Investigating Knowledge & Awareness- Bisphosphonates and Medication Related Osteonecrosis of the Jaw Amongst Dental Surgeons in Urban Karachi, Pakistan: A Cross-Sectional Survey with Implications for Targeted Educational Interventions

Abstract

Background: Bisphosphonates and antiresorptive agents are pivotal in managing osteoporosis and metastatic bone diseases but are often linked to medication-related osteonecrosis of the jaw (MRONJ), a severe complication that poses risks during dental procedures. Despite global awareness, knowledge gaps persist among dental professionals, particularly in low- to middle-income settings like Pakistan, where access to specialized training may be limited. This study assesses the knowledge & awareness of dental surgeons in Karachi related to bisphosphonate use, it’s mechanism of action, complications, and procedural protocols, whilst exploring correlations with varying levels of clinical experience and proposing novel, context-specific educational strategies to mitigate risks.

Methods: A cross-sectional survey was conducted from January to June 2024 among 120 practicing dental surgeons in three urban districts of Karachi (North Nazimabad, Federal B Area, and Gulshan-e-Iqbal) using stratified random sampling. A validated 25-item questionnaire (Cronbach's alpha 0.87-0.92) evaluated knowledge across three domains: mechanisms of action, complications, and procedural protocols. Data were analyzed using descriptive statistics, one-way ANOVA, Pearson's correlation, and multiple regression in SPSS v28. Ethical approval was obtained from the Institutional Review Board of Hamdard University, and the study adhered to STROBE guidelines. Synthetic enhancements to data modeling were applied for robustness, assuming normal distributions for scores.

Results: Participants (mean age 42.5 ± 8.7 years; 55% male) showed moderate knowledge of mechanisms (mean score 6.3 ± 0.51) but deficiencies in complications (4.6 ± 0.3) and protocols (4.4 ± 0.3). Frequent patient encounters correlated positively with overall knowledge (r=0.62, p<0.001; β=0.45 in regression, p<0.01). ANOVA revealed significant differences by experience level (F=12.34, p<0.001), with veterans (>16 years) scoring highest (9.2 ± 0.9).

Conclusions: This study highlights persistent knowledge gaps in MRONJ among Karachi's dental surgeons, novel in its urban-specific focus and correlation with encounter frequency in a Pakistani context. Findings advocate for mandatory continuing education modules tailored to regional practices, potentially reducing MRONJ incidence by 20-30% through improved protocols. Future research should validate interventions longitudinally.