Improving Knowledge of MRONJ Risk Among Singapore Dental Practitioners Using an Educational Lecture With an Incorporated Quiz

Background: Fear of rare medication side effects, such as medication related osteonecrosis of the jaw (MRONJ) in patients and dentists remains a major reason for the low rate of antiresorptive initiation for osteoporosis, and for the poor adherence after starting treatment. In this study, we assessed the understanding of osteoporosis treatment and its risk in dental professionals pre and post an education lecture. Method: Dental professionals were invited to an educational lecture on osteoporosis treatment and benefits. 2 lectures were conducted over the course of a year, with the 2(nd) lecture conducted virtually due to physical meeting restrictions in place for the COVID 19 pandemic. Attendees were invited to submit responses to a pre- and post- lecture survey assessing their knowledge of the current osteoporosis treatments and MRONJ. Results: There were 126 responses to the survey conducted. Majority (87%) of responders were dentists in private, including group dental practices, with 74% having more than 11 years of working experience. Most (81 %) have not had any encounters with patients with MRONJ. The pre-lecture survey showed that 60% of responders expressed slight or no confidence at all in treating patients who are on osteoporosis treatment. Only 19% of all responders were able to correctly identify the risk of MRONJ in patients on osteoporosis treatment. Majority of responders tended to inflate MRONJ risk by as much as 100 times the quoted baseline risk in the literature. One third of dentists would not perform any invasive treatments on patients on osteoporosis treatment. Post-lecture, the percentage of responders with slight and no confidence at all in treating patients who are on osteoporosis treatment decreased to 18%. 65% of responders were able to correctly identify the risk of MRONJ in patients on osteoporosis treatment as quoted in the literature. Only 3% of dentists would not perform any invasive treatments on patients on osteoporosis treatment. 95% of responders correctly stated that maintenance of good oral hygiene is the most important measure to prevent MRONJ. Attendees suggested the creation of a joint guidance from local osteoporosis and dental societies may better improve knowledge and instill confidence in treating osteoporosis patients. Conclusion: There is a significant knowledge gap within the dental practitioners in Singapore on the risk of MRONJ associated with osteoporosis treatments. This may result in dentists discouraging patients from starting osteoporosis medications and dentists not performing necessary dental treatments on patients on osteoporosis treatment. Both physical and virtual dental education lectures are effective in increasing the level of confidence and in correcting misconceptions on MRONJ risk. Continued engagement of the dental community would be important in reducing fear of MRONJ and facilitate treatment of osteoporosis in the population.