Türkiye’de Diş Hekimlerinin Bifosfonatlar Konusundaki Farkındalık Ve Bilgilerinin Değerlendirilmesi

Öz

Amaç: Bisfosfonatlar çeşitli hastalıkların tedavisinde kullanılan inorganik pirofosfat analoglarıdır. Bu çalışma uzman olmayan diş hekimlerinin, uzmanlık öğrencilerinin ve uzmanların ilaca bağlı gelişen çene osteonekrozuna yönelik bilgi ve tutumlarını değerlendirmenin yanında, gelecekteki eğitim programlarını optimize etmeyi amaçlamıştır.
Materyal ve Metot: Çalışmaya 209 katılımcı dahil edilmiştir. Türk Dişhekimleri Birliği’nin desteğiyle bir anket hazırlanmış ve üyeler arasında e-posta ile paylaşılmıştır. Katılımcıların demografik bilgiler, ilaca bağlı çene osteonekrozları, bisfosfonatlar ve tedavi yaklaşımları ile ilgili 7 sorudan oluşan anketi yanıtlamaları istenmiştir. Bu anket sorularına hekimlerin verdiği cevaplar sayı ve yüzde ile tanımlanmıştır.
Bulgular: Ankete katılan uzmanlık öğrencilerinin ortalama yaşı, uzman olmayan diş hekimleri ve uzmanlardan anlamlı olarak düşük bulunmuştur (P = 0.003, P = 0.038). Uzman olmayan diş hekimleri, baş-boyun bölgesinde gözlemlenen ekspoze kemiğin bisfosfonat tedavisi ya da radyoterapiye bağlı olabilme ihtimalini diğer gruplara göre daha az değerlendirmiştir (P=0.048, P=0.008). Uzman ve uzmanlık öğrencilerine kıyasla uzman olmayan diş hekimleri, bisfosfonat kullanan hastaların radyolojik ve ağız içi bulguları hakkında daha az bilgi sahibi olduğunu belirtmiştir (P = 0.034).
Sonuç: Diş hekimlerinin bisfosfonatların kullanımı ve yan etkileri konusunda artan farkındalığı MRONJ’un önlenmesi için önemlidir. Diş hekimleri arasında MRONJ ve bisfosfonatlar ile ilgili bilincin artırılması için daha fazla çaba gösterilmesi ve hedef kitleye yönelik eğitim planları oluşturulması gerekmektedir.

Anahtar Kelimeler

• İlaca bağlı çene osteonekrozları
• bisfosfonatlar
• diş hekimi
• koruyucu hekimlik
• anket

The Evaluation of Dentists’ Awareness and Knowledge in Turkey Regarding Bisphosphonates

Abstract

Aim: Bisphosphonates (BPs) are inorganic pyrophosphate analogs used for the treatment of various diseases. This study aimed to evaluate the knowledge and attitudes of general dental practitioners (GDP), specialist trainees (ST), and specialists (S) in Turkey toward medication-related osteonecrosis of the jaw (MRONJ) and to optimize future training programs in this field.
Materials and Methods: A self-report questionnaire consisting of 7 questions about demographic data, knowledge about BPs, MRONJ and treatment modalities was prepared and send to the members of Turkish Dental Association via email.
Results: A total of 209 participants were included in this survey. The mean age of the ST group was significantly lower than the mean ages of the GDP and S groups (P= 0.003, P= 0.038). GDP are less likely to think of BPs administration and radiotherapy treatment than S or ST upon observation of an exposed bone in the head-and-neck region (P=0.048, P=0.008). In comparison to the S and ST groups, the GDP group displayed less knowledge regarding the radiological and intraoral examination of patients undergoing BP therapy (P= 0.034).
Conclusion: The increasing awareness of dentists about usage and side effects of BPs is important for preventing MRONJ. The GDP group displayed significantly less knowledge regarding the radiological and intraoral examinations of patients undergoing BP therapy. Greater efforts are required to increase education and knowledge of MRONJ and BPs among dental practitioners.

Keywords

• Medication-related osteonecrosis of the jaws
• MRONJ
• bisphosphonates
• dentist
• preventive dentistry
• survey

References

1. References 1. Sigua-Rodriguez EA, da Costa Ribeiro R, de Brito AC, Alvarez-Pinzon N, de Albergaria-Barbosa JR. Bisphosphonate-related osteonecrosis of the jaw: a review of the literature. Int J Dent 2014;2014:192320.
2. 2. Masson DR, O’Callaghan E, Seager M. The knowledge and attitudes of North Wales healthcare professionals to bisphosphonate associated osteochemonecrosis of the jaws. JDOH 2009;10:175-183.
3. 3. Bauer JS, Beck N, Kiefer J, Stockmann P, Wichmann M, Eitner S. Awareness and education of patients receiving bisphosphonates. J Craniomaxillofac Surg 2011;40: 277-282.
4. 4. Liu J, Huang W, Zhou R, Jia S, Tang W, Luo Y, Zhang J. Bisphosphonates in the treatment of patients with metastatic breast, lung, and prostate cancer: a meta-analysis. Medicine (Baltimore) 2015;94:1-4.
5. 5. Tanna N., Steel C., Stagnell S., Bailey E. (2017). Awareness of medication related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners. BDJ 2017;222:121-125.
6. 6. Voss PJ, Poxleitner P, Schmelzeisen R, Stricker A, Semper-Hogg W. Update MRONJ and perspectives of its treatment. Journal of Somatology, Oral and Maxillofacial surgery, 2017;118:232-235.
7. 7. Wang J, Goodger NM, Pogrel MA. Osteonecrosis of the jaw associated with cancer chemotherapy. J Oral Maxillofac Surg 2003;61:1104-1107.
8. 8. Pazdur R. Postmarketing safety review: Bisphosphonates. Food and Drug Administration, Office of Drug Safety. http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4095b2_03_02-fda-tab1.doc; Accessed January 2017.

9. 9. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. J Oral Maxillofac Surg 2014;72:1938-1956.
10. 10. Hamadeh IS, Ngwa BA, Gong Y. Drug induced osteonecrosis of the jaw. Cancer Treat Rev 2015;41:455-464.
11. 11. Walter C, Laux C, Sagheb K. Radiologic bone loss in patients with bisphosphonate-associated osteonecrosis of the jaws: a case-control study. Clin Oral Investig 2014;18:385-390.
12. 12. Fantasia JE. Bisphosphonates—what the dentist needs to know: practical considerations. J Oral Maxillofac Surg 2009;67:53-60.
13. 13. Al-Mohaya MA, Al-Khashan HI, Mishriky AM, Al-Otaibi LM. Physicians’ awareness of bisphosphonates-related osteonecrosis of the jaw. Saudi Med J 2011;32:830-835.
14. 14. Hong JW, Nam W, Cha IH, et al. Oral bisphosphonate-related osteonecrosis of the jaw: the first report in Asia. Osteoporos Int 2010;21:847-853.
15. 15. Beninati F, Pruneti R, Ficarra G. Bisphosphonate-related osteonecrosis of the jaws (Bronj). Med Oral Patol Oral Cir Bucal, 2013;18:e752-e758.
16. 16. 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;1:90-95.
17. 17. Lemound J, Eckardt A, Kokemüller H, et al. Bisphosphonate-associated osteonecrosis of the mandible: reliable soft tissue reconstruction using a local myofascial flap. Clin Oral Investig 2012;16:1143-1152. 18. Norholt SE, Hartlev J. Surgical treatment of osteonecrosis of the jaw with the use of platelet-rich fibrin: a prospective study of 15 patients. Int J Oral Maxillofac Surg 2016;45:1256-1260.
18. 19. Aljohani S, Fliefel R, Ihbe J, Kühnisch J, Ehrenfeld M, Otto S. (2017). What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: a systematic review. Journal of Cranio-maxillofacial Surgery, 45, 1493–1502.
19. 20. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, Kanis J A. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 2012;23:949-955. 21. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-1117.
20. 22. Marx RE, Cillo JE, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 2007;65:2397-2410. 23. Ho A, Ahn JH, Ameerally P. Awareness of bisphosphonate—related osteonecrosis of the jaws in healthcare professionals. Face Mouth Jaw Surgery 2013;3:21-28.
21. 24. 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;16:878-882.
22. 25. Muthukrishnan A, Al-Ismail S, Bertelli G, Browne P. MRONJ risk reduction pathway— 360-degree survey. BDJ 2017;222:386-390.
23. 26. Kyrgidis A, Vahtsevanos K, Koloutsos G, et al. Bisphosphonate-related osteonecrosis of the jaws: a case-control study of risk factors in breast cancer patients. Jpn J Clin Oncol 2008;26:4634-4638.
24. 27. Enciso R., Keaton J., Saleh N., Ahmadieh A., Clark G. T., & Sedghizadeh P. P. Assessing the utility of serum C-telopeptide cross-link of type 1 collagen as a predictor of bisphosphonate-related osteonecrosis of the jaw: a systematic review and meta-analysis. JADA 2016;147:551-560.e11.
25. 28. Peisker A, Raschke GF, Fahmy MD, Guentsch A, Roshanghias K, König KC, Schultze-Mosgau S. Cross-sectional study of four serological bone turnover markers for the risk assessment of medication-related osteonecrosis of the jaw. Journal of Craniofacial Surgery 2018;29:e137-e140.
26. 29. Bamias A, Kastritis E, Bamia C, et al. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 2005;23:8580- 8587. 30. Marx, R. Oral, and intravenous bisphosphonate-induced osteonecrosis of the jaws: history, etiology, prevention, and treatment (2nd ed). Hanover Park, IL: Quintessence Publishing; 2003.
27. 31. Sinningen K, Tsourdi E, Rauner M, Tilman DR, Hamann C, Lorenz CH. Skeletal and extraskeletal actions of denosumab. Endocrine 2012;42:52-62.
28. 32. Chambers DW, Lyon LJ. How dentists read a technique article: a grounded theory investigation. J Prosthodont 2017;26:682-687.
29. 33. Çebi AT. Knowledge and awareness of dentists working at a dental hospital in a city bbout bone osteonecrosis due to medication. ACU Sağlık Bil Derg 2019; 10(3):438-442.