## 4 Discussion
A simple panoramic X-ray, which is commonly used by dentists, can indicate some of the initial signs, but after that, for more accurate information regarding the dimension of the lesion, cone beam computer tomography or magnetic resonance imaging are preferred. A systematic review to answer the question of whether drug withdrawal at the time of tooth extraction or dentoalveolar surgery is necessary to prevent the development of MRONJ was conducted [9]. As previously mentioned, drug withdrawal is commonly used and the prescribers involved in our study tended to stop the administration of BMA before dental treatment mostly for bisphosphonates, rather than other BMAs, even though there currently is no evidence of benefit for this intervention and there are no studies that directly compare discontinuation with continuation of bisphosphonates or other BMAs. The effect of drug stoppage is still debated because of the different pharmacokinetics of BMAs. Temporary discontinuation of denosumab could be favorable due to denosumab's short half-life but unfavorable for i.v. bisphosphonates with a longer half-life [9], and drug interruptions should be continued for at least four months to prevent poor prognosis after surgery [10]. Our study reinforces the idea that insufficient information is available regarding the ideal period for a drug holiday pre-operatively or post-operatively and regarding which kind of dental intervention should indicate this preventative measure. When allowed, such medication interruptions would ideally come to an end once the soft tissue has healed, and each case should be assessed separately. Due to the multifactorial etiology of MRONJ, we recommend a multidisciplinary approach for these patients which should mandatorily include the dentist. The value of educating medical professionals about this issue and keeping current with new knowledge is immeasurable. Prescribers must be aware of MRONJ in order to properly assess the risks associated with prescribing medications associated with the condition and increase focus on necessary preventative measures. Before initiating BMA treatment, a dental check-up should be performed, any oral disease should be treated, and a good oral status should be obtained, with subsequent regular dental follow-ups necessary. It is clear that the dentist plays a crucial role in MRONJ prevention by evaluating local risk factors in patients who are undergoing BMA therapy. Patients receiving these medications should also be advised to pay closer attention to oral care and report any symptoms or signs of ONJ. Although treatment of the condition improves symptoms, curing ONJ is a difficult goal to achieve in most patients using the current methods available. The patient should be informed regarding the risk of developing MRONJ, clear information regarding factors risk must be delivered, and the patient should be advised to maintain very good oral health to prevent the appearance of ONJ. Poor patient knowledge or comprehension of preventative measures is a significant barrier to MRONJ prevention. Improvement of oral hygiene by a preventive dental check-up must be performed. In addition, imaging examinations for these patients using X-rays should be included as screening measures, with simple panoramic X-ray or cone beam computed tomography use for the attainment of more accurate information. Although the results of the study are very useful, there are some inherent limitations. Due to its single-center nature, our results are difficult to generalize, though they can create a snapshot of the current knowledge and practices of physicians prescribing BMAs for patients with MRONJ at an academic-hospital level in our region. Furthermore, a higher number of responders would have improved the generalizability of the results; as participation was voluntary, the number of respondents was limited.