Unveiling the landscape of MRONJ awareness (2025): a comprehensive national cross-sectional study of Tunisian dentists’ knowledge, attitudes, and practices

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) represents a significant complication for patients receiving antiresorptive therapy. Dentists play a pivotal role in prevention, early detection, and management, yet global studies suggest variable practitioner preparedness. This study aimed to assess the current knowledge, attitudes, and clinical practices (KAP) of Tunisian dentists concerning MRONJ and identify factors influencing competency. METHODS: A nationwide, cross-sectional online survey was distributed in September 2024. The validated 26-item questionnaire covered demographics, MRONJ knowledge, risk perception, and reported clinical behaviors. Data were analyzed descriptively and analytically. RESULTS: Among 106 respondents (mean age: 30 years; 79.2% female; 83% general practitioners), key findings revealed a profound knowledge-practice gap. While 77.4% identified intravenous bisphosphonates and extractions as primary risks, only 11.3% felt confident managing affected patients. Clinical caution was pronounced: 87.7% were reluctant to perform surgery, 63.2% would routinely refer, and 39.6% had refused treatment. Analytical results identified younger age (< 35 years), specialist status, and urban practice as significant positive correlates with accurate knowledge (p < 0.05). A defensive cycle emerged, linking low patient exposure to higher anxiety and avoidance behaviors. CONCLUSION: This first national study in Tunisia highlights critical deficits in dentist preparedness for MRONJ, driven by knowledge gaps and risk overestimation. The findings underscore an urgent need for structured, continuous education programs, clear national guidelines, and interdisciplinary collaboration to transform defensive practice into evidence-based, proactive patient management.