# Awareness of Medication-Related Osteonecrosis of the Jaws amongst Dental Professionals in Poland
## 4 Discussion  
To the best of our knowledge, this is the first study assessing MRONJ knowledge among dental practitioners and dentistry students from Poland. Comparing the obtained results with those from similar studies carried out in other countries, responses of participants in our study are on a satisfactory level and stand out positively compared to other surveys [13; 15; 19; 20]. On the basis of the survey, 94.6% of respondents stated that they know the term MRONJ, which is the highest result among other studies conducted so far. Jaw-bone osteonecrosis associated with the use of bisphosphonates and other antiresorptive drugs (MRONJ) is widely regarded as one of the most serious complications in the treatment of diseases characterized by an excessive bone resorption. Currently, there is no effective treatment for MRONJ and therefore the key is the prevention of this disease and the management of the recommended therapeutic strategies in relation to the advancement of MRONJ [5; 6]. The results concerning the level of knowledge of MRONJ guidelines seem alarming, as only 26.3% of the surveyed dentists of other specialties (group G2) declared knowledge of these guidelines, and in the remaining groups (G3 and G4) the results are only slightly higher. Only specialists in the field of dental and maxillofacial surgery report a significantly higher degree of knowledge of procedures for the treatment of patients with this osteopathy (87.0%). This may result from the specificity of the specialization, which is associated with a greater likelihood of contact with patients suffering from MRONJ. According to the results of the study, 87.0% of the surveyed dental and maxillofacial surgeons reported having prior contact with a patient with MRONJ symptoms. It is also interesting that dentists working in the public sector show more knowledge in this area, which may be related to the implementation of specialization, which in Poland takes place mainly in the public sector. On the other hand, the study showed that seniority has no significant impact on the level of knowledge about MRONJ. Due to the expansion of medical indications for therapy with bisphosphonates and other antiresorptive drugs (e.g., denosumab), the number of patients suffering from MRONJ has increased significantly [1; 21]. The results show that although 94.6% of respondents know about the existence of such a disease, only 33.7% know that BP, denosumab and angiogenesis inhibitors are drugs that increase the risk of MRONJ. In the research of [PERSON], who assessed the knowledge of medical students in Italy in his study, out of 72 respondents, only 12 (16.7%) possessed knowledge about the type of drugs that increased the risk of MRONJ [20]. Without this crucial knowledge about therapeutics, the risk of treatment complication is elevated. One third of the respondents indicated only bisphosphonates, which may be the result of the knowledge of the publication on bisphosphonate-related bone necrosis (BRONJ), which was first described in 2003 by [PERSON] et al. [22]. However, in 2014, the AAOMS proposed the use of the term MRONJ due to the increasing number of reported cases of osteonecrosis of the jaws associated with other antiresorptive drugs [1]. According to the survey evaluating the awareness of MRONJ within the Birmingham GMP community, only 6% of participants were aware of change in terminology from BRONJ to MRONJ [23]. Without a thorough knowledge of drugs used in antiresorptive therapies, dentists may contribute to an increased risk of developing MRONJ by not following the recommendations in patients at risk of osteonecrosis of the jaws [3; 24]. The 2014 AAOMS criteria indicate that a patient may be suspected of MRONJ if all of the following conditions are met: current antiresorptive or antiangiogenic drug therapy or past history of such treatment; exposure of the craniofacial bones or intra- or extraoral fistula in this area-lasting for more than 8 weeks; no history of radiation therapy to the jaws; no neoplastic metastases to the jaw bones [1].