###### Abstract  
Osteonecrosis of the jaw represents interference by external and internal factors in the natural bone remodeling system. Numerous bone remodeling agents (BMAs), such as bisphosphonates, denosumab, and tyrosine kinase inhibitors, can lead to medication-related osteonecrosis of the jaw (MRONJ). This is a serious condition that occurs as a side-effect of treatment in patients with osteoporosis or malignancies. Antiresorptive drugs are medications that target osteoclasts with the aim of preventing bone resorption and are used to treat osteoporosis, osteopenia, and a variety of other conditions, such as Paget's disease. They are also used in cancer patients with active bone metastases where antiresorptive treatment is used for the prevention of skeletal complications. Poor dental health, infections, and especially dental surgery are the primary causes of MRONJ, while other risk factors, such as smoking, alcohol abuse, and diabetes mellitus, can also influence its development. Prevention is the key component of management, and thus awareness of the risk factors among prescribers is very important. The aim of our study was to evaluate current knowledge about MRONJ among BRA prescribers in an academic hospital and their awareness about oral health and dental check-ups. By using a custom-designed questionnaire addressed to general and internal medical practitioners, endocrinologists, rheumatologists, and oncologists as an instrument for collecting data, we tried to identify trends in BMA prescription among different specialists and their recommended preventative measures, with the aim of creating new strategies to prevent the occurrence of MRONJ. The survey revealed a low awareness among physicians of the potential risk factors and underlined the need for a concerted effort to improve patient management. In this sense, a multidisciplinary team approach that includes the patient, the drug prescriber, the dentist, and the oral surgeon could significantly improve the quality of life of patients with MRONJ. Keywords:osteonecrosis of the jaw; medication-related osteonecrosis of the jaw; bisphosphonate-related osteonecrosis of the jaw; dentistry; oral health; multidisciplinary approach +
Footnote †: journal: Medicality in affected patients. After denosumab was approved for the treatment of osteoporosis and metastatic bone diseases, cases of osteonecrosis of the jaw were identified and defined as denosumab-related osteonecrosis of the jaw [2; 3]. Another drug related to the appearance of osteonecrosis is sunitinib, a multi-targeted tyrosine kinase receptor inhibitor with a potent antitumor effect that is used in second- and first-line chemotherapy in renal cell carcinoma [4; 5]. The current definition of MRONJ summarizes osteonecrosis of the jaw resulting from bisphosphonates, denosumab, and antiangiogenic drugs, such as bevacizumab, sunitinib, and affibercpt, or other bone modifying agents (BMAs). Eating disorders, pain, and local erythema are usually the initial symptoms of MRONJ, with signs specific to a local infection appearing later and evidence of purulent secretion, with or without drainage fistula, and denudated bone as further possible occurrences. Other signs include sensory disorders, deformities of the jaw, and even pathological fractures of the jaw, especially at the mandibular level, and the appearance of maxillary oroantral communications, where the denudated bone size can vary from a few millimeters to a few centimeters in size. The diagnosis of MRONJ requires that all of the characteristics listed in Table 1 be present. The optimal treatment of MRONJ is still debated and, depending on the clinical stage of the disease, general steps are recommended, such as local hygiene with antiseptic solutions, local and general antibiotic treatment, pain control, and local surgical interventions with curettage or classical sequestrectomy.