Low awareness of medication-related osteonecrosis of the jaw among dentists: a systematic review with a medical and bioethical perspective

Abstract

Introduction Medication-related osteonecrosis of the Jaw (MRONJ) is a serious adverse drug reaction that can seriously affect the quality of life of patients if not promptly diagnosed and treated. To date, preventive measures have been the most effective strategy for reducing the incidence of MRONJ. The role of dental practitioners in managing patients treated with Bone Modifying Agents (BMAs) varies across countries, with some healthcare systems providing a more structured approach than others. This systematic review aims to investigate the knowledge and awareness of MRONJ among dentists, interpreting the findings from a medical and bioethical perspective. Materials and methods The protocol for this study was designed following the PRISMA guideline and registered on PROSPERO (CRD420251015032). A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICo question: Are dentists well-informed and aware of the risk of MRONJ in patients receiving BMAs? Furthermore, to address potential geographic differences, a country-specific literature review was conducted to compare the level of MRONJ awareness between patients receiving BMAs and dental professionals within the same country. Studies published up to March 2025 were screened. Results Twenty-two studies were included in this systematic review. Among the 10,536 dentists involved, 62.8% were well-informed about MRONJ, but only 9.7% were aware of its risk factors. The most common sources of information were university education, followed by scientific journals and specific training courses or conferences. Studies performed in the same countries investigating MRONJ awareness among patients taking BMAs were analyzed. Country-based analysis revealed significant discrepancies between dentists’ (68.5%) and patients’ (19.5%) knowledge and awareness of MRONJ in the USA, Saudi Arabia, Bulgaria, and Brazil. Finally, a bioethical analysis of European legal frameworks on informed consent for pharmacological therapies revealed that adequately informing patients about treatment risks is both an ethical obligation and a legal duty, rooted in constitutional and legislative principles. Conclusion This systematic review reveals a low level of awareness despite an acceptable level of knowledge among dentists, highlighting an alarming discrepancy. Beyond knowledge of the disease, awareness of its risk factors and preventive strategies is essential for dentists to adopt a personalized and safe workflow for these patient groups. Ensuring personalized therapy requires a structured and collaborative approach based on ethical principles and shared knowledge. Strengthening interprofessional training and teamwork is essential to improving prevention and patient empowerment.