Bisphosphonate Associated Osteonecrosis: Survey of Oncologists

Objectives: To show referral from oncologists (who prescribe bisphosphonates for metastatic bone cancers and hypercalcemia of malignancy) to dentists could reduce morbidity associated with bisphosphonate related osteonecrosis of the jaws (ONJ).

Methods: A questionnaire was developed to evaluate the perceived importance of ONJ and limitations in dental treatment. Interdepartmental mail and Survey Monkeyİ were used to conduct a survey of University Hospitals Ireland Cancer Center oncologists.

Results: The questionnaire had a 17% response rate. Responding oncologists were familiar with the condition; 91% of oncologists report confusion about the development, presentation and treatment of the condition. 66% of oncologists reported having patients develop the condition. 39% believe they are currently treating ONJ patients; however, only 30% communicated with the attending dentist.

66% reported their patients receive routine dental care. Access and cost of dental care are cited limitations. Only 36% of oncologists refer their patients to dentists prior to start of bisphosphonate therapy, while 63% believe their patients could have undiagnosed chronic oral conditions, which could increase the risk of emergent procedures associated with ONJ onset following bisphosphonate therapy.

When asked if oncologists could predict which patients were more susceptible to ONJ based on chronic oral risk factors, all said they would refer these patients to a dentist before starting treatment. All said that ONJ could be better prevented with dental insurance coverage.

Conclusion: Oncologists would refer potential or suspected ONJ cases to dentist if they could identify oral risk factors. Adequate diagnosis and care of these cases would require greater dental insurance coverage and increased communication between specialists. Development of a referral protocol prior to the start of bisphosphonate therapy (similar to that used in radiotherapy cases) would be useful.