Discepoli
- Department of Medical Biotechnologies, Unit of Periodontology, University of Siena, Siena, Italy
| | - A M Carrassi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - M Rigoni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - F Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - R Cavalcanti
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Bari, Italy
- Private Practice, Bari, Italy
| | - A Crea
- Private Practice, Viterbo, Italy
| | - R Gianserra
- Private Practice, Campobasso and Roma, Italy
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Assari AS, Alanazi Y, Mubarak Algharbi E, Abuhabsha A, Alshammry B, Alzahrani A, Alduhaim A, Abuhaimed R. Awareness of Medication-Related Osteonecrosis of the Jaws Amongst Patients on Antiresorptive and Antiangiogenic Medications. Cureus 2024; 16:e52896. [PMID: 38406100 PMCID: PMC10891455 DOI: 10.7759/cureus.52896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Background Medication-related osteonecrosis of the jaws (MRONJ) is a rare but severe condition that has garnered increasing attention in recent years. It primarily affects individuals undergoing treatment with antiresorptive and antiangiogenic medications, such as bisphosphonates and denosumab, commonly prescribed for osteoporosis and cancer-related bone metastases. Therefore, the present study aimed to assess awareness and understanding of MRONJ among patients receiving antiresorptive and antiangiogenic medications. Methods A cross-sectional survey was conducted among 110 patients receiving antiresorptive and antiangiogenic medications in a clinical setting. Participants were given a structured questionnaire to assess their awareness of MRONJ. The questionnaire covered aspects such as MRONJ, bisphosphonate usage, and awareness of the condition's potential complications. Demographic information was also collected. Chi-square and Fisher's tests were performed using SPSS statistical software. Results In terms of gender distribution, 63.6% of the participants were female. Concerning age distribution, the majority (43.6%) fell within the 21 to 40 age group, whereas only 5.5% were aged over 60. Regarding educational attainment, a substantial majority (58.2%) of the participants held a bachelor's degree. The study findings reveal that a considerable proportion (35.5%) of participants possess awareness regarding jaw osteonecrosis, and this association is statistically significant (p=0.002). A substantial number of participants administered the medication orally (30.9%), while others utilized various administration routes, including injection (IV and others) (40%), and this difference was also statistically significant (p=0.001). Most participants took bisphosphonates for osteoporosis (41.8%) or cancer (13.6%), both statistically significant (p<0.01). Gender had no significant impact (p>0.01), but age showed potential associations (p=0.07 for awareness, p=0.003 for medication use). Educational backgrounds had no significant link, except for bisphosphonate usage (p<0.01) and side effects reporting (p<0.01). Conclusion Notably, a small percentage of participants demonstrated awareness of this condition, indicating a need for continued education and awareness campaigns. Further research and interventions may be warranted to address the specific needs of different age groups and educational backgrounds in promoting safe and effective medication management.
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Affiliation(s)
- Ahmad S Assari
- Department of Oral Maxillofacial Surgery and Diagnostic Sciences, Riyadh Elm University, Riyadh, SAU
| | - Yosef Alanazi
- Department of Oral and Maxillofacial Surgery, University of Hail, Hail, SAU
| | - Elaf Mubarak Algharbi
- Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Preventive Dental Science, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, SAU
| | | | - Basel Alshammry
- Department of Oral and Maxillofacial Surgery, University of Hail, Hail, SAU
| | - Ali Alzahrani
- Department of Oral and Maxillofacial Surgery, Ministry of Health, Riyadh, SAU
| | | | - Reem Abuhaimed
- Department of Dentistry, King Saud University, Riyadh, SAU
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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; 25:62-67. [PMID: 38514433 DOI: 10.5005/jp-journals-10024-3622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
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. How to cite this article: Aljohani MH, Aljohani AS, Aljohani RM, et al. 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.
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Affiliation(s)
- Marwan Hamed Aljohani
- Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Madinah, Saudi Arabia, Phone: +966569198623, e-mail:
| | | | | | - Wahab Khalifah Alsharif
- Saudi Board of Orthodontics and Maxillofacial Orthopedics, Ohud Specialty Dental Center, MOH, Madinah, Kingdom of Saudi Arabia
| | - Ibrahim Nourwali
- Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Madinah, Saudi Arabia
| | - Shadia A Elsayed
- Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Madinah, Saudi Arabia
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Boston B, Ipe D, Capitanescu B, Gresita A, Hamlet S, Love R, Hadjiargyrou M, Huang CL, Nusem I, Miroiu RI, Popa-Wagner A, Warnke PHH, Petcu EB. Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients. J Am Geriatr Soc 2023. [PMID: 37224415 DOI: 10.1111/jgs.18414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is clinically defined as a non-healing jawbone ulcerative-necrotic lesion appearing after dental therapy or minor trauma in patients treated previously with anti-resorptive, anti-angiogenic or immunomodulators. Older patients with osteoporosis and cancer receive these pharmacological agents regularly. As these patients are long-term survivors, efficient treatment is of paramount importance for their quality of life. METHODS Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ. RESULTS Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no "gold standard" therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study. CONCLUSIONS It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.
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Affiliation(s)
- Bridget Boston
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Deepak Ipe
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Bogdan Capitanescu
- Department Anatomy, University of Medicine, and Pharmacy, Craiova, Romania
| | - Andrei Gresita
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Stephen Hamlet
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Robert Love
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Michael Hadjiargyrou
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Chien-Ling Huang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Iulian Nusem
- Department of Orthopaedic Surgery, Logan Hospital, Meadowbrook, Queensland, Australia
- Queensland Bone Bank, Coopers Plains, Queensland, Australia
| | - Rodica Ileana Miroiu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Aurel Popa-Wagner
- Experimental Research Center for Normal and Pathological Aging, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Patrick Hans-Heinrich Warnke
- Department of Oral and Maxillofacial Surgery, University of Kiel and Praxisklinik am Ballastkai, Flensburg, Germany
| | - Eugen Bogdan Petcu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
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Kazmi SMR, Siddiqui HK, Khan FR, Khan SRA. Knowledge, attitudes and practices of physicians and dentists on medication-related osteonecrosis of the jaw: a cross-sectional survey. Br Dent J 2023:10.1038/s41415-023-5852-3. [PMID: 37225843 DOI: 10.1038/s41415-023-5852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 05/26/2023]
Abstract
Background Bisphosphonate medication can cause osteonecrosis of the jaw, which is an uncommon but serious complication. This survey explores the knowledge, attitudes and practices of dentists and physicians regarding medication-related osteonecrosis of the jaw (MRONJ).Methods A cross-sectional study was conducted among physicians and dentists of Pakistan's secondary and tertiary care hospitals between March and June 2021. Data were collected through a web-based questionnaire distributed among the eligible clinicians involved in prescribing bisphosphonates to patients or management of osteonecrosis. SPSS Statistics 23.0 was used for the data analysis. The frequencies and proportions of the descriptive variables were reported.Results A response rate of 29% was achieved. Only six dentists (n = 6/61; 9.8%) were aware that mammalian target of rapamycin inhibitors could lead to osteonecrosis. Only one-third (n = 9/26; 34.6%) of physicians informed their patients about the possible side effects of bisphosphonates. The most commonly identified risk factor among them was the duration of the drug (n = 77/87; 88.5%) and the least identified was gender (n = 34/87; 39.0%).Conclusions Our study revealed insufficient knowledge among the respondents about the recently updated established guidelines available on MRONJ. The majority of physicians don't refer patients to dentists before prescribing bisphosphonates and other associated medications.
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Affiliation(s)
- Syed Murtaza Raza Kazmi
- Assistant Professor, Prosthodontics, Dental Section, Department of Surgery, Aga Khan University, Pakistan.
| | - Humayun Kaleem Siddiqui
- Assistant Professor, Oral and Maxillofacial Surgery, Dental Section, Department of Surgery, Aga Khan University, Pakistan
| | - Farhan Raza Khan
- Associate Professor, Operative Dentistry and Endodontics, Dental Section, Department of Surgery, Aga Khan University, Pakistan
| | - Shah Rukh Ali Khan
- Resident, Dental Section, Department of Surgery, Aga Khan University, Pakistan
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A 5-year retrospective cohort study of denosumab induced medication related osteonecrosis of the jaw in osteoporosis patients. Sci Rep 2022; 12:8641. [PMID: 35606457 PMCID: PMC9126865 DOI: 10.1038/s41598-022-11615-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/20/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractDenosumab has been suggested as a first-line therapy for osteoporotic patients. However, a standardized protocol for the prevention of denosumab induced medication-related osteonecrosis of the jaw (MRONJ) has not yet been established. The purpose of this study was to report denosumab induced MRONJ cases, and investigate the factors affecting the occurrence of MRONJ in patients who underwent denosumab and invasive dental treatment (especially tooth extraction) between October 2016 and March 2020. Four of the 98 patients developed MRONJ before and after tooth extraction. The participants were divided into two groups: receiving only denosumab (n = 51) and receiving bisphosphonate as first treatment and denosumab as second treatment (n = 47). There was no significant difference between groups in the occurrence of MRONJ and factors affecting MRONJ. Two out of 4 patients developed MRONJ regardless of invasive treatment after denosumab administration and proceeded with extraction; one patient developed MRONJ after denosumab administration and extraction. The other patient underwent a tooth extraction without osteoporosis treatment, and non-identified MRONJ developed after denosumab administration. MRONJ cases reported in this study show that MRONJ can develop as chronic inflammation without invasive dental treatment; therefore, implementing preventive dental treatment before initiating denosumab treatment is necessary to reduce the occurrence of MRONJ.
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Arnaud MP, Talibi S, Lejeune-Cairon S. Knowledge and attitudes of French dentists on bone resorption inhibitors (bisphosphonates and denosumab): A cross-sectional study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:163-170. [PMID: 33930600 DOI: 10.1016/j.jormas.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/10/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION A cross-sectional study by questionnaire was performed to evaluate the knowledge of French dentists about bone resorption inhibitors (BRIs) and medication-related osteonecrosis of the jaw (MRONJ). MATERIALS AND METHODS 498 digital questionnaires were collected and 358 complete responses of French dental practionners in active practice except for orthodontists were analyzed. Descriptive analysis was computed and categorical variables were compared by Z test. The independence of the compared variables was tested by χ2 test. The scores obtained to the knowledge questions were compared by Mann-Whitney's tests depending on age, gender and year of graduation. RESULTS 84% of the respondents routinely record antiresorptive medication history in the medical chart. Therefore, almost all the practitioners know the importance to report in anamnesis the use of BRIs, but we noticed some contradictions: Less than half of the respondents recognized the brand names of BRIs and their indications. The combination of BRIs with other drugs like antiangiogenic or corticosteroid therapies is identified as a MRONJ systemic risk factor by respectively 46,3% and 29,7% of the respondents. Likewise, only 43,2% of the practitioners identified removable dentures as a local risk factor. We showed that practitioners under 30 years old and/or who graduated for less than 10 years reached a significantly higher score putting university as the main source of information on that subject. CONCLUSION According to our results, it is evident that there is a lack of knowledge about BRI, the risk of MRONJ, and the methods and means of preventing this complication.
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Affiliation(s)
- Marie-Pierre Arnaud
- Faculté d'odontologie de Rennes, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France; Centre de Soins Dentaires de Rennes, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033 Rennes cedex 9, France
| | - Sarra Talibi
- Faculté d'odontologie de Rennes, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France; Centre de Soins Dentaires de Rennes, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033 Rennes cedex 9, France
| | - Sophie Lejeune-Cairon
- Faculté d'odontologie de Rennes, Université de Rennes 1, 2 avenue du Professeur Léon Bernard, 35043 Rennes, France; Centre de Soins Dentaires de Rennes, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033 Rennes cedex 9, France.
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Wilmott S, Yates J, Pretty IA. Dental extractions in primary care for patients at risk of MRONJ. Br Dent J 2021:10.1038/s41415-021-3674-8. [PMID: 34887554 DOI: 10.1038/s41415-021-3674-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/25/2021] [Indexed: 11/09/2022]
Abstract
Aims This study aims to understand the experiences of general dental practitioners (GDPs) performing dental extractions for patients at risk of developing medication-related osteonecrosis of the jaw (MRONJ) and to identify the key features of the patients who are referred to secondary care for their extractions.Materials and methods A mixed-method study consisting of quantitative analysis of anonymised electronic referrals and thematic analysis of in-depth telephone interviews with GDPs.Results In total, 122 electronic referrals for patients at risk of MRONJ were identified. The majority of the referrals contained insufficient information to categorise the patient's risk of developing MRONJ. In-depth telephone interviews with six GDPs were analysed and the themes identified were consequences, difficult decisions, patient awareness and bridging the gap.Conclusion Our results show that fewer than half of the referrals to secondary care investigated in this study showed a clear indication for secondary care involvement and the quality of the patient information provided was often insufficient to determine the patients' risk of developing MRONJ. Improved local guidance for the management of these patients and a dedicated pathway for their post-operative complications may encourage GDPs to perform more of these dental extractions in practice.
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Affiliation(s)
- Sheryl Wilmott
- Speciality Dentist in Oral and Maxillofacial Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
| | - Julian Yates
- Professor of Oral and Maxillofacial Surgery/Honorary Consultant in Oral Surgery, University of Manchester Dental School, Manchester, UK
| | - Iain A Pretty
- Specialist in Dental Public Health, University of Manchester, Manchester, UK
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Barry E, Taylor T, Patel J, Hamid U, Bryant C. The incidence of medication-related osteonecrosis of the jaw following tooth extraction in patients prescribed oral bisphosphonates. Br Dent J 2021:10.1038/s41415-021-3620-9. [PMID: 34815482 DOI: 10.1038/s41415-021-3620-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 11/09/2022]
Abstract
Aims To determine the incidence of medication-related osteonecrosis of the jaw in patients prescribed oral bisphosphonate medication following dental extraction in a dedicated clinic within the Department of Oral Surgery of King's College Hospital. The effect of factors such as sex, duration of therapy, medical comorbidities and site of extraction, which have previously been reported to significantly affect the risk of developing osteonecrosis of the jaw, was also examined.Materials and methods Data were gathered from the dental records of patients who had extractions over an eight-year period and were included in this retrospective study. Patients with previous or current exposure to intravenous bisphosphonates, denosumab, novel-targeted chemotherapies used in the oncology setting or radiotherapy to the head and neck were excluded from this study.Results The incidence of medication-related osteonecrosis of the jaw following tooth extraction in this group of 652 was 0.8%. A significantly increased risk of developing medication-related osteonecrosis of the jaw was evident in patients prescribed oral bisphosphonates for four years or more (p = 0.02), with an incidence in this group of 1.6%.Conclusion This study demonstrates that, following dental extraction, patients who are prescribed oral bisphosphonates are at risk of developing medication-related osteonecrosis of the jaw and that this risk increases significantly when the patient has been taking the bisphosphonate for four years or more.
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Affiliation(s)
- Elizabeth Barry
- Specialty Doctor in Oral Surgery, King´s College Hospital, London, SE5 9RS, UK.
| | - Talli Taylor
- Specialty Doctor in Oral Surgery, King´s College Hospital, London, SE5 9RS, UK
| | - Jashme Patel
- Consultant in Oral Surgery, King´s College Hospital, London, SE5 9RS, UK
| | - Umar Hamid
- Specialty Doctor in Oral Surgery, King´s College Hospital, London, SE5 9RS, UK
| | - Cathy Bryant
- Consultant in Oral Surgery, King´s College Hospital, London, SE5 9RS, UK
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Meade MJ. Medication-related osteonecrosis of the jaw: A cross-sectional survey assessing the quality of information on the Internet. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:e83-e90. [PMID: 34753689 DOI: 10.1016/j.oooo.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the quality of information and readability of online content regarding medication-related osteonecrosis of the jaw (MRONJ). STUDY DESIGN Three search engines were used to identify websites containing information regarding MRONJ. The content was assessed with 5 quality of information and readability tools. Statistical analyses were performed via GraphPad Software (GraphPad Software Inc., La Jolla, Calif, United States). RESULTS The Health on the Net (HONcode) seal was present in 2 of the 21 websites that satisfied inclusion/exclusion criteria. The mean JAMA (Journal of the American Medical Association) benchmark satisfied per website was 1.619 out of 4 (standard deviation [SD] = 1.2; 95% confidence interval [CI], 1.07-2.17). The mean overall Quality Evaluation Scoring Tool score was 15.29 out of a maximum 28 (SD = 6.174; 95% CI, 12.48-18.1). The Quality Evaluation Scoring Tool scores of those websites that satisfied ≥3 JAMA criteria were significantly higher than those that did not (P = .01; 95% CI, -11.41 to -1.79). The readability levels of all content ranged from fairly difficult to very difficult. CONCLUSIONS The information related to MRONJ on the Internet is unreliable and too difficult for the general public to read. Authors of online MRONJ information should consider use of quality of information and readability tools to ensure that reliable information is understood by those with poor health literacy skills.
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Affiliation(s)
- Maurice J Meade
- PR Begg Chair in Orthodontics, The School of Dentistry, The University of Adelaide, Adelaide, South Australia, Australia.
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Yang G, Kim YN, Kim H, Lee BK. Effect of Human Umbilical Cord Matrix-Derived Mesenchymal Stem Cells on Bisphosphonate-Related Osteonecrosis of the Jaw. Tissue Eng Regen Med 2021; 18:975-988. [PMID: 34347277 DOI: 10.1007/s13770-021-00372-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe sequela caused by bisphosphonates (BPs), which are widely used to treat osteoporosis or other malignancies. However, the mechanism underlying BRONJ remains unclear. Recently, human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) have been studied for treatment of diverse diseases and injuries. This study aimed to investigate the therapeutic effects of hUC-MSCs in BRONJ. METHODS The therapeutic effects of hUC-MSCs were examined in rat bone marrow (rBM)-derived cells using cell viability, colony-forming, and real-time PCR assays and FACS for analyzing essential proinflammatory and bone regeneration markers in vitro. To demonstrate the in vivo therapeutic and adverse effects of transfused hUC-MSCs, micro-CT, H&E staining, IHC (Angiogenesis marker gene expression) staining, and parathyroid hormone (PTH)/calcium assay were conducted in a BRONJ-induced animal model. RESULTS BP-induced cytotoxicity and inflammation in rBM-derived cells decreased, after co-culture with hUC-MSCs. The expression levels of bone regeneration markers (RUNX2, OSX, and BMP-2) significantly increased in BP-treated rBM-derived cells, after co-culture with hUC-MSCs. The BP-induced abnormal shift in RANKL/OPG expression ratio in rBM-derived cells was normalized by hUC-MSCs. Consistent with these in vitro results, transfused hUC-MSCs markedly decreased BRONJ and significantly healed injured mucosa in the BRONJ-induced animal model. The animals exhibited serious destruction of the kidney structure and increases in serum PTH and calcium levels, which were significantly normalized by hUC-MSC transfusion. CONCLUSION hUC-MSCs exerted therapeutic effects on BRONJ in vitro and in vivo through their anti-cytotoxicity, anti-inflammatory activity and ability to recover bone regeneration.
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Affiliation(s)
- Gwanghyun Yang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young-Nam Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hyunjeong Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Bu-Kyu Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea. .,Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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Laimer J, Hechenberger M, Müller D, Walch B, Kolk A, Schnabl D, Schomaker M, Bruckmoser E. Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy. Future Oncol 2021; 17:2705-2711. [PMID: 33880956 DOI: 10.2217/fon-2020-1240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a 'real-world' setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.
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Affiliation(s)
- Johannes Laimer
- University Hospital for Cranio-Maxillofacial & Oral Surgery, A-6020, Innsbruck, Austria
| | - Martin Hechenberger
- University Hospital for Cranio-Maxillofacial & Oral Surgery, A-6020, Innsbruck, Austria
| | - Daniela Müller
- University Hospital for Cranio-Maxillofacial & Oral Surgery, A-6020, Innsbruck, Austria
| | - Benjamin Walch
- University Hospital for Cranio-Maxillofacial & Oral Surgery, A-6020, Innsbruck, Austria
| | - Andreas Kolk
- University Hospital for Cranio-Maxillofacial & Oral Surgery, A-6020, Innsbruck, Austria
| | - Dagmar Schnabl
- University Hospital for Dental Prosthetics & Restorative Dentistry, A-6020, Innsbruck, Austria
| | - Michael Schomaker
- UMIT - University for Health Sciences, Medical Informatics & Technology, Institute of Public Health, Medical Decision Making & Health Technology Assessment, A-6060, Hall in Tirol, Austria.,University of Cape Town, Centre for Infectious Disease Epidemiology & Research, Cape Town, 7925, South Africa
| | - Emanuel Bruckmoser
- Private Practice for Oral & Maxillofacial Surgery, A-5020, Salzburg, Austria
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The awareness and practice of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey. BMC Oral Health 2021; 21:155. [PMID: 33761923 PMCID: PMC7992948 DOI: 10.1186/s12903-021-01475-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background 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. 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. Methods An 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. Results Although 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). Conclusions These 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 registration Not applicable. Supplementary information The online version contains supplementary material available at 10.1186/s12903-021-01475-6.
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EKMEKÇİOĞLU A, AKAY G, KARADAĞ Ö, GÜNGÖR K. The Awareness and Knowledge of Dentists about Medication-Related Osteonecrosis of Jaws. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.701257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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16
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Kanwar N, Bakr MM, Meer M, Siddiqi A. Emerging therapies with potential risks of medicine-related osteonecrosis of the jaw: a review of the literature. Br Dent J 2021; 228:886-892. [PMID: 32541753 DOI: 10.1038/s41415-020-1642-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the past, osteonecrosis of the jaw (ONJ) was generally reported with bisphosphonate drugs; hence, the term BRONJ (bisphosphonate-related osteonecrosis of the jaw) was initially proposed. This was followed by the term ARONJ (antiresorptive osteonecrosis of the jaw). More recently, other novel medications such as vascular endothelial growth factor (VEGF) inhibitors, tyrosine kinase inhibitors and humanised antibodies that affect osteoclastic action have been reported to initiate ONJ in several cases. For this reason, in 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) changed the term to MRONJ - medication-related osteonecrosis of the jaw. The review primarily focuses on ONJ associated with emerging therapies for the management of bone disorders. This article sheds some light on the risk factors that predispose dental patients to the development of osteonecrosis, the mechanisms of drug therapies associated with MRONJ, and potential treatment and management regimes for MRONJ patients. The current review noted that the incidence and associated risk of MRONJ is significant with the new therapeutic agents discussed. Therefore, for optimised patient care, pharmacovigilance with the new medications is essential for dental professionals.
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Affiliation(s)
- Nupur Kanwar
- General Dentist, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia
| | - Mahmoud M Bakr
- Director of Clinical Education (Dentistry), Senior Lecturer, General Dental Practice, School of Dentistry and Oral Health, Griffith University Queensland, 4222, Australia
| | - Mohammed Meer
- Senior Lecturer, Oral and Maxillofacial Surgery, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia
| | - Allauddin Siddiqi
- Department of Periodontics, School of Dentistry and Oral Health, Griffith University, Queensland, 4222, Australia.
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El-Ma'aita A, Da'as N, Al-Hattab M, Hassona Y, Al-Rabab'ah M, Al-Kayed MA. Awareness of the risk of developing medication-related osteonecrosis of the jaw among bisphosphonate users. J Int Med Res 2020; 48:300060520955066. [PMID: 32924697 PMCID: PMC7493245 DOI: 10.1177/0300060520955066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective In this retrospective observational study, we evaluated awareness among patients using bisphosphonates (BPs) regarding the risk of developing medication-related osteonecrosis of the jaw (MRONJ) and whether they received appropriate dental screening and treatment prior to commencing medication. Methods Patients using BPs who attended the endodontics clinic at Jordan University Hospital in 2019 were interviewed using a pre-designed questionnaire. Data were analysed using descriptive statistics and chi-squared tests. Results In total, 110 patients were interviewed (84 women, 26 men; age 40–78 years). A total of 94 patients were using oral BP and 16 received intravenous (IV) BP. We found that only 12.4% of participants were aware about the risk of MRONJ following BP use, and only one third of them has received information from their prescribing physicians. In total, 5% of participants were referred to a dentist for screening prior to initiating BP treatment. Patients receiving IV BP and those with a university-level education had better awareness about the risk of MRONJ than oral BP users and those with a high school education level. Conclusion Patients’ awareness about MRONJ risk was low in our population. Better patient education and collaboration among physicians and dentists are needed prior to starting BP treatment.
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Affiliation(s)
| | - Noor Da'as
- Jordan University Hospital, Amman, Jordan
| | | | - Yazan Hassona
- School of Dentistry, University of Jordan, Amman, Jordan
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Abstract
This article explores how to prevent and manage complications of dentoalveolar surgery. Many complications are avoidable. Surgical skills and knowledge of anatomy play an important role in prevention of complications. Prevention starts with detailed history and physical examination of the patient. Key to perioperative management of patients is risk assessment. Without a proper history and physical examination, the clinician is unable to assess the risk of performing surgery and anesthesia for each patient. Some illnesses and medications increase the risk of complications. The following complications are discussed: alveolar osteitis, displacement, fracture, hemorrhage, infection, nonhealing wound, oroantral communication, swelling, and trismus.
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Affiliation(s)
- Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, 1919 7th Avenue South, SDB 419, Birmingham, AL 35294, USA.
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19
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Current knowledge regarding medication-related osteonecrosis of the jaw among different health professionals. Support Care Cancer 2020; 28:5397-5404. [PMID: 32144584 DOI: 10.1007/s00520-020-05374-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the current knowledge regarding medication-related osteonecrosis of the jaw (MRONJ); the adverse effects of anti-resorptive (AR) and anti-angiogenic (AA) drugs; strategies for MRONJ prevention and treatment; and perception of the dentist's role in assisting patients who use these drugs among physicians, dentists, and nurses. METHODS Using questionnaires, the current knowledge of MRONJ was assessed among dentists, physicians, and nurses, who were divided into group I, which included specialties that directly assist cancer patients, and group II, which included other specialties. The questionnaires assessed the characteristics of the health professionals, training time, and specialties; their knowledge of AR and AA drugs; and their knowledge of MRONJ. RESULTS A total of 1370 health professionals participated in the study, including 1032 dentists, 239 physicians, and 99 nurses. Among dentists and physicians, the training time (p = 0.036 and p < 0.001, respectively) and specialization in group I domains (p < 0.001 and p < 0.001, respectively) had a significant impact on MRONJ knowledge, while nurses showed no significant impact regardless of the training time and specialty. Less than 10% of the physicians and dentists could correlate the signs and symptoms of all stages of MRONJ. CONCLUSION The findings indicated a notable lack of knowledge regarding MRONJ among dental surgeons and physicians, and especially among nurses. More experienced professionals and specialists in the areas that assist cancer patients usually have a greater understanding of the dentist's role in MRONJ prevention, diagnosis, treatment, and patient care and will introduce or are already using AR and AA drugs.
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20
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Dahlgren M, Larsson Wexell C. Uncertainty managing patients treated with antiresorptive drugs: a cross-sectional study of attitudes and self-reported behavior among dentists in Sweden. Acta Odontol Scand 2020; 78:109-117. [PMID: 31441343 DOI: 10.1080/00016357.2019.1655586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To evaluate the level of knowledge and attitudes among Swedish general dentists regarding the behavior and management of patients treated with bisphosphonates and denosumabMaterials and Methods: A questionnaire was sent to 656 dentists. The web-based survey included questions on demographics, risk perception of osteonecrosis of the jaws (ONJ), the experience of managing patients treated with bisphosphonates and denosumab and requests to acquire new knowledge. Independence and associations were tested using Fisher's exact test and the chi-square test function.Results: The overall response rate was 57.6%. Most of the dentists, 69.7%, had been in the profession for more than 5 years. The criteria for ONJ were not known by 43.2% and 86.9% did not feel comfortable with their current level of knowledge when managing the patients in question. The rest of the respondents felt uncertain and more than 70% were unaware of the different stages of ONJ, when to refer a patient to a specialist and when to prescribe antibiotics.Conclusion: Dentists practicing in Sweden express a strong need for an improved level of knowledge when managing patients treated with bisphosphonates and denosumab. The results demonstrate a need for the necessary advancement of education and clinical training at dental schools in order to prepare dentists to provide safe, modern care within the healthcare sector.
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Affiliation(s)
- Mathias Dahlgren
- Department of Oral and Maxillofacial Surgery, Public Dental Service, Södra Älvsborgs Hospital, Borås, Sweden
| | - Cecilia Larsson Wexell
- Department of Oral and Maxillofacial Surgery, Public Dental Service, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden
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Medication-Related Osteonecrosis of the Jaw—Comparison of Bone Imaging Using Ultrashort Echo-Time Magnetic Resonance Imaging and Cone-Beam Computed Tomography. Invest Radiol 2020; 55:160-167. [DOI: 10.1097/rli.0000000000000617] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Franchi S, Brucoli M, Boffano P, Dosio C, Benech A. Medical students' knowledge of medication related osteonecrosis of the jaw. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:344-346. [PMID: 31672685 DOI: 10.1016/j.jormas.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/21/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The objective of this study was to assess medical students' knowledge of "medication related osteonecrosis of the jaws" (MRONJ). METHODS A questionnaire survey was administered to all the medical students in the last two years of school of medicine at the University of Eastern Piedmont between January 2019 and March 2019. The questionnaire contained a first section regarding demographic and personal data of the student and a second section regarding the knowledge on MRONJ. RESULTS On the whole, 72 medical students agreed to participate to this study and filled in the questionnaire. As for indications for the use of bisphosphonates 45 students correctly answered "osteoporosis, osteogenesis imperfecta, multiple myeloma, or metastasis of some malignant tumors". Almost all students (71 out of 72) answered that a thorough examination of oral cavity and a dentist screening is needed and fundamental before starting bisphosphonate assumption. As for drugs responsible for MRONJ, only 12 students out of 72 correctly answered "bisphosphonates, denosumab, and antiangiogenic drugs". DISCUSSION A better level of knowledge and awareness by medical doctors and young physicians may lead, in future, to minimize incidence of MRONJ as well as to a better resolution of ONJ cases. Theoretical and practical initiatives could be promoted to improve and consolidate the knowledge of future physicians about this important issue.
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Affiliation(s)
- S Franchi
- Division of Maxillofacial Surgery, University of Eastern Piedmont, Novara, Italy
| | - M Brucoli
- Division of Maxillofacial Surgery, University of Eastern Piedmont, Novara, Italy
| | - P Boffano
- Division of Maxillofacial Surgery, University of Eastern Piedmont, Novara, Italy.
| | - C Dosio
- Division of Maxillofacial Surgery, University of Eastern Piedmont, Novara, Italy
| | - A Benech
- Division of Maxillofacial Surgery, University of Eastern Piedmont, Novara, Italy
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Sturrock A, Preshaw PM, Hayes C, Wilkes S. General dental practitioners' perceptions of, and attitudes towards, improving patient safety through a multidisciplinary approach to the prevention of medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in the North East of England. BMJ Open 2019; 9:e029951. [PMID: 31213454 PMCID: PMC6597093 DOI: 10.1136/bmjopen-2019-029951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To explore general dental practitioners' (GDPs') perceptions of, and attitudes towards, the risks of medication-related osteonecrosis of the jaw (MRONJ) and the current/potential multidisciplinary approach(es) to prevention of the condition. DESIGN Interpretivist methodology using a grounded theory approach and constant comparative analysis to undertake an iterative series of semistructured interviews. Ritchie and Spencer's framework analysis facilitated the identification and prioritisation of salient themes. SETTING Primary care general dental practices in the North East of England. PARTICIPANTS 15 GDPs. RESULTS GDPs are aware of the risk of MRONJ with commonly implicated medicines; however, they report limited collaboration between professional groups in person-centred avoidance of complications, which is a key requirement of the preventive advice recommended in extant literature. Four salient and inter-related themes emerged: (1) perception of knowledge; indicating the awareness of the risk, limited knowledge of implicated medications and experience of managing the condition; (2) risk; indicating the importance of accurate medication histories, the treatment of low risk patients in primary dental care, counselling of poorly informed patients, the fear of litigation and perceived low priority of oral health in the context of general health and well-being; (3) access and isolation; referring to access to general medical records, professional isolation and somewhat limited and challenging professional collaborative relationships; (4) interprofessional working; indicating oral health education of other professional groups, collaboration and communication, and a focus on preventive care. CONCLUSIONS Patients continue to be at risk of developing MRONJ due to limited preventive interventions and relatively disparate contexts of multidisciplinary team healthcare. Effective collaboration, education and access to shared medical records could potentially improve patient safety and reduce the potential risk of developing MRONJ.
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Affiliation(s)
- Andrew Sturrock
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Philip M Preshaw
- National University Centre for Oral Health, National University of Singapore, Singapore
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Scott Wilkes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Al-Samman AA, Al-Ani RS. Across-sectional survey on medication-related osteonecrosis of the jaws' knowledge and awareness in a sample of dental society. J Craniomaxillofac Surg 2019; 47:926-931. [DOI: 10.1016/j.jcms.2019.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/12/2018] [Accepted: 02/11/2019] [Indexed: 11/25/2022] Open
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Escobedo M, García-Consuegra L, Junquera S, Olay S, Ascani G, Junquera L. Medication-related osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain). JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:395-400. [DOI: 10.1016/j.jormas.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/21/2018] [Accepted: 04/12/2018] [Indexed: 12/19/2022]
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Nicolatou-Galitis O, Kouri M, Papadopoulou E, Vardas E, Galiti D, Epstein JB, Elad S, Campisi G, Tsoukalas N, Bektas-Kayhan K, Tan W, Body JJ, Migliorati C, Lalla RV. Osteonecrosis of the jaw related to non-antiresorptive medications: a systematic review. Support Care Cancer 2018; 27:383-394. [PMID: 30353228 DOI: 10.1007/s00520-018-4501-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/03/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The reporting of osteonecrosis of the jaw (ONJ) related to anticancer agents without known antiresorptive properties (non-antiresorptives), such as antiangiogenics, tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, immune checkpoint inhibitors, and cytotoxic chemotherapy is increasing. OBJECTIVE To review characteristics of ONJ in cancer patients receiving non-antiresorptives. METHODS A systematic review of the literature between 2009 and 2017 was conducted by the Bone Study Group of MASCC/ISOO. RESULTS Of 6249 articles reviewed and from personal communication, 42 ONJ cases related to non-antiresorptives were identified. No gender predilection was noted. Median age was 60 years and ONJ stage 2 was most common, with predilection for posterior mandible. Exposed bone, pain, and infection were common at diagnosis. In comparison to bone targeting agents (BTAs), radiology, histology, and management were similar, with medication often discontinued. Delayed diagnosis (median 8 weeks) was noted. Important differences included earlier time to ONJ onset (median 20 weeks), absence of trigger event (40%), and greater likelihood of healing and shorter healing time (median 8 weeks) as compared to BTA-related ONJ. Gastrointestinal cancers predominated, followed by renal cell carcinomas compared to breast, followed by prostate cancers in BTA-related ONJ, reflecting different medications. CONCLUSIONS Data about non-antiresorptive-related ONJ is sparse. This type of ONJ may have better prognosis compared to the BTA-related ONJ, suggested by greater likelihood of healing and shorter healing time. However, the delay in diagnosis highlights the need for more education. This is the first attempt to characterize ONJ associated with different non-antiresorptives, including BRAF and immune checkpoint inhibitors.
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Affiliation(s)
- Ourania Nicolatou-Galitis
- Dental School, National and Kapodistrian University of Athens, Bouboulinas 41, N. Psyhico, 154 51, Athens, Greece.
| | - Maria Kouri
- Dental School, National and Kapodistrian University of Athens, Bouboulinas 41, N. Psyhico, 154 51, Athens, Greece
| | - Erofili Papadopoulou
- Dental School, National and Kapodistrian University of Athens, Bouboulinas 41, N. Psyhico, 154 51, Athens, Greece
| | - Emmanouil Vardas
- Dental School, National and Kapodistrian University of Athens, Bouboulinas 41, N. Psyhico, 154 51, Athens, Greece
| | - Dimitra Galiti
- Dental School, National and Kapodistrian University of Athens, Bouboulinas 41, N. Psyhico, 154 51, Athens, Greece
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Health System, Los Angeles CA and City of Hope National Medical Center, Duarte, CA, USA
| | - Sharon Elad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Giuseppina Campisi
- Sector of Oral Medicine "V. Margiotta", Department Di.Chir.On.S, University of Palermo, Palermo, Italy
| | - Nikolaos Tsoukalas
- Consultant Medical Oncologist, Oncology Department, Veterans Hospital (NIMTS), Athens, Greece
| | - Kivanc Bektas-Kayhan
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey
| | - Winston Tan
- Hematology/Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Cesar Migliorati
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA
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Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:117-135. [PMID: 30393090 DOI: 10.1016/j.oooo.2018.09.008] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/16/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
Skeletal complications caused by osteoporosis or bone metastases are associated with considerable pain, increased mortality, and reduced quality of life. Furthermore, such events place a burden on health care resources. Agents that prevent bone resorption, such as bisphosphonates or denosumab, can reduce the risk of skeletal-related events and are widely used in patients with osteoporosis or bone metastases of cancer. Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but potentially serious, adverse event associated with high cumulative doses of bisphosphonates or denosumab. However, MRONJ can be treated, and the likelihood of the development of this condition can be reduced through prophylactic dental care and the maintenance of good oral hygiene. Dentists, as part of a multiprofessional team, have a critical role in preventing MRONJ. This review describes the incidence and pathophysiology of MRONJ and provides guidance for dental practitioners with regard to the screening, prophylactic treatment, diagnosis, and management of patients with this condition.
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Otto S, Pautke C, Van den Wyngaert T, Niepel D, Schiødt M. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treat Rev 2018; 69:177-187. [PMID: 30055439 DOI: 10.1016/j.ctrv.2018.06.007] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 01/12/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is primarily an adverse side effect of denosumab or bisphosphonates (particularly when used at high doses to prevent skeletal-related events [SREs] in patients with cancer and bone metastases) or possibly anti-angiogenic cancer treatment. While the implementation of preventive measures over recent years has reduced the risk of MRONJ in patients with bone metastases due to cancer, it is imperative to balance the risk of MRONJ against the beneficial effects of treatment with denosumab or bisphosphonates on the skeletal health of patients. Despite growing awareness of MRONJ within the medical community, there is a lack of large-scale, prospective clinical studies in this rapidly evolving field. Discussing preventive measures with patients and implementing them, both before and during treatment with bisphosphonates or denosumab, is the best option to reduce the risk of MRONJ. In particular, avoiding bone trauma and preventing and treating dental infections before and during denosumab or bisphosphonate therapy is crucial to minimize the risk of MRONJ. If MRONJ develops, conservative (non-surgical) treatment can provide symptom relief, but achieving mucosal closure remains challenging. When management of symptoms and mucosal healing are the ultimate goals of therapy, or after failure of conservative treatment, a surgical approach may be beneficial. This critical review, based on a best-evidence review of currently available literature, provides clear practical guidelines to help to prevent, manage and treat MRONJ. Overall, a multidisciplinary, pragmatic approach to MRONJ should be adopted, prioritizing patient's quality of life and management of their skeletal malignant disease.
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Affiliation(s)
- Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Christoph Pautke
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Antwerp, Belgium; Molecular Imaging Center Antwerp, University of Antwerp, Antwerp, Belgium.
| | | | - Morten Schiødt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen, Denmark.
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Chan BH, Yee R, Puvanendran R, Ang SB. Medication-related osteonecrosis of the jaw in osteoporotic patients: prevention and management. Singapore Med J 2018; 59:70-75. [PMID: 29568850 PMCID: PMC6119741 DOI: 10.11622/smedj.2018014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Osteoporosis is a major, growing healthcare issue. This is especially of concern in an ageing population like that of Singapore. Osteoporotic patients are at risk of fractures, which can result in increased morbidity and mortality. The use of antiresorptive therapy with bisphosphonates or denosumab has been proven to reduce fracture risk. However, the use of these medications has rarely been associated with the development of osteonecrosis of the jaw, a potentially debilitating condition affecting one or both jaws. Appropriate understanding of the patient's antiresorptive therapy regime, as well as early institution of preventive dental measures, can play an important role in preventing medication-related osteonecrosis of the jaw (MRONJ). Regular monitoring and prompt referral to specialist care is warranted for patients with established MRONJ.
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Affiliation(s)
- Boon Hui Chan
- Dental Service, KK Women’s and Children’s Hospital, Singapore
| | - Ruixiang Yee
- Dental Service, KK Women’s and Children’s Hospital, Singapore
| | | | - Seng Bin Ang
- Family Medicine Service, KK Women’s and Children’s Hospital, Singapore
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Pharmacology: Sea change of indications. Br Dent J 2017; 222:563-4. [DOI: 10.1038/sj.bdj.2017.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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