1 | INTRIDUCTION
Bisphosphonates are a group of medications prescribed for conditions such as osteoporosis and malignant bone metastasis. Bisphosphonates caused a great progress in treatment of musculoskeletal disorders such that they are currently among the most commonly used medications for clinical treatment of osteoporosis. Moreover, some reports are available regarding their effective role in management of some other skeletal and joint diseases such as the Paget’s disease, bone metastasis, developmental anomalies, dysplastic fibrosis, Charcot arthropathy, sympathetic dystrophy, aseptic osteomyelitis, multiple myeloma, osteopenia, and osteogenesis imperfecta.1, 2
Despite the numerous advantages of bisphosphonates, recently, osteonecrosis of the jaw was proposed as a major complication developing in patients taking bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was first described by Marx in 2003; since then, number of reported cases of BRONJ has increased.3-6The exact mechanism of BRONJ has not yet been clarified. BRONJ is characterized by an exposed area of jawbone, remaining for more than 8 weeks in patients who have not undergone radiotherapy but have a history of, or are currently taking bisphosphonates.7Bisphosphonates are deposited in bone and are integrated into the bone matrix. During the bone remodeling process, bisphosphonates are taken up by osteoclasts. In their cytoplasm, bisphosphonates inhibit the activity of osteoclasts and induce their apoptosis. Bisphosphonates inhibit the osteoclastic bone resorption, with the help of osteoblasts. They also have anti-angiogenic properties. Under such circumstances, the bone turnover greatly decreases, and the bone undergoes slight physiological remodeling over time. Thus, the bone becomes brittle and cannot repair the tiny fractures that occur during daily activities.
This study aimed to assess the knowledge level of physicians prescribing bisphosphonates (oncologists, orthopedists, rheumatologists, and endocrinologists) in Tehran city about dental considerations in such patients and prevention and treatment of BRONJ in 2019.