Conhecimento e conduta clínica sobre medicamentos anti-reabsortivos e osteonecrose dos maxilares: um estudo transversal

MARLIÉRE, Daniel Amaral Alves; COSTA, Tony Eduardo; JUNQUEIRA, Rafael Binato; BARBOSA, Saulo de Matos; ASPRINO, Luciana; CHAVES NETTO, Henrique Duque de Miranda

Daniel Amaral Alves MARLIÉRE Correspondência para / Correspondence to: DAA Marlière. E-mail:ctbmf.marliere@gmail.com.

Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Diagnóstico Oral, Divisão de Cirurgia Oral e Maxilofacial. Av. Limeira, 901, Areião, 13414-903, Piracicaba, SP, Brasil.

Collaborators DAA MARLIÈRE, had full access to all study data andassumes responsibility for the integrity of said data as well as theaccuracy of the data analysis. Study concept and design: DAAMARLIÈRE, HDM CHAVES NETTO. Acquisition of data: TE COSTA.Statistical analysis: DAA MARLIÈRE. Analysis and interpretationof data: DAA MARLIÈRE, TE COSTA, L ASPRINO, HDM CHAVESNETTO. Drafting of the manuscript: DAA MARLIÈRE, TE COSTA.Critical revision of the manuscript in terms of significant editorialcontent: SM BARBOSA, L ASPRINO, RB JUNQUEIRA. Studysupervision: HDM CHAVES NETTO.

http://orcid.org/0000-0003-4897-355X

Tony Eduardo COSTA

Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Hospital Therezinha de Jesus, Divisão de Odontologia. Juiz de Fora, MG, Brasil.

Collaborators DAA MARLIÈRE, had full access to all study data andassumes responsibility for the integrity of said data as well as theaccuracy of the data analysis. Study concept and design: DAAMARLIÈRE, HDM CHAVES NETTO. Acquisition of data: TE COSTA.Statistical analysis: DAA MARLIÈRE. Analysis and interpretationof data: DAA MARLIÈRE, TE COSTA, L ASPRINO, HDM CHAVESNETTO. Drafting of the manuscript: DAA MARLIÈRE, TE COSTA.Critical revision of the manuscript in terms of significant editorialcontent: SM BARBOSA, L ASPRINO, RB JUNQUEIRA. Studysupervision: HDM CHAVES NETTO.

http://orcid.org/0000-0003-2138-5715

Rafael Binato JUNQUEIRA

Universidade Federal de Juiz de Fora, Departamento de Odontologia, Divisão de Endodontia. Governador Valadares, MG, Brasil.

Collaborators DAA MARLIÈRE, had full access to all study data andassumes responsibility for the integrity of said data as well as theaccuracy of the data analysis. Study concept and design: DAAMARLIÈRE, HDM CHAVES NETTO. Acquisition of data: TE COSTA.Statistical analysis: DAA MARLIÈRE. Analysis and interpretationof data: DAA MARLIÈRE, TE COSTA, L ASPRINO, HDM CHAVESNETTO. Drafting of the manuscript: DAA MARLIÈRE, TE COSTA.Critical revision of the manuscript in terms of significant editorialcontent: SM BARBOSA, L ASPRINO, RB JUNQUEIRA. Studysupervision: HDM CHAVES NETTO.

http://orcid.org/0000-0002-0732-2753

Saulo de Matos BARBOSA

Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic. Campinas, SP, Brasil.

Luciana ASPRINO

Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Diagnóstico Oral, Divisão de Cirurgia Oral e Maxilofacial. Av. Limeira, 901, Areião, 13414-903, Piracicaba, SP, Brasil.

Collaborators DAA MARLIÈRE, had full access to all study data andassumes responsibility for the integrity of said data as well as theaccuracy of the data analysis. Study concept and design: DAAMARLIÈRE, HDM CHAVES NETTO. Acquisition of data: TE COSTA.Statistical analysis: DAA MARLIÈRE. Analysis and interpretationof data: DAA MARLIÈRE, TE COSTA, L ASPRINO, HDM CHAVESNETTO. Drafting of the manuscript: DAA MARLIÈRE, TE COSTA.Critical revision of the manuscript in terms of significant editorialcontent: SM BARBOSA, L ASPRINO, RB JUNQUEIRA. Studysupervision: HDM CHAVES NETTO.

http://orcid.org/0000-0002-7761-1753

Henrique Duque de Miranda CHAVES NETTO

Universidade Federal de Juiz de Fora, Departamento de Odontologia, Divisão de Clínica Odontológica. Juiz de Fora, MG, Brasil.

Collaborators DAA MARLIÈRE, had full access to all study data andassumes responsibility for the integrity of said data as well as theaccuracy of the data analysis. Study concept and design: DAAMARLIÈRE, HDM CHAVES NETTO. Acquisition of data: TE COSTA.Statistical analysis: DAA MARLIÈRE. Analysis and interpretationof data: DAA MARLIÈRE, TE COSTA, L ASPRINO, HDM CHAVESNETTO. Drafting of the manuscript: DAA MARLIÈRE, TE COSTA.Critical revision of the manuscript in terms of significant editorialcontent: SM BARBOSA, L ASPRINO, RB JUNQUEIRA. Studysupervision: HDM CHAVES NETTO.

http://orcid.org/0000-0002-9133-2347

Collaborators

DAA MARLIÈRE, had full access to all study data andassumes responsibility for the integrity of said data as well as theaccuracy of the data analysis. Study concept and design: DAAMARLIÈRE, HDM CHAVES NETTO. Acquisition of data: TE COSTA.Statistical analysis: DAA MARLIÈRE. Analysis and interpretationof data: DAA MARLIÈRE, TE COSTA, L ASPRINO, HDM CHAVESNETTO. Drafting of the manuscript: DAA MARLIÈRE, TE COSTA.Critical revision of the manuscript in terms of significant editorialcontent: SM BARBOSA, L ASPRINO, RB JUNQUEIRA. Studysupervision: HDM CHAVES NETTO.

Correspondência para / Correspondence to: DAA Marlière. E-mail:ctbmf.marliere@gmail.com.

Variable	Category	n (%)
Gender	Male	27 (26.73)
Gender	Female	74 (73.27)
Dental school*	Public	57 (57)
	Private	43 (43)
	Until 5 years	76 (75.25)
Time after completing undergraduate course	5 to 10 years	6 (5.94)
	10 to 20 years	13 (12.87)
	More than 20 years	6 (5.94)
Post-graduate course completed	Yes	34 (33.66)
Post-graduate course completed	No	67 (66.34)
Post-graduate course in progress	Yes	56 (55.45)
Post-graduate course in progress	No	45 (44.55)
Post-graduate course in the future	Yes	42 (41.58)
Post-graduate course in the future	No	59 (58.42)

Questions		Answers	n (%)	Inferior – superior^* * Confidence interval limits;
Q1. Knowledge on the class of AM^§ § Missing data: 03 participants did not answer.		Yes	58 (59.18)	0.49 – 0.67
		No	40 (40.82)	0.31 – 0.50
Q2. In the anamnesis, do you think it is important to know whether the patient takes or took AM?^§ § Missing data: 03 participants did not answer.		Yes	83 (83)	0.75 – 0.90
		No	17 (17)	0.09 – 0.24
Q3	a. Recognition of AM^§ § Missing data: 03 participants did not answer.	None	48 (48.98)	0.39 – 0.60
		Partially	45 (45.92)	0.36 – 0.56
		Fully	5 (5.10)	0 – 0.16
	b. Identification of brand names of AM in a list of 10 medications^ Alendronate, pamidronate, denosumab, clodronate, zoledronate;	Up to 2	30 (56.60)	0.43 – 0.69
		At least 3	23 (43.40)	0.30 – 0.56
Q4	a. Recognition of the indication for use of AM	Yes	64 (63.37)	0.53 – 0.72
	a. Recognition of the indication for use of AM	No	37 (36.63)	0.27 – 0.46
	b. Identification of alternatives representing indications for use of AM^* ***** Osteoporosis, Paget’s disease, osteogenesis imperfecta, bone metastasis, multiple myeloma;	Up 1	41 (64.06)	0.52 – 0.75
		At least 2	23 (35.94)	0.24 – 0.47
Q5	a. Recognition of some side effect of AM in the oral cavity^§ § Missing data: 03 participants did not answer.	Yes	53 (53)	0.43 – 0.62
		No	47 (47)	0.37 – 0.56
	b. Identification of the side effect in the oral cavity	Correctly	34 (69.39)	0.56 – 0.82
	b. Identification of the side effect in the oral cavity	Incorrectly	15 (30.61)	0.17 – 0.43
Q6	a. Recognition of systemic risk factors related to AM, which would increase the likelihood of occurrence of side effects in the oral cavity^§ § Missing data: 03 participants did not answer.	Yes	50 (50)	0.40 – 0.59
		No	50 (50)	0.40 – 0.59
	b. Identification of alternatives you think that represent systemic risk factors^** ****** Diabetes, chronic use of corticosteroid, use of immune-suppressors, smoking, osteoporosis, intravenous AM;	Upto 4	22 (43.14)	0.29 – 0.56
		At least 5	29 (56.86)	0.43 – 0.70
Q7	a. Recognition of local risk factors related to AM, which would increase the likelihood of development of side effects in the oral cavity^§§	Yes	65 (65.00)	0.55 – 0.74
		No	35 (35.00)	0.25 – 0.44
	b. Identification of alternatives you think that represent local risk factors^** ****** Diabetes, chronic use of corticosteroid, use of immune-suppressors, smoking, osteoporosis, intravenous AM;	Upto 4	41 (62.12)	0.50 – 0.73
		At least 5	25 (37.88)	0.26 – 0.49

Clinical cases		Behavior		n (%)
Q8. A 62-year-old woman with osteoporosis and under treatment with oral BP presented indication for dental intervention to be performed according to the medication usage time ^§ § Missing data: until 10 did not answer.	a. Simple tooth extraction: use of BP < 3 years	Performing the procedure		18 (19.35)
		Discontinuing BP, performing the procedure and resuming BP		28 (30.11)
		Performing no procedure (i.e. referral of the patient)		47 (50.54)
	b. Simple tooth extraction: use of BP > 3 years	Performingt he procedure		13 (14.29)
		Discontinuing BP, performing the procedure and resuming BP		27 (29.67)
		Performing no procedure (i.e. referral of the patient)		51 (56.04)
Q9. A 65-year-old man diagnosed with non-surgical adenocarcinoma of the prostate taking intravenous BP regularly to prevent bone metastasis ^§ § Missing data: until 10 did not answer.	a. Dental implant: use of BP < 3 years	Performing the procedure		6 (6.32)
		Discontinuing BP, performing the procedure and resuming BP		17 (17.89)
		Performing no procedure (i.e. referral of the patient)		72 (75.79)
	b. Dental implant: use of BP < 3 years	Performing the procedure		4 (4.17)
		Discontinuing BP, performing the procedure and resuming BP		10 (10.42)
		Performing no procedure (i.e. referral of the patient)		82 (85.42)
Q10. Would you feel comfortable treating patients who developed ONJ?^§ § Missing data: 03 participants did not answer.			Yes	27(27.27)
			No	72 (72.73)

Question	Answers		n (%)
Q11. Which resources would you use to keep up with dentistry?^§ § Missing data: 2 participants did not answer.	Research on Internet	Yes	52 (52.53)
	Research on Internet	No	47 (47.47)
	Scientific articles	Yes	73 (73.74)
	Scientific articles	No	26 (26.26)
	Continued education courses	Yes	63 (63.64)
	Continued education courses	No	36 (36.36)
Q12. Where did you learn about AM and its side effects in the oral cavity?^§ § Missing data: 2 participants did not answer.	Undergraduate dental courses	Yes	49 (49.49)
	Undergraduate dental courses	No	50 (50.51)
	Postgraduate dental courses	Yes	10 (10.10)
	Postgraduate dental courses	No	89 (89.90)
	Continued education courses	Yes	10 (10.10)
	Continued education courses	No	89 (89.89)
	Scientific articles	Yes	21 (21.21)
	Scientific articles	No	78 (78.79)
	Neverbefore	Yes	32 (32.32)
	Neverbefore	No	67 (67.68)
Q13. Which would be your preference for acquiring knowledge on AM and ONJ?^§ § Missing data: 2 participants did not answer.	On-line courses	Yes	12 (12.12)
	On-line courses	No	87 (87.88)
	Short courses	Yes	37 (37.37)
	Short courses	No	62 (62.63)
	Scientific articles	Yes	52 (52.53)
	Scientific articles	No	47 (47.47)
	Continued education courses	Yes	50 (50.51)
	Continued education courses	No	49 (49.49)

Q2. Do you think it is important to know whether the patient takes or took AM during the anamnesis?	Extraction - use of oral BP for more than 3 years			p-value
	Not performed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	6	6	1
Yes	44	7	26	<0.01
Q12. Where did you learn about AM and ONJ? Neverlearned	Extraction – use of oral BP for less than 3 years			p-value
Q12. Where did you learn about AM and ONJ? Neverlearned	Notperformed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	28	13	25
Yes	18	5	3	0.03
Q12. Where did you learn about AM and ONJ? Post-graduate dental courses	Extraction - use of oral BP for more than 3 years			p-value
	Notperformed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	45	14	23
Yes	1	4	3	0.01
Q12. Where did you learn about AM and ONJ? Under-graduate dental courses	Extraction - use of oral BP for more than 3 years			p-value
	Notperformed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	29	9	7
Yes	21	4	20	<0.01
Q12. Where did you learn about AM and ONJ? Neverlearned	Extraction - use of oral BP for more than 3 years			p-value
Q12. Where did you learn about AM and ONJ? Neverlearned	Notperformed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	31	6	26
Yes	19	7	1	<0.01
Q12. Where did you learn about AM and ONJ? Under-graduate dental courses	Dental implant – use of IV BP for less than 3 years			p-value
	Notperformed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	41	3	3
Yes	31	3	14	0.01
Q12. Where did you learn about AM and ONJ? Neverlearned	Dental implant – use of IV BP for less than 3 years			p-value
Q12. Where did you learn about AM and ONJ? Neverlearned	Notperformed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	46	3	17
Yes	26	3	0	<0.01
Q12. Where did you learn about AM and ONJ? Under-graduate dental courses	Dental implant – use of IV BP for more than 3 years			p-value
	Notperformed^ Referral	Performed	Discontinuing BP, performing the procedure and resuming BP	p-value
No	45	2	1
Yes	37	2	9	0.02

Co-variable (Explicative variable)	Dependentvariable - Q3b.
Co-variable (Explicative variable)	SE^* * Confidence interval limits;	Standard error	z-test	p-value	Fvalue^ Estimated predictive value, propensity score or odds ratio;
Intercept^* ***** Model level; Q12. Post-graduate course	-0.6931 2,0794	0.3273 0.8557	-2.118 2.430	0.0342 0.0151	0.80
Co-variable (Explicative variable)	Dependentvariable - Q4b.
Co-variable (Explicative variable)	SE^* * Punctual estimation;	Standard error	z-test	p-value	Fvalue^ Estimated predictive value, propensity score or odds ratio;
Intercept^* ***** Model level;	3.4447	1.9564	1.761	0.0783	0.91
Age^** ****** Age group of the oral surgeons close to the median.	-0.2025	0.0797	- 2.542	0.0110
Q6a. Systemic risk factors	1.4311	0.7057	2.028	0.0426
Q12. Post-graduate course	2.5368	1.2819	1.979	0.0478
Co-variable (Explicative variable)	Dependentvariable - Q5b.
Co-variable (Explicative variable)	SE^* * Punctual estimation;	Standard error	z-test	p-value	Fvalue^ Estimated predictive value, propensity score or odds ratio;
Intercept^* ***** Model level;	3.3916	1.7160	1.976	0.0481	0.91
Age^** ****** Age group of the oral surgeons close to the median.	- 0.15290	0.0608w	- 2.517	0.0118
Dentistry school	1.7800	0.8797	2.024	0.0430
Q12. Scientific articles	3.1688	1.3773	2.299	0.0215
Co-variable (Explicative variable)	Dependentvariable - Q6b.
Co-variable (Explicative variable)	SE^* * Punctual estimation;	Standard error	z-test	p-value	Fvalue^ Estimated predictive value, propensity score or odds ratio;
Intercept^* ***** Model level;	- 2.07900	1.061	- 1.961	0.0499	0.66
Q4a. Indications for use of AM	2.7730	1.110	2.498	0.0125	0.66

[1] Collaborators

DAA MARLIÈRE, had full access to all study data andassumes responsibility for the integrity of said data as well as theaccuracy of the data analysis. Study concept and design: DAAMARLIÈRE, HDM CHAVES NETTO. Acquisition of data: TE COSTA.Statistical analysis: DAA MARLIÈRE. Analysis and interpretationof data: DAA MARLIÈRE, TE COSTA, L ASPRINO, HDM CHAVESNETTO. Drafting of the manuscript: DAA MARLIÈRE, TE COSTA.Critical revision of the manuscript in terms of significant editorialcontent: SM BARBOSA, L ASPRINO, RB JUNQUEIRA. Studysupervision: HDM CHAVES NETTO.

Brasil

Brasil

Conhecimento e conduta clínica sobre medicamentos anti-reabsortivos e osteonecrose dos maxilares: um estudo transversal

RESUMO

Objetivo:

Métodos:

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Conclusão: