Referral patterns from general medical practitioners to dentists prior to the use of oral bisphosphonates in Australia

Introduction: Osteonecrosis of the jaw (ONJ) is a rare but serious complication of bisphosphonate therapy. There is international consensus in recommending dental referral prior to initiating IV bisphosphonates, but no consensus when starting on oral bisphosphonate therapy for the treatment of osteoporosis.

Aims: This study aims to investigate if general medical practitioners (GP’s) refer patients to dentists for oral health assessment prior to commencement of oral bisphosphonates, and identify the reasons for not doing so. Dentists were asked if they receive referrals form GP’s in these cases and how dentists manage these.

Method: A two-page survey was sent out to all GP’s and Dentists currently practicing in the Gold Coast region (Queensland, Australia).

Result: The majority of GP’s never referred patients to dentists (29%), or only occasionally (25%). Most of the GP’s discuss the risks of ONJ with their patients (39%) although 11% never do so. The main reasons not to refer to dentists were: small risk, delays treatment and cost. The majority of dentists report that they never received referrals from GP’s (63%), but they always discuss the risks of ONJ prior to high risk procedures (75%). The most common procedures dentists do to prevent ONJ are: referral to OMFS, antibiotic prophylaxis and ask GP for clearance.

Conclusion: There is no worldwide consensus on GP’s referring patients to dentists prior to oral bisphosphonates, and in Australia, despite the guidelines recommending it, GP’s are not doing so and dentists do not know how to deal with these cases.

Conflict of interest: This project was funded by the Australian Dental Research Foundation (Undergraduate Research Grant), and by the ADA/Dentsply Student Clinician Research Program.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Referral patterns from general medical practitioners to dentists prior to the use of oral bisphosphonates in Australia
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