Background While typically prescribed in oncology, bisphosphonates (BP) are also used in rheumatology, particularly in osteoporosis treatment. The most serious complication of BP is osteonecrosis of the jaw (ONJ). In the 2012 guidelines for good clinical practices, the French Society of Stomatology and Maxillofacial Surgery reported a much lower incidence of ONJ in BP-treated patients for rheumatologic diseases (0.001–0.1%) than in oncology (1–10%).
Objectives We recorded the viewpoints of dental surgeons in the Auvergne region of France on these treatments.
Methods A questionnaire was sent to 880 dental surgeons. This questionnaire comprised four independent sections:
– characteristics of the participating dental surgeons;
– evaluation of everyday practice during dental surgery consultations;
– evaluation of practices for patients already treated with BP for rheumatologic indications;
– evaluation of practices for patients meant to start BP treatment for rheumatologic indications.
Results We obtained 382 responses (43.4%), finally analyzing 376 respondents with available data. Of these, 58.7% were men (n=221) and 198 were aged between 46 and 65 years (52.6%). In total, 156 had attended an in-service training course (ISTC) on the topic (41.5%).
Our results demonstrated that 237 dental surgeons systematically asked their patients if they were treated with BPs (63.0%); this percentage was higher among those who had been practicing for less than 10 years (p<0.004), who worked in a group practice (71.3%, p<0.001) or who had attended an ISTC on the topic (71.6%, p<0.001).
For patients on BPs, 84.5% of the practitioners felt uncomfortable about performing dental surgery (n=318) and 11% about non-surgical dental care (n=41). These results did not differ significantly according to overall practice experience or practice structure, nor for practice location. Of the respondents, 67% stated that their practice differed depending on the BP administration (per os or i.v.) route. Dental panoramic radiography was systematically performed prior to all work by 55.3% of dentists (n =208). 81.6% did not discontinue BP per os prior to dental surgery (n =307).
Of the practitioners, 53.7% felt uncomfortable when a rheumatologist asked whether the patient's dental status allowed for BP prescription (n=202). This percentage was higher among those who had not attended any ISTC (62.6% vs. 50.7%; p<0.03). On completion of dental work, 27.4% of the practitioners waited 1–3 months before approving the initiation of BP treatment (n =103).
In all, 71 practitioners reported at least one case of dental complication under BP treatment (18.8%), consisting of 49 ONJs, 12 healing problems, and three bone sequestrae. Four dental surgeons stated the complications arose in patients under treatment for cancer.
Conclusions This original study reveals that dental surgeons are uncomfortable about giving dental care to patients receiving BPs. Closer collaboration and better information-sharing between rheumatologists and dental surgeons appears necessary to facilitate the use of BPs in rheumatology.
Disclosure of Interest None declared