Comparison of Knowledge and Awareness Status of Senior Dental and Medical Students About MRONJ: A Cross-Sectional Study

Abstract

Objective: Medication-related osteonecrosis of the jaw (MRONJ), a condition that can be managed and prevented through effective collaboration between dental and medical professionals, is a rare yet potentially serious disease. This study aimed to assess the knowledge and awareness of Turkish dental and medical school students regarding MRONJ. Methods: A cross-sectional study was conducted among 254 dental and 234 medical students. Data were collected using an electronic and paper-based self-administered structured modified questionnaire consisting of five sections. SPSS Version 23 (IBM Corporation, Armonk, NY, USA) was utilized, with a significance level set at p<0.05. Results: Both dental and medical students indicated that their curricula included courses on antiresorptive, antiangiogenic drugs, and the development of MRONJ associated with the use of these drugs. However, the level of knowledge and awareness among students in both groups regarding MRONJ was low. When comparing the awareness of MRONJ between medical and dental students, dental students (%88.6) exhibited a higher level than medical students (%52.1). Dental students also demonstrated greater awareness of the appropriate imaging techniques for diagnosing MRONJ compared to their medical counterparts (p<0.05). However, medical students' knowledge about dental approaches during bisphosphonate therapy was not as comprehensive as that of dental students. Conclusion: Despite both dental and medical students having courses on MRONJ in their curriculum, their awareness and knowledge appear insufficient. This inadequacy may lead to misdiagnosis and inappropriate treatment modalities. Enhancing the quality and quantity of courses, with a focus on drugs inducing MRONJ and updated treatment protocols, could be proposed to address these issues.

Keywords

• MRONJ
• Dental Students
• Medical Students
• Knowledge
• Awareness

DİŞ HEKİMLİĞİ VE TIP FAKÜLTESİ SON SINIF ÖĞRENCİLERİNİN İLAÇLA İLİŞKİLİ ÇENE OSTEONEKROZU (MRONJ) HAKKINDA BİLGİ VE FARKINDALIK DURUMUNUN DEĞERLENDİRİLMESİ: KESİTSEL BİR ÇALIŞMA

Abstract

Amaç: Antiresorptif, anti-anjiojenik ilaçların kullanımına bağlı gelişen çene kemik ölümü (MRONJ), diş ve tıp profesyonelleri arasındaki etkili işbirliği ile yönetilebilen ve önlenebilen nadir ancak potansiyel olarak ciddi bir durumdur. Bu çalışmanın amacı, Türk diş ve tıp fakültesi öğrencilerinin MRONJ hakkındaki bilgi düzeyini ve farkındalığını değerlendirmektir. Yöntemler: 254 diş ve 234 tıp öğrencisi arasında kesitsel bir çalışma gerçekleştirildi. Veriler, beş bölümden oluşan bir elektronik ve kağıt tabanlı yapılandırılmış modifiye anket kullanılarak toplandı. Analizlerde SPSS Sürüm 23 (IBM Corporation, Armonk, NY, ABD) kullanıldı ve anlamlılık düzeyi p<0.05 olarak belirlendi. Bulgular: Hem diş hem de tıp öğrencileri, müfredatlarının antiresorptif, anti-anjiojenik ilaçlar ve bu ilaçların kullanımına bağlı olarak gelişen MRONJ konulu dersleri içerdiğini belirtmişlerdir. Ancak, her iki grup öğrenci arasında MRONJ hakkındaki bilgi ve farkındalık düzeyi düşük bulunmuştur. Tıp ve diş hekimliği öğrencileri arasında MRONJ farkındalığı karşılaştırıldığında, diş hekimliği öğrencilerinin (%88.6), tıp öğrencilerine (%52.1) göre daha yüksek bir farkındalık düzeyine sahip olduğu gözlemlenmiştir. Diş hekimliği öğrencileri ayrıca, MRONJ teşhisi için uygun görüntüleme teknikleri konusunda tıp öğrencilerine göre daha fazla farkındalık göstermiştir (p<0.05). Tıp öğrencilerinin bifosfonat tedavisi almış veya almakta olan hastalarda diş tedavisi yaklaşımları konusundaki bilgisi, diş hekimliği öğrencilerinin bilgisi kadar kapsamlı bulunmamıştır. Sonuç: Hem diş hem de tıp öğrencilerinin müfredatlarında MRONJ dersleri olmasına rağmen, farkındalık ve bilgilerinin yetersiz olduğu görülmektedir. Bu yetersizlik, yanlış teşhise ve uygun olmayan tedavi yöntemlerine yol açabilir. Bu sorunları ele almak için, MRONJ'a neden olan ilaçlar ve güncellenmiş tedavi protokollerine odaklanan derslerin kalitesini ve miktarını artırmak önerilebilir.

Keywords

• MRONJ
• Diş Öğrencileri
• Tıp Öğrencileri
• Bilgi
• Farkındalık

References

1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61:1115-7.
2. 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):1938-56.
3. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. 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):920-43.
4. Hess LM, Jeter JM, Benham-Hutchins M, Alberts DS. Factors associated with osteonecrosis of the jaw among bisphosphonate users. Am J Med. 2009;121:475–83.
5. Mercer E, Norton T, Woo S, Treister N, Dodson TB, Solomon DH. Ninetyone osteoporosis patients affected with bisphosphonaterelated osteonecrosis of the jaw: a case series. Calcif Tissue Int. 2013;93:241–8.
6. Hallmer F, Bjørnland T, Nicklasson A, Becktor JP, Andersson G. Osteonecrosis of the jaw in patients treated with oral and intravenous bisphosphonates: experience in Sweden. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:202–8.
7. 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.
8. Abu-Id MH, Warnke PH, Gottschalk J, et al. "Bis-phossy jaws"- high and low risk factors for bisphosphonate-induced osteonecrosis of the jaw. J Craniomaxillofac Surg. 2008;36(2):95-103.

9. Bauer JS, Beck N, Kiefer J, Stockmann P, Wichmann M, Eitner S. Awareness and education of patients receiving bisphosphonates. J Craniomaxillofac Surg. 2012;40:277–82.
10. Almousa MA, Alharbi GK, Alqahtani AS, Chachar Y, Alkadi L, Aboalela A. Dental practitioners' and students' knowledge of medication related osteonecrosis of the jaw (MRONJ). Saudi Pharm J. 2021;29:96-103.
11. El Osta L, El Osta B, Lakiss S, Hennequin M, El Osta N. Bisphosphonate-related osteonecrosis of the jaw: awareness and level of knowledge of Lebanese physicians. Support Care Cancer. 2015;23:2825-31.
12. Acharya S, Patil V, Ravindranath V, Kudva A, Nikhil K. Medication-related osteonecrosis of the jaw: knowledge and perceptions of medical professionals on the usage of bone modifying agents and dental referrals. J Med Life. 2022;15:368-73.
13. Rosella D, Papi P, Pompa G, Capogreco M, De Angelis F, Di Carlo S. Dental students' knowledge of medication-related osteonecrosis of the jaw. Eur J Dent. 2017;11:461-8.
14. Escobedo M, García-Consuegra L, Junquera S, Olay S, Ascani G, Junquera L. Medicationrelated osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain). J Stomatol Oral Maxillofac Surg. 2018;119:395-400.
15. Franchi S, Brucoli M, Boffano P, Dosio C, Benech A. Medical students' knowledge of medication related osteonecrosis of the jaw. J Stomatol Oral Maxillofac Surg. 2020;121:344-6.
16. Miranda-Silva W, Montezuma MA, Benites BM, Bruno JS, Fonseca FP, Fregnani ER. Current knowledge regarding medicationrelated osteonecrosis of the jaw among different health professionals. Support Care Cancer. 2020;28:5397-404.
17. Yamori M, Tamura M, Mikami M, et al. Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients. Int Dent J. 2021;71(4):336-42.
18. Yoo JY, Park YD, Kwon YD, Kim DY, Ohe JY. Survey of Korean dentists on the awareness of bisphosphonate-related osteonecrosis of the jaws. J Investig Clin Dent. 2010;1:90-5.
19. Tanna N, Steel C, Stagnell S, Bailey E. Awareness of medication-related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners. Br Dent J. 2017;222:121-5.
20. de Lima PB, Brasil VL, de Castro JF, et al. Knowledge and attitudes of Brazilian dental students and dentists regarding bisphosphonate-related osteonecrosis of the jaw. Support Care Cancer. 2015;23(12):3421- 6.
21. Alhussain A, Peel S, Dempster L, Clokie C, Azarpazhooh A. Knowledge, practices, and opinions of Ontario dentists when treating patients receiving bisphosphonates. J Oral Maxillofac Surg. 2015;73:1095-105.
22. López-Jornet P, Camacho-Alonso F, Molina-Miñano F, Gomez-Garcia F. Bisphosphonate-associated osteonecrosis of the jaw. Knowledge and attitudes of dentists and dental students: a preliminary study. J Eval Clin Pract. 2010;16:878-82.
23. Moreno-Rabié C, Gaêta-Araujo H, Oliveira- Santos C, Politis C, Jacobs R. Early imaging signs of the use of antiresorptive medication and MRONJ: a systematic review. Clin Oral Investig. 2020;24:2973-89.
24. Wongratwanich P, Shimabukuro K, Konishi M, et al. Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review. Dentomaxillofac Radiol. 2021;50:20200417.
25. Henry DH, Costa L, Goldwasser F, et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol. 2011;29(9):1125-32.