Management of Patients Prescribed Bisphosphonates: General Dental Practitioner Survey

Methods: A cross-sectional, theory-based questionnaire was mailed to a random sample of 300 GDPs in Scotland prior to guidance publication. Reminders were sent two and four weeks post-initial mailing. Data were analyzed for basic trends.

Results: A response rate of 35% (N=105) was achieved. GDPs were primarily principals (51%) or associates (48%). Currently, 60% of GDPs ask patients about bisphosphonate use; 77% think doing this is very important. Thirty-six percent were not confident they could diagnose BONJ, accurately assess BONJ risk (40%), perform dental treatment without increasing BONJ risk (23%), or perform bone-impacting treatment without increasing BONJ risk (64%). For patients prescribed a bisphosphonate for osteoporosis, 30% of GDPs would refer a straightforward extraction to a specialist and 62% would refer for other bone impacting treatment. For patients prescribed bisphosphonates for malignancy, percentages rose to 58% and 78% respectively. Regardless of the reason for bisphosphonate prescription, 38% of GDPs usually/always prescribe antibiotics and 65% usually/always prescribe chlorhexadine mouthwash when performing an extraction or bone-impacting treatment. When asked about their concerns when treating patients on bisphosphonates, GDPs cited confusion over evidence, low confidence, and necessity of practical guidance.

Conclusions: These findings provide a baseline measure of current attitudes and behaviour regarding GDP management of patients prescribed bisphosphonates. Practice in some areas differs from the guidance recommendations. The survey will be repeated six months post-guidance publication to enable assessment of the impact of guidance publication and to inform the development of additional implementation strategies if required.