The awareness and perceptions of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey

The awareness and perceptions of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article The awareness and perceptions of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey A lum Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-117921/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Mar, 2021 Read the published version in BMC Oral Health → Version 2 posted 7 You are reading this latest preprint version Show more versions Abstract Background : Accurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. I aimed to determine the awareness of Korean dentists regarding medication-related osteonecrosis of the jaw and the duration of drug holidays they prescribe to patients who need to undergo various dental procedures. Methods : An online, questionnaire-based survey was conducted among 1000 dentists registered in an online community in Korea. The following were determined: general characteristics; type of practice; recordkeeping regarding patients’ use of bone-modifying agents; requirement of a doctor’s referral letter; advice given regarding drug holidays of bone-modifying agents before dental surgery procedures; and experience with medication-related osteonecrosis of the jaw. Differences between dentists with and without experience in treating patients with medication-related osteonecrosis of the jaw were evaluated using the χ 2 test. Results : Although a relatively high proportion (293/1000, 29.3%) of dentists had experienced cases of medication-related osteonecrosis of the jaw, only 650/1000 (65.0%) routinely documented the type of bone-modifying agent used by patients and the duration of its use. Moreover, only 591/1000 (59.1%) dentists routinely requested referral letters from doctors before performing dental surgery on patients. Although the recommended period for a drug holiday differs for each drug, 533/1000 (53.3%) dentists did not make such a distinction. There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in medication-related osteonecrosis of the jaw (707/1000) and those who had such experience ( P = 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and without prior experience with the condition ( P = 0.001). Conclusions : These results suggest that dentists do not respond consistently to patients' drug history prior to performing dental procedures. This implies the need for increased cooperation between dentists and physicians, as well as the development of targeted educational interventions for the dental profession, to reduce the risk of medication-related osteonecrosis of the jaw. Trial registration: Not applicable. Dentistry awareness dentists education osteoporosis Background Several medications decelerate or prevent bone loss. However, patients on bone-modifying medications should be treated with caution by dentists because of the possibility of medication-related osteonecrosis of the jaw (MRONJ). Many studies on MRONJ have been conducted since the first report by Marx (2003) [1] almost two decades ago. In 2014, the American Association of Oral and Maxillofacial Surgeons revised their recommendations on diagnosis and treatment strategies for the condition [2]. One of the updated recommendations was to replace the term “bisphosphonate-related osteonecrosis of the jaw” (BRONJ) with “MRONJ.” This was done following many reports of MRONJ that were associated with the use of bone-resorption inhibitors, such as denosumab (e.g., Prolia and Xgeva [Amgen Inc., Thousand Oaks, CA, USA]), and angiogenesis inhibitors, since the publication of their first position paper [2]. In the United States, the prevalence of BRONJ in patients on intravenous bisphosphonate therapy has been reported as 0.7/100,000 (0.8%–12%) [3]. Using a survey, the prevalence of BRONJ in Europe has been reported as 95/100,000 (0.095%) and 1/100,000 (0.001%) for patients receiving intravenous and oral administration, respectively [4]. In another study, a low prevalence of BRONJ (0.004%) was identified among patients on oral therapy than among those on intravenous therapy [5]. Lo et al. (2010), on the other hand, documented an increase in prevalence of BRONJ from 0.04% to 0.21% after more than 4 years of continued bisphosphonate therapy [6]. The prevalence of MRONJ in patients receiving denosumab was 0.085% in a study in which changes were monitored in women with postmenopausal osteoporosis after 5 years’ exposure to denosumab [7]. Therefore, although the prevalence of MRONJ varies across countries, its general prevalence appears to be relatively low. There are several risk factors for MRONJ. These include the patient's underlying disease, duration of administration of anti-osteoporosis drugs, whether or not to extract teeth, its anatomical structure, whether to use dentures, and accompanying oral diseases. [8, 9]. Due to the long skeletal retention time of bisphosphonates, its inhibitory effect on bone resorption remains for a time after its discontinuation. Moreover, the long-term use of bisphosphonates causes side effects such as BRONJ and atypical femoral fractures. To prevent such side effects, physicians normally propose a "drug holiday." Patients at low risk of fracture are recommended to take a drug holiday after taking oral or intravenous bisphosphonates for 5 or 3 years, respectively. Because the effects of denosumab do not persist after treatment is discontinued, a drug holiday for patients taking this drug is not necessary [7, 10]. Dentists have an important role in assessing the risk of MRONJ by accurately documenting their patients’ medical and drug history. An inadequate knowledge of this medical condition and the option to discontinue bone-modifying medications (i.e., to take a drug holiday) in patients with osteoporosis can have serious consequences. Therefore, the awareness and perceptions of dentists regarding MRONJ should be analyzed in order to identify existing knowledge deficiencies and inform the development of targeted educational interventions in the dental profession. Studies in this field are scarce and the level of awareness among dentists likely varies across countries due to differences in training and definitive treatment protocols. Thus, I investigated the awareness of Korean dentists regarding MRONJ, as well as the durations of drug holidays they advised their patients to take before undergoing various dental procedures. The overarching aim with this study was to determine the need for cooperation between dentists and physicians in terms of MRONJ, as well as for enhanced educational protocols for the dental profession. Methods Ethical approval This study was approved by the institutional bioethics committee of our university hospital (approval number: 2019-03-015) and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all study participants. Participants According to health insurance statistics of 2017, approximately 25,300 dentists practice in Korea. This study was conducted among dentists registered on DentPhoto (http://www.dentphoto.com/), the largest online community of dentists in Korea. Survey method The survey was initiated online in April 2020 and closed automatically after it was completed by 1000 dentists. I prepared the questionnaire by adapting existing research data [11]. I used it to record general characteristics of the dentists, such as sex, age, clinical experience, and type of practice. The type of practice was categorized as either private (i.e., dentists engaged in private practice) or non-private (e.g., employed dentists and public dentists). Questions were also included to determine the following: whether dentists recorded details of current or prior usage of bone-modifying agents (e.g., the drug name and duration of therapy) before implant placement or tooth extraction; the required period of drug discontinuation before treating patients; specific management protocols employed while treating patients on bone-modifying medications; and prior experience with MRONJ. Statistical analysis IBM SPSS Statistics for Windows version 21.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Frequencies were calculated and cross-tabulation analyses were performed to evaluate knowledge pertaining to MRONJ among dentists. Data were presented as frequencies (%), as all variables were categorical. Differences between dentists with and those without prior experience in treating patients with MRONJ were evaluated using the χ 2 test. The level of statistical significance was set at P < 0.05. Results General characteristics of survey respondents The majority of survey respondents were male (78.7%) and almost half (46.6%) were 41–50 years of age. Dentists engaged in private practice accounted for 85.3% of survey respondents, with the remainder being engaged in non-private practice. There was wide variation in clinical experience in dental practice (Table 1). Table 1 . General characteristics of survey respondents Variable N % Sex Male 787 78.7% Female 213 21.3% Age (y) ≤30 32 3.2% 31–40 298 29.8% 41–50 466 46.6% 51–60 172 17.2% ≥61 32 3.2% Type of practice Private clinic a 853 85.3% Non-private clinic b 147 14.7% Clinical experience (y) ≤5 102 10.2% 6–10 179 17.9% 11–15 256 25.6% 16–20 212 21.2% ≥21 251 25.1% Abbreviations: y, year a Dentists engaged in private practice b Employed dentists, public dentists, etc. Dentist protocols, awareness of MRONJ, and drug holidays Most (96.9%) of the dentists reported that they regularly documented the medication history (including that of bone-modifying agents) of patients before implant placement or tooth extraction. Over half (65.0%) recorded both the drug name and duration of use, while 16.3% of the respondents only documented the drug name. Referral letters were requested by 59.1% of respondents prior to dental surgery procedures. In terms of the time that patients were advised to discontinue anti-osteoporotic agents before tooth extraction or implant placement, 45.7% of respondents indicated that it was 3–5 months; 14.9% and 39.4% of respondents indicated that it was ≤2 and ≥6 months, respectively (Table 2). Different durations of drug holidays, depending on the type of bone-modifying agent (bisphosphonates, denosumab, selective estrogen-receptor modulators, or parathyroid hormone) used, were advised by 46.7% of respondents. MRONJ was most often reported to result from bisphosphonate therapy (27.6%); denosumab therapy was cited as the cause of MRONJ by only 1.3% of respondents. Almost three-quarters (70.7%) of respondents reported no prior experience of treating patients with MRONJ (Table 2). Table 2 . Dentists’ awareness of MRONJ and protocol followed before dental procedures Variable N % Do you record if the patient is taking anti-osteoporotic drugs? Yes 969 96.9% No 31 3.1% Do you record the name of the drug and duration of its use? No 187 18.7% Name only 163 16.3% Name and duration 650 65.0% Do you ask for a doctor's referral letter prior to dental surgery procedures? Yes 591 59.1% No 409 40.9% How long do you advise patients to discontinue the anti-osteoporotic agent before tooth extraction or implant placement? ≤2 months 149 14.9% 3–5 months 457 45.7% ≥6 months 394 39.4% Do you recommend different drug holidays depending on the type of drug (bisphosphonates, denosumab, SERMs, PTH)? Yes 467 46.7% No 533 53.3% If you have encountered case/s of MRONJ, what type of medication caused it? Bisphosphonates 276 27.6% Denosumab 13 1.3% SERMs 4 0.4% No experience 707 70.7% Abbreviations: MRONJ, medication-related osteonecrosis of the jaw; SERMs, selective estrogen-receptor modulators; PTH, parathyroid hormone. Awareness and specific management according to prior MRONJ experience The largest proportion (689/969, 71.1%) of dentists who documented anti-osteoporotic medication use had no prior experience with MRONJ (Table 3). There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in MRONJ and those who had ( P = 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and those without prior experience of MRONJ ( P = 0.001). There was no significant difference in the proportion of dentists who recommended different periods of drug holidays (depending on drug type) between those with and those without prior experience with MRONJ. Table 3 . Awareness and management protocol according to prior MRONJ experience MRONJ experience P a No Yes Sex Male 541 (76.5%) 246 (84.0%) 0.009 Female 166 (23.5%) 47 (16.0%) Age (y) ≤30 5 (0.7%) 27 (9.2%) <0.0001 31–40 226 (32%) 72 (24.6%) 41–50 350 (49.5%) 116 (39.6%) 51–60 102 (14.4%) 70 (23.9%) ≥61 24 (3.4%) 8 (2.7%) Type of practice Private clinic b 605 (85.6%) 248 (84.6%) 0.705 Non-private clinic c 102 (14.4%) 45 (15.4%) Clinical experience (y) ≤5 64 (9.1%) 38 (13%) 0.030 6–10 135 (19.1%) 44 (15%) 11–15 193 (27.3%) 63 (21.5%) 16–20 150 (21.2%) 62 (21.2%) ≥21 165 (23.3%) 86 (29.4%) Do you record if the patient is taking anti-osteoporotic drugs? Yes 689 (97.5%) 280 (95.6%) 0.116 No 18 (2.5%) 13 (4.4%) Do you record the name of the drug and duration of its use? No 115 (16.3%) 72 (24.6%) 0.007 Name only 115 (16.3%) 48 (16.4%) Name and duration 477 (67.5%) 173 (59.0%) Do you ask for a doctor's referral letter prior to dental surgery procedures? Yes 423 (59.8%) 168 (57.3%) 0.466 No 284 (40.2%) 125 (42.7%) How long do you advise patients to discontinue the anti-osteoporotic agent before tooth extraction or implant placement? ≤2 months 88 (12.4%) 61 (20.8%) 0.001 3–5 months 321 (45.4%) 136 (46.4%) ≥6 months 298 (42.1%) 96 (32.8%) Do you recommend different drug holidays depending on the type of drug (bisphosphonates, denosumab, SERMs, PTH)? Yes 319 (45.1%) 148 (50.5%) 0.120 No 388 (54.9%) 145 (49.5%) If you have encountered case/s of MRONJ, what type of medication caused it? Bisphosphonates - 276 (94.2%) - Denosumab - 13 (4.4%) SERMs - 4 (1.4%) No experience 707 (100.0%) - Abbreviations: y, year; MRONJ, medication-related osteonecrosis of the jaw; SERMs, selective estrogen-receptor modulators; PTH, parathyroid hormone a Differences between dentists with and those without prior MRONJ experience were evaluated using the χ 2 test. The level of statistical significance was set at P < 0.05. Data are presented as N (%). b Dentists engaged in private practice c Employed dentists, public dentists, leave of absence, etc. Discussion In this study, most dentists (65.0%) recorded both the name of the anti-osteoporotic drug and its duration of use. While the recommended period for a drug holiday differs for each drug, most (53.3%) dentists did not make such a distinction. There were no statistically significant differences in whether bone-modifying medications were recorded or whether a referral from the attending physician was requested prior to dental surgery procedures between dentists with and those without experience with MRONJ. This result suggests what are necessary for the prevention of MRONJ. In a previous study, it was reported that the proportion of dentists who did not contact or ask for referral from an attending physician prior to dental procedures was low, and that it decreased slightly from 2014 (12.86%) to 2018 (11.67%) [11]. The authors of that study noted that such unsupervised procedures can reduce patients' quality of life. We observed that more dentists advised patients to take drug holidays ≥6 months than ≤2 months for the prevention of MRONJ. This period is longer than that recommended in the literature [7, 10]. Hence, the optimal duration of a drug holiday cannot be determined from the results of our study alone, and further long-term studies are required for definitive conclusions to be drawn. Due to the aging population, not only in Korea but also worldwide, an increasing number of elderly individuals with multiple co-morbidities are expected to undergo dental procedures, including implant placement. Thus, an awareness of the potential interactions in treatment regimens prescribed to the same patient by doctors in different fields of specialization will become increasingly important, necessitating optimal communication between healthcare professionals. Poor patient compliance is one of the primary obstacles in the treatment of osteoporosis, commonly resulting from side effects of bone-modifying agents, or the fear thereof [12, 13]. On the other hand, excessive use of bone-modifying agents can increase the risk of MRONJ. MRONJ is a rare but serious complication following treatment with certain medications, and is defined as the presence of exposed bone in the oral and maxillofacial regions (or extra- or intra-oral fistulas) lasting more than 8 weeks. To be diagnosed with MRONJ, a patient should have no prior history of radiation, or of treatment with bone-resorption inhibitors or angiogenesis inhibitors, for tumor metastasis to the jawbones [7]. The exact mechanism of development of MRONJ is unclear, in spite of several proposed hypotheses. Additionally, varied opinions regarding the efficacy of surgical and non-surgical treatments have been presented [14, 15]. In addition to bisphosphonates, several drugs such as denosumab, steroids, and other angiogenesis inhibitors can cause MRONJ [7, 16]. Denosumab is an anti-human receptor activator of the nuclear factor kappa-Β ligand and inhibits the activity of osteoclasts. It is used to treat osteoporosis caused by bone absorption disorders [17], similar to bisphosphonates, and its cost-effectiveness [18] and convenience of administration has recently led to its increased use in Korea. Denosumab is also associated with a risk for MRONJ; however, the risk of fracture may increase either temporarily or permanently when its use is discontinued [7]. The determination of the type of bone-modifying medication and its duration of use, potential alternative medications, and a drug holiday of 2–3 months before performing dental procedures is essential for preventing MRONJ [7, 10]. The disadvantages of drug discontinuation should be weighed against its advantages. In a post-hoc analysis, Anagnostis et al. (2017) [19] concluded that drug holidays are advisable for patients who have not experienced recent fractures and for those at low risk of fracture, defined as follows: a femoral neck T-score ≥ -2.5; age <70 years; and no diseases or medications that could increase fracture risk. Drug holidays should be considered for patients with a 5-year history of alendronate use or a 3-year history of zoledronic acid (or risedronate) use [19, 20]. The duration of the drug holiday should also be based on bone mineral density [20]. The management of the osteoporotic condition with other bone-modifying medications is advisable if denosumab is discontinued [21, 22]. However, drug holidays are not recommended for bone-modifying medications such as denosumab, hormone replacement therapy, selective estrogen-receptor modulators, and teriparatide [21], or for patients with severe osteoporosis [10, 22]. Therefore, the determination of a drug discontinuation protocol may be beyond the scope of dentistry and it is important that dentists request a doctor's referral letter prior to any dental procedure in patients at risk for MRONJ. In addition, detailed records of bone-modifying agents must be requested and maintained. However, the results of our study showed that the proportion of dentists requesting referral letters was relatively low (59.1%). In addition, the proportion of dentists that encountered cases of MRONJ (29.3%) was higher than the general prevalence of MRONJ. This highlights the importance of dentists possessing adequate knowledge pertaining to this condition, and of proper dental management protocols. Several prior studies have been conducted to examine the awareness of dentists regarding MRONJ in different countries. In a survey of 120 dentists in Romania, the majority were aware of bisphosphonate therapy and its complications, but were not familiar with the pathophysiology, diagnosis, and treatment of BRONJ [23]. In a survey of 204 Brazilian dentists and dental students, researchers discovered a lack of knowledge regarding bisphosphonates and BRONJ [24]. In a survey of 60 dentists and 60 dental students in Spain, 30 (50%) students and 41 (68.36%) dentists were determined to have up-to-date knowledge regarding BRONJ [25]. In a survey of 129 British dentists, more than 90% admitted a lack of awareness regarding drugs (other than bisphosphonates) that cause MRONJ. Furthermore, the lack of a standardized protocol was reported as the primary reason for reluctance in managing such patients [26]. In a survey of 222 Saudi physicians and dentists, only 31.5% were aware of BRONJ. The authors suggested that this could be improved through education [27]. In the present study, we found that the level of experience among dentists regarding MRONJ was high (29.3%); nevertheless, the documentation of patients’ history pertaining to the type of bone-modifying agent and the duration of its use was insufficient (65.0%). Hence, dentists should be made aware of the guidelines for treatment of such patients through regular educational programs. Our study had some limitations. First, only 1000 dentists were surveyed; therefore, the results may not be generalizable to all dentists in Korea. Second, due to the limited scope of the questions in the survey, it was not possible to elucidate dentists’ knowledge of MRONJ pathogenesis. Third, due to the questionnaire survey system, the number of questions was limited, so detailed surveys were not possible. Nevertheless, the results of this survey can serve as a basis for larger, more detailed, long-term studies to investigate the dentist's perception. Conclusions Elderly individuals often have multiple co-morbidities that require multidisciplinary management. Due to an aging demographic, dentists are likely to encounter an increasing number of elderly patients with osteoporosis who require implant surgery. Thus, the successful management of such patients will require an approach that encourages cooperation between doctors and dentists, as well as the development of educational programs to increase knowledge and awareness of MRONJ. List Of Abbreviations BRONJ, bisphosphonate-related osteonecrosis of the jaws MRONJ, medication-related osteonecrosis of the jaws PTH, parathyroid hormone SERM, selective estrogen-receptor modulators Declarations Ethics approval and consent to participate This study was approved by the institutional bioethics committee of our university hospital (IRB approval number: 2019-03-015) and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all study participants. Consent for publication I obtained written consent from study participants. I put the following phrase at the top of the questionnaire: “The results of this questionnaire will be used for research purposes and will not be used for any purpose other than research. If you agree to this, please fill out and submit the questionnaire.” A sample of the questionnaire was submitted to and approved by the IRB. Availability of data and materials All data generated or analyzed during this study are included in this article. Competing interests The author declares that they have no competing interests Funding This study was supported by Wonkwang University in 2020 Authors' contributions ALH performed all work involved in this study (including study conception, hypothesis, experimental design, data collection and analysis, and write-up of manuscript) and approved the final manuscript. 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Supplementary Files Researchquestionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 24 Mar, 2021 Read the published version in BMC Oral Health → Version 2 posted Review # 1 received at journal 04 Feb, 2021 Reviewer # 2 agreed at journal 21 Jan, 2021 Reviewers invited by journal 18 Jan, 2021 Reviewer # 1 agreed at journal 18 Jan, 2021 Editor assigned by journal 17 Jan, 2021 Submission checks completed at journal 17 Jan, 2021 Editor invited by journal 17 Jan, 2021 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-117921","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":8447415,"identity":"c2931f79-83ee-4cf3-99ef-cd665613c388","order_by":0,"name":"A lum Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYDACZh446wDJWtgSiLUGroXHgDgNfMd5Dz78UXNP3px/zbcHP9ts8hnYDx/dgE+L5GG+ZGOeY8WGO2e83W7Y25Zm2cCTlnYDnxaDwzxm0kBvMG64cXabBM+ZwwYMEjxmBLVI/viXYL/hxplnkn/O/CdOiwRvW0LihvM9bNI8FQcIawH7hbcvIXnDDTYzaZmKZAM2Qn7hO38WGGLfEmw3nD/8TPKNgZ0BP/vhY3i1MByAMSQSIDQbXuUoWvgP4FY0CkbBKBgFIxsAACv5Sd0ZrWDLAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"A","middleName":"lum","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2020-11-28 19:54:53","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-117921/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-117921/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-021-01475-6","type":"published","date":"2021-03-24T15:00:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":13651292,"identity":"653a2c81-8a7f-472a-a5b7-553f0bd583fc","added_by":"auto","created_at":"2021-09-17 09:44:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":472691,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-117921/v2/b2cd51cd-1464-4a81-8d41-ea0eafce1902.pdf"},{"id":5254062,"identity":"81890415-67c9-4a79-ad02-36acbc8b6d0e","added_by":"auto","created_at":"2021-01-25 22:12:59","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":17226,"visible":true,"origin":"","legend":"","description":"","filename":"Researchquestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-117921/v2/8c8e196460d3cffc330a0f5d.docx"}],"financialInterests":"","formattedTitle":"The awareness and perceptions of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey","fulltext":[{"header":"Background","content":"\u003cp\u003eSeveral medications decelerate or prevent bone loss. However, patients on bone-modifying medications should be treated with caution by dentists because of the possibility of medication-related osteonecrosis of the jaw (MRONJ). Many studies on MRONJ have been conducted since the first report by Marx (2003) [1] almost two decades ago. In 2014, the American Association of Oral and Maxillofacial Surgeons revised their recommendations on diagnosis and treatment strategies for the condition [2]. One of the updated recommendations was to replace the term \u0026ldquo;bisphosphonate-related osteonecrosis of the jaw\u0026rdquo; (BRONJ) with \u0026ldquo;MRONJ.\u0026rdquo; This was done following many reports of MRONJ that were associated with the use of bone-resorption inhibitors, such as denosumab (e.g., Prolia and Xgeva [Amgen Inc., Thousand Oaks, CA, USA]), and angiogenesis inhibitors, since the publication of their first position paper [2].\u003c/p\u003e\n\u003cp\u003eIn the United States, the prevalence of BRONJ in patients on intravenous bisphosphonate therapy has been reported as 0.7/100,000 (0.8%\u0026ndash;12%) [3]. Using a survey, the prevalence of BRONJ in Europe has been reported as 95/100,000 (0.095%) and 1/100,000 (0.001%) for patients receiving intravenous and oral administration, respectively [4]. In another study, a low prevalence of BRONJ (0.004%) was identified among patients on oral therapy than among those on intravenous therapy [5]. Lo et al. (2010), on the other hand, documented an increase in prevalence of BRONJ from 0.04% to 0.21% after more than 4 years of continued bisphosphonate therapy [6]. The prevalence of MRONJ in patients receiving denosumab was 0.085% in a study in which changes were monitored in women with postmenopausal osteoporosis after 5 years\u0026rsquo; exposure to denosumab [7]. Therefore, although the prevalence of MRONJ varies across countries, its general prevalence appears to be relatively low.\u003c/p\u003e\n\u003cp\u003eThere are several risk factors for MRONJ. These include the patient's underlying disease, duration of administration of anti-osteoporosis drugs, whether or not to extract teeth, its anatomical structure, whether to use dentures, and accompanying oral diseases. [8, 9].\u003c/p\u003e\n\u003cp\u003eDue to the long skeletal retention time of bisphosphonates, its inhibitory effect on bone resorption remains for a time after its discontinuation. Moreover, the long-term use of bisphosphonates causes side effects such as BRONJ and atypical femoral fractures. To prevent such side effects, physicians normally propose a \"drug holiday.\" Patients at low risk of fracture are recommended to take a drug holiday after taking oral or intravenous bisphosphonates for 5 or 3 years, respectively. Because the effects of denosumab do not persist after treatment is discontinued, a drug holiday for patients taking this drug is not necessary [7, 10].\u003c/p\u003e\n\u003cp\u003eDentists have an important role in assessing the risk of MRONJ by accurately documenting their patients\u0026rsquo; medical and drug history. An inadequate knowledge of this medical condition and the option to discontinue bone-modifying medications (i.e., to take a drug holiday) in patients with osteoporosis can have serious consequences. Therefore, the awareness and perceptions of dentists regarding MRONJ should be analyzed in order to identify existing knowledge deficiencies and inform the development of targeted educational interventions in the dental profession.\u003c/p\u003e\n\u003cp\u003eStudies in this field are scarce and the level of awareness among dentists likely varies across countries due to differences in training and definitive treatment protocols. Thus, I investigated the awareness of Korean dentists regarding MRONJ, as well as the durations of drug holidays they advised their patients to take before undergoing various dental procedures. The overarching aim with this study was to determine the need for cooperation between dentists and physicians in terms of MRONJ, as well as for enhanced educational protocols for the dental profession.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional bioethics committee of our university hospital (approval number: 2019-03-015) and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to health insurance statistics of 2017, approximately 25,300 dentists practice in Korea. This study was conducted among dentists registered on DentPhoto (http://www.dentphoto.com/), the largest online community of dentists in Korea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey was initiated online in April 2020 and closed automatically after it was completed by 1000 dentists. I prepared the questionnaire by adapting existing research data [11]. I used it to record general characteristics of the dentists, such as sex, age, clinical experience, and type of practice. The type of practice was categorized as either private (i.e., dentists engaged in private practice) or non-private (e.g., employed dentists and public dentists). Questions were also included to determine the following: whether dentists recorded details of current or prior usage of bone-modifying agents (e.g., the drug name and duration of therapy) before implant placement or tooth extraction; the required period of drug discontinuation before treating patients; specific management protocols employed while treating patients on bone-modifying medications; and prior experience with MRONJ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIBM SPSS Statistics for Windows version 21.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Frequencies were calculated and cross-tabulation analyses were performed to evaluate knowledge pertaining to MRONJ among dentists. Data were presented as frequencies (%), as all variables were categorical. Differences between dentists with and those without prior experience in treating patients with MRONJ were evaluated using the \u0026chi;\u003csup\u003e2\u003c/sup\u003e test. The level of statistical significance was set at \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral characteristics of survey respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of survey respondents were male (78.7%) and almost half (46.6%) were 41\u0026ndash;50 years of age. Dentists engaged in private practice accounted for 85.3% of survey respondents, with the remainder being engaged in non-private practice. There was wide variation in clinical experience in dental practice (Table 1).\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eTable 1\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003e. General characteristics of survey respondents\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;margin-left:-8.8pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eVariable\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e51\u0026ndash;60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e172\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e17.2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101.85pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026ge;61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e3.2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114.65pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eType of practice\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101.85pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003ePrivate clinic\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e853\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e85.3%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101.85pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNon-private clinic\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e147\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e14.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 114.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eClinical experience (y)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101.85pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026le;5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e102\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e10.2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101.85pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e6\u0026ndash;10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e179\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e17.9%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101.85pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e11\u0026ndash;15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e256\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e25.6%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101.85pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e16\u0026ndash;20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e212\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e21.2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026ge;21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e251\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:154.35pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e25.1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eAbbreviations: y, year\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003ea\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eDentists engaged in private practice\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eb\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eEmployed dentists, public dentists, etc.\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp\u003e\u003cstrong\u003eDentist protocols, awareness of MRONJ, and drug holidays\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost (96.9%) of the dentists reported that they regularly documented the medication history (including that of bone-modifying agents) of patients before implant placement or tooth extraction. Over half (65.0%) recorded both the drug name and duration of use, while 16.3% of the respondents only documented the drug name. Referral letters were requested by 59.1% of respondents prior to dental surgery procedures. In terms of the time that patients were advised to discontinue anti-osteoporotic agents before tooth extraction or implant placement, 45.7% of respondents indicated that it was 3\u0026ndash;5 months; 14.9% and 39.4% of respondents indicated that it was \u0026le;2 and \u0026ge;6 months, respectively (Table 2).\u003c/p\u003e\n\u003cp\u003eDifferent durations of drug holidays, depending on the type of bone-modifying agent (bisphosphonates, denosumab, selective estrogen-receptor modulators, or parathyroid hormone) used, were advised by 46.7% of respondents. MRONJ was most often reported to result from bisphosphonate therapy (27.6%); denosumab therapy was cited as the cause of MRONJ by only 1.3% of respondents. Almost three-quarters (70.7%) of respondents reported no prior experience of treating patients with MRONJ (Table 2).\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eTable 2\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003e. Dentists\u0026rsquo; awareness of MRONJ and protocol followed before dental procedures\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 268.45pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid black;border-right: none;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid black;border-right: none;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid black;border-right: none;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 268.45pt;border: none;padding: 0in 5.4pt;height: 37.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you record if the patient is taking anti-osteoporotic drugs?\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2pt;border: none;padding: 0in 5.4pt;height: 37.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 46.65pt;border: none;padding: 0in 5.4pt;height: 37.7pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e969\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e96.9%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e3.1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 268.45pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you record the name of the drug and duration of its use?\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 46.65pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e187\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e18.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eName only\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e163\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e16.3%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eName and duration\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e650\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e65.0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 268.45pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you ask for a doctor\u0026apos;s referral letter prior to dental surgery procedures?\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.65pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e591\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e59.1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e409\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e40.9%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 268.45pt;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHow long do you advise patients to discontinue the anti-osteoporotic agent before tooth extraction or implant placement?\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2pt;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 46.65pt;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026le;2 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e149\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e14.9%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e3\u0026ndash;5 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e457\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e45.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026ge;6 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e394\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e39.4%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 268.45pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you recommend different drug holidays depending on the type of drug (bisphosphonates, denosumab, SERMs, PTH)?\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46.65pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e467\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e46.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e533\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e53.3%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 268.45pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eIf you have encountered case/s of MRONJ, what type of medication caused it?\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 46.65pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eBisphosphonates\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e276\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e27.6%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDenosumab\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e1.3%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSERMs\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.4%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0.75pt;height: 11.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo experience\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:39.2pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e707\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.65pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e70.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eAbbreviations: MRONJ, medication-related osteonecrosis of the jaw; SERMs, selective estrogen-receptor modulators; PTH, parathyroid hormone.\u003c/span\u003e\u003c/p\u003e\u003cbr\u003e\u003cp\u003e\u003cstrong\u003eAwareness and specific management according to prior MRONJ experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe largest proportion (689/969, 71.1%) of dentists who documented anti-osteoporotic medication use had no prior experience with MRONJ (Table 3). There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in MRONJ and those who had (\u003cem\u003eP \u003c/em\u003e= 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and those without prior experience of MRONJ (\u003cem\u003eP \u003c/em\u003e= 0.001). There was no significant difference in the proportion of dentists who recommended different periods of drug holidays (depending on drug type) between those with and those without prior experience with MRONJ.\u003c/p\u003e\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eTable 3\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003e. Awareness and management protocol according to prior MRONJ experience\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.4e+2pt;border: none;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 254.9pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 134.7pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eMRONJ experience\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55.45pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eP\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003ea\u003c/span\u003e\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSex\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e541 (76.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e246 (84.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.009\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e166 (23.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e47 (16.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eAge (y)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026le;30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e5 (0.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e27 (9.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026lt;0.0001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e31\u0026ndash;40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e226 (32%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e72 (24.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e41\u0026ndash;50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e350 (49.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e116 (39.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e51\u0026ndash;60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e102 (14.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e70 (23.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026ge;61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e24 (3.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e8 (2.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eType of practice\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003ePrivate clinic\u003csup\u003eb\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e605 (85.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e248 (84.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.705\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 23.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNon-private clinic\u003csup\u003ec\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 23.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e102 (14.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 23.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e45 (15.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eClinical experience (y)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026le;5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e64 (9.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e38 (13%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.030\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e6\u0026ndash;10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e135 (19.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e44 (15%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e11\u0026ndash;15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e193 (27.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e63 (21.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e16\u0026ndash;20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e150 (21.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e62 (21.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026ge;21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e165 (23.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e86 (29.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you record if the patient is taking anti-osteoporotic drugs?\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e689 (97.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e280 (95.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.116\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e18 (2.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e13 (4.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you record the name of the drug and duration of its use?\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e115 (16.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e72 (24.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.007\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eName only\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e115 (16.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e48 (16.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eName and duration\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e477 (67.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e173 (59.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.45pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you ask for a doctor\u0026apos;s referral letter prior to dental surgery procedures?\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e423 (59.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e168 (57.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.466\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e284 (40.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e125 (42.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHow long do you advise patients to discontinue the anti-osteoporotic agent before\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family: \"Calibri\",sans-serif;'\u003etooth extraction or implant placement?\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026le;2 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e88 (12.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e61 (20.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e3\u0026ndash;5 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e321 (45.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e136 (46.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026ge;6 months\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e298 (42.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e96 (32.8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 162.8pt;padding: 0in 5.4pt;height: 26.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDo you recommend different drug holidays depending on the type of drug (bisphosphonates, denosumab, SERMs, PTH)?\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 26.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 26.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e319 (45.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 26.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e148 (50.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55.45pt;padding: 0in 5.4pt;height: 26.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e0.120\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 14.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 14.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e388 (54.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 14.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e145 (49.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 162.8pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eIf you have encountered case/s of MRONJ, what type of medication caused it?\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eBisphosphonates\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e276 (94.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDenosumab\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e13 (4.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSERMs\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e4 (1.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.1pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNo experience\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e707 (100.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.8pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eAbbreviations: y, year; MRONJ, medication-related osteonecrosis of the jaw; SERMs, selective estrogen-receptor modulators; PTH, parathyroid hormone\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003ea\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eDifferences between dentists with and those without prior MRONJ experience were evaluated using the \u0026chi;\u003csup\u003e2\u003c/sup\u003e test. The level of statistical significance was set at \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05. Data are presented as N (%).\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eb\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eDentists engaged in private practice\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003ec\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003eEmployed dentists, public dentists, leave of absence, etc.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:200%;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, most dentists (65.0%) recorded both the name of the anti-osteoporotic drug and its duration of use. While the recommended period for a drug holiday differs for each drug, most (53.3%) dentists did not make such a distinction.\u003c/p\u003e\n\u003cp\u003eThere were no statistically significant differences in whether bone-modifying medications were recorded or whether a referral from the attending physician was requested prior to dental surgery procedures between dentists with and those without experience with MRONJ. This result suggests what are necessary for the prevention of MRONJ. In a previous study, it was reported that the proportion of dentists who did not contact or ask for referral from an attending physician prior to dental procedures was low, and that it decreased slightly from 2014 (12.86%) to 2018 (11.67%) [11]. The authors of that study noted that such unsupervised procedures can reduce patients' quality of life.\u003c/p\u003e\n\u003cp\u003eWe observed that more dentists advised patients to take drug holidays \u0026ge;6 months than \u0026le;2 months for the prevention of MRONJ. This period is longer than that recommended in the literature [7, 10]. Hence, the optimal duration of a drug holiday cannot be determined from the results of our study alone, and further long-term studies are required for definitive conclusions to be drawn.\u003c/p\u003e\n\u003cp\u003eDue to the aging population, not only in Korea but also worldwide, an increasing number of elderly individuals with multiple co-morbidities are expected to undergo dental procedures, including implant placement. Thus, an awareness of the potential interactions in treatment regimens prescribed to the same patient by doctors in different fields of specialization will become increasingly important, necessitating optimal communication between healthcare professionals.\u003c/p\u003e\n\u003cp\u003ePoor patient compliance is one of the primary obstacles in the treatment of osteoporosis, commonly resulting from side effects of bone-modifying agents, or the fear thereof [12, 13]. On the other hand, excessive use of bone-modifying agents can increase the risk of MRONJ. MRONJ is a rare but serious complication following treatment with certain medications, and is defined as the presence of exposed bone in the oral and maxillofacial regions (or extra- or intra-oral fistulas) lasting more than 8 weeks. To be diagnosed with MRONJ, a patient should have no prior history of radiation, or of treatment with bone-resorption inhibitors or angiogenesis inhibitors, for tumor metastasis to the jawbones [7].\u003c/p\u003e\n\u003cp\u003eThe exact mechanism of development of MRONJ is unclear, in spite of several proposed hypotheses. Additionally, varied opinions regarding the efficacy of surgical and non-surgical treatments have been presented [14, 15]. In addition to bisphosphonates, several drugs such as denosumab, steroids, and other angiogenesis inhibitors can cause MRONJ [7, 16]. Denosumab is an anti-human receptor activator of the nuclear factor kappa-\u0026Beta; ligand and inhibits the activity of osteoclasts. It is used to treat osteoporosis caused by bone absorption disorders [17], similar to bisphosphonates, and its cost-effectiveness [18] and convenience of administration has recently led to its increased use in Korea. Denosumab is also associated with a risk for MRONJ; however, the risk of fracture may increase either temporarily or permanently when its use is discontinued [7].\u003c/p\u003e\n\u003cp\u003eThe determination of the type of bone-modifying medication and its duration of use, potential alternative medications, and a drug holiday of 2\u0026ndash;3 months before performing dental procedures is essential for preventing MRONJ [7, 10]. The disadvantages of drug discontinuation should be weighed against its advantages. \u0026nbsp;In a post-hoc analysis, Anagnostis et al. (2017) [19] concluded that drug holidays are advisable for patients who have not experienced recent fractures and for those at low risk of fracture, defined as follows: a femoral neck T-score \u0026ge; -2.5; age \u0026lt;70 years; and no diseases or medications that could increase fracture risk. Drug holidays should be considered for patients with a 5-year history of alendronate use or a 3-year history of zoledronic acid (or risedronate) use [19, 20]. The duration of the drug holiday should also be based on bone mineral density [20]. The management of the osteoporotic condition with other bone-modifying medications is advisable if denosumab is discontinued [21, 22]. However, drug holidays are not recommended for bone-modifying medications such as denosumab, hormone replacement therapy, selective estrogen-receptor modulators, and teriparatide [21], or for patients with severe osteoporosis [10, 22]. Therefore, the determination of a drug discontinuation protocol may be beyond the scope of dentistry and it is important that dentists request a doctor's referral letter prior to any dental procedure in patients at risk for MRONJ. In addition, detailed records of bone-modifying agents must be requested and maintained. However, the results of our study showed that the proportion of dentists requesting referral letters was relatively low (59.1%). In addition, the proportion of dentists that encountered cases of MRONJ (29.3%) was higher than the general prevalence of MRONJ. This highlights the importance of dentists possessing adequate knowledge pertaining to this condition, and of proper dental management protocols.\u003c/p\u003e\n\u003cp\u003eSeveral prior studies have been conducted to examine the awareness of dentists regarding MRONJ in different countries. In a survey of 120 dentists in Romania, the majority were aware of bisphosphonate therapy and its complications, but were not familiar with the pathophysiology, diagnosis, and treatment of BRONJ [23]. In a survey of 204 Brazilian dentists and dental students, researchers discovered a lack of knowledge regarding bisphosphonates and BRONJ [24]. In a survey of 60 dentists and 60 dental students in Spain, 30 (50%) students and 41 (68.36%) dentists were determined to have up-to-date knowledge regarding BRONJ [25]. In a survey of 129 British dentists, more than 90% admitted a lack of awareness regarding drugs (other than bisphosphonates) that cause MRONJ. Furthermore, the lack of a standardized protocol was reported as the primary reason for reluctance in managing such patients [26]. In a survey of 222 Saudi physicians and dentists, only 31.5% were aware of BRONJ. The authors suggested that this could be improved through education [27]. In the present study, we found that the level of experience among dentists regarding MRONJ was high (29.3%); nevertheless, the documentation of patients\u0026rsquo; history pertaining to the type of bone-modifying agent and the duration of its use was insufficient (65.0%). Hence, dentists should be made aware of the guidelines for treatment of such patients through regular educational programs.\u003c/p\u003e\n\u003cp\u003eOur study had some limitations. First, only 1000 dentists were surveyed; therefore, the results may not be generalizable to all dentists in Korea. Second, due to the limited scope of the questions in the survey, it was not possible to elucidate dentists\u0026rsquo; knowledge of MRONJ pathogenesis. Third, due to the questionnaire survey system, the number of questions was limited, so detailed surveys were not possible. Nevertheless, the results of this survey can serve as a basis for larger, more detailed, long-term studies to investigate the dentist's perception.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eElderly individuals often have multiple co-morbidities that require multidisciplinary management. Due to an aging demographic, dentists are likely to encounter an increasing number of elderly patients with osteoporosis who require implant surgery. Thus, the successful management of such patients will require an approach that encourages cooperation between doctors and dentists, as well as the development of educational programs to increase knowledge and awareness of MRONJ.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eBRONJ, bisphosphonate-related osteonecrosis of the jaws\u003c/p\u003e\n\u003cp\u003eMRONJ, medication-related osteonecrosis of the jaws\u003c/p\u003e\n\u003cp\u003ePTH, parathyroid hormone\u003c/p\u003e\n\u003cp\u003eSERM, selective estrogen-receptor modulators\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional bioethics committee of our university hospital (IRB approval number: 2019-03-015) and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI obtained written consent from study participants. I put the following phrase at the top of the questionnaire: \u0026ldquo;The results of this questionnaire will be used for research purposes and will not be used for any purpose other than research. If you agree to this, please fill out and submit the questionnaire.\u0026rdquo; A sample of the questionnaire was submitted to and approved by the IRB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Wonkwang University in 2020\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eALH performed all work involved in this study (including study conception, hypothesis, experimental design, data collection and analysis, and write-up of manuscript) and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI express my sincere appreciation for the site manager who assisted me in the distribution of the questionnaire to the 1000 participating dentists and collection of answer sheets. I thank Editage (www.editage.co.kr) for English language editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMarx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61:1115-8.\u003c/li\u003e\n\u003cli\u003eRuggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw\u0026mdash;2014 update. J Oral Maxillofac Surg. 2014;72:1938-56.\u003c/li\u003e\n\u003cli\u003eAdvisory Task Force on Bisphosphonate-Related Osteonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Associaton of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. 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J Clin Endocrinol Metab. 2019;104:1595-622.\u003c/li\u003e\n\u003cli\u003eAnagnostis P, Paschou SA, Kenanidis E, Kenanidis E, Lambrinoudaki I, Potoupnis M, Tsiridis E, et al. \u0026ldquo;Holidays\u0026rdquo; for osteoporosis drugs: a case-based approach. Case Rep Womens Health. 2019;23:e00127.\u003c/li\u003e\n\u003cli\u003eFerrari S, Libanati C, Lin CJF, Brown JP, Cosman F, Czerwiński E, et al. Relationship between bone mineral density T‐score and nonvertebral fracture risk over 10 years of denosumab treatment. J Bone Miner Res. 2019;34:1033-40.\u003c/li\u003e\n\u003cli\u003eHodsman AB, Bauer DC, Dempster DW, Dian L, Hanley DA, Harris ST, et al. Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev. 2005;26:688-703.\\\u003c/li\u003e\n\u003cli\u003ede Lima PB, Brasil VLM, de Castro JFL, de Moraes Ramos-Perez FM, Alves FA, dos Anjos Pontual ML, et al. Knowledge and attitudes of Brazilian dental students and dentists regarding bisphosphonate-related osteonecrosis of the jaw. Support Care Cancer. 2015;23:3421-6.\\\u003c/li\u003e\n\u003cli\u003eL\u0026oacute;pez‐Jornet P, Camacho‐Alonso F, Molina‐Mi\u0026ntilde;ano F, Gomez‐Garcia F. Bisphosphonate‐associated osteonecrosis of the jaw. Knowledge and attitudes of dentists and dental students: a preliminary study. J Eval Clin Pract. 2010;16:878-82.\u003c/li\u003e\n\u003cli\u003eTanna N, Steel C, Stagnell S, Bailey E. Awareness of medication related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners. Br Dent J. 2017;222:121-5.\u003c/li\u003e\n\u003cli\u003eAl Mohaya MA, Al Khashan HI, Mishriky AM, Al-Otaibi LM. Physicians' awareness of bisphosphonates-related osteonecrosis of the jaw. Saudi Med J. 2011;32:830-5.\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"awareness, dentists, education, osteoporosis","lastPublishedDoi":"10.21203/rs.3.rs-117921/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-117921/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Accurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. I aimed to determine the awareness of Korean dentists regarding medication-related osteonecrosis of the jaw and the duration of drug holidays they prescribe to patients who need to undergo various dental procedures.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: An online, questionnaire-based survey was conducted among 1000 dentists registered in an online community in Korea.\u003cstrong\u003e \u003c/strong\u003eThe following were determined: general characteristics; type of practice; recordkeeping regarding patients’ use of bone-modifying agents; requirement of a doctor’s referral letter; advice given regarding drug holidays of bone-modifying agents before dental surgery procedures; and experience with medication-related osteonecrosis of the jaw. Differences between dentists with and without experience in treating patients with medication-related osteonecrosis of the jaw were evaluated using the χ\u003csup\u003e2\u003c/sup\u003e test.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Although a relatively high proportion (293/1000, 29.3%) of dentists had experienced cases of medication-related osteonecrosis of the jaw, only 650/1000 (65.0%) routinely documented the type of bone-modifying agent used by patients and the duration of its use. Moreover, only 591/1000 (59.1%) dentists routinely requested referral letters from doctors before performing dental surgery on patients. Although the recommended period for a drug holiday differs for each drug, 533/1000 (53.3%) dentists did not make such a distinction. There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in medication-related osteonecrosis of the jaw (707/1000) and those who had such experience (\u003cem\u003eP \u003c/em\u003e= 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and without prior experience with the condition (\u003cem\u003eP\u003c/em\u003e = 0.001).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: These results suggest that dentists do not respond consistently to patients' drug history prior to performing dental procedures. This implies the need for increased cooperation between dentists and physicians, as well as the development of targeted educational interventions for the dental profession, to reduce the risk of medication-related osteonecrosis of the jaw.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e Not applicable.\u003c/p\u003e","manuscriptTitle":"The awareness and perceptions of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2021-01-25 19:26:54","doi":"10.21203/rs.3.rs-117921/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-02-05T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable pending editorial decision\n"},{"type":"reviewerAgreed","content":"","date":"2021-01-22T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-01-19T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-01-19T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2021-01-18T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-01-17T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-01-17T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-12-04 17:27:50","doi":"10.21203/rs.3.rs-117921/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-12-27T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-12-26T00:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nOverall a very informative paper which will be a great eye opener for many dentists on the importance of thorough history taking and secondly if there is lack of knowledge to a medical condition to request referral note from medical specialist. After reading this article there is a need for continued education on this subject.\n1. Research question was well addressed.\n2. In the results section, some elements could have been included i.e. referral notes\n3. Discussion was well rounded linking literature to to results.\n4.Conclusion the key message were conveyed achieving the outcomes of the title.\n5. Title is well reflective of the paper.\n6. There certain aspects that could be communicated better. i have indicated on the paper were better clarity is required.\n7. A few minor changes required.\n\n\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **'I declare that I have no competing interests'**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-12-19T00:00:00+00:00","index":2,"fulltext":"Recommendation: Reject\nForm responses:\n---\n\nComments to Author:\n---\nAlthough the MS follows an academic study discipline, the topic is not interesting and adds little to the literature. Further, many similar studies are already performed with similar results.\n\nSecondly; the MS have used an existing questionnaire. However, the original questionnaire was developed in Romania in another language other than Korean. I assume that the present study used a questionnarie in Korean, which was not clear in the MS, unfortunately, direct translation of the questionnaire is not a reliable method in these kind of studies, but a culturel adaptation method of the questionnaire should be used instead, and adaptation method should be explained in the methods section.\n\nThirdly; The research question and the concluison was not complemetive to each other. The conclusions of the MS was more like a statement other than scientific based conclusions.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that i have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-12-14T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-12-07T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-11-25T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-11-25T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-11-24T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-11-24T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-11-17T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1d96faa-2387-45c3-b0e5-7cbd56479581","owner":[],"postedDate":"January 25th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":1339625,"name":"Dentistry"}],"tags":[],"updatedAt":"2021-03-29T15:01:01+00:00","versionOfRecord":{"articleIdentity":"rs-117921","link":"https://doi.org/10.1186/s12903-021-01475-6","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2021-03-24 15:00:34","publishedOnDateReadable":"March 24th, 2021"},"versionCreatedAt":"2021-01-25 19:26:54","video":"","vorDoi":"10.1186/s12903-021-01475-6","vorDoiUrl":"https://doi.org/10.1186/s12903-021-01475-6","workflowStages":[]},"version":"v2","identity":"rs-117921","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-117921","identity":"rs-117921","version":["v2"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}