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Participants must answer at least 12 of 15 questions correctly (80%) to earn CE credit.

AGD - Self-Instruction Exercise No. 420 - Special Patient Care
The role of dental care providers in the management of patients prescribed bisphosphonates: brief clinical guidance

Self-Instruction Exercise No. 420
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Exercise No. 420
Subject Code: 750
Special Patient Care

The 15 questions for this exercise are based on the article The role of dental care providers in the management of patients prescribed bisphosphonates: brief clinical guidance on pages 18-24. This exercise was developed by Riki Gottlieb, DMD, MS, FAGD, in association with the General Dentistry Self-Instruction committee.

Reading the article and answering the questions will enable you to:

  • consider the action, chemical structure, and common uses of bisphosphonates;
  • understand the risks and the importance of proper management of dental patients with medication-related osteonecrosis of the jaw (MRONJ); and
  • review clinical guidance for dental care providers regarding MRONJ.

Answers for this exercise must be received by April 30, 2019.

  1. Bisphosphonates accumulate in areas of ______ bone turnover.

    A. no
    B. low
    C. moderate
    D. high

  2. Use of bisphosphonates results in all of the following except one. Which is the exception?

    A. reduced osteoclast activity
    B. antiangiogenesis effects
    C. prevention of osteoclast apoptosis
    D. downregulation of matrix metalloproteases

  3. The risk of developing MRONJ in patients treated with oral bisphosphonate differs substantially from the risk in those prescribed intravenous therapy. The incidence of developing osteonecrosis of the jaw is not based on the reason the patient takes the drug.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  4. The incidence of MRONJ is estimated to be 1-10 cases per ______ in osteoporosis patients treated with antiresorptive drugs.

    A. 100,000
    B. 50,000
    C. 10,000
    D. 5,000

  5. Bisphosphonates are used to treat all of the following nonmalignant conditions except one. Which is the exception?

    A. multiple myeloma
    B. Paget disease
    C. fibrous dysplasia
    D. primary hyperparathyroidism

  6. A bisphosphonate drug holiday is not justified in patients who are at risk of spinal fracture. Early in treatment, the benefits of continuing osteoporosis therapy in patients at risk of fracture exceed the risk of rare adverse events.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  7. MRONJ is an unhealed, exposed area of bone present for more than ___ weeks in a nonirradiated maxilla or mandible of a patient treated with bisphosphonates.

    A. 2
    B. 4
    C. 6
    D. 8

  8. The term MRONJ is a recent updating of the original term ____________.

    A. bisphosphonate-related osteonecrosis of the jaw (BRONJ)
    B. bisphosphonate-related osteonecrosis of the bone (BRONB)
    C. intravenous injection–related osteonecrosis of the bone (IIRONB)
    D. antiresorptive therapy–related osteonecrosis of the jaw (ARTRONJ)

  9. According to the American Association of Oral and Maxillofacial Surgeons, MRONJ can be diagnosed in ___ different stages.

    A. 2
    B. 3
    C. 4
    D. 5

  10. Patients at risk of developing MRONJ are recommended to have regular dental follow-up every ___ months.

    A. 2
    B. 3
    C. 4
    D. 5

  11. A study by Vahtsevanos et al identified ____ cases of MRONJ after _> 6 months of intravenous bisphosphonate treatment.

    A. 80
    B. 90
    C. 100
    D. 110

  12. Asymptomatic exposed necrotic bone with no evidence of infection should be treated with ________.

    A. analgesics
    B. systemic antibiotics
    C. antimicrobial mouthrinse
    D. debridement and irrigation

  13. Most microbes isolated from exposed bone in MRONJ are sensitive to the _________ category of antimicrobial medications.

    A. metronidazole
    B. erythromycin
    C. clindamycin
    D. penicillin

  14. Resection is the treatment of choice for MRONJ patients presenting with ________.

    A. periapical infection
    B. extraoral fistula
    C. intraoral fistula
    D. osteosclerosis

  15. Lo et al examined 8572 patients who received ________________ treatment.

    A. oral bisphosphonate
    B. intravenous bisphosphonate
    C. multiple myeloma
    D. breast cancer


Evaluation

Please respond to the statements below, using the following scale:
1 Poor; 2 Below average; 3 Average; 4 Above average; 5 Excellent

Practicality of the content 1 2 3 4 5
Benefit to your clinical practice 1 2 3 4 5
Quality of illustrations 1 2 3 4 5
Clarity of objectives 1 2 3 4 5
Clarity of exercise questions 1 2 3 4 5
Relevance of exercise questions 1 2 3 4 5
 
Did this exercise achieve its objectives? Yes No
Did this article present new information? Yes No
How much time did it take you to complete this exercise? mins


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