Digital Decision Support for Medication-Related Osteonecrosis of the Jaw–Related Dental Anxiety: An Explanatory Sequential Mixed Methods Study

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious complication of antiresorptive therapy for osteoporosis. Despite its low incidence, fear of MRONJ often leads to heightened anxiety, delayed dental care, and suboptimal treatment adherence among older adults. We evaluated the feasibility and psychological impact of Dental Confidence, a web-based decision support tool designed to provide personalized MRONJ risk communication and actionable guidance. In a prospective explanatory sequential mixed methods study, 51 patients with osteoporosis completed pre- and post-intervention assessments of anticipatory dental anxiety, trait dental anxiety, knowledge, and user satisfaction, followed by semi-structured interviews in a purposive subsample. Mean anticipatory dental anxiety significantly decreased after use of the tool (mean difference − 8.43, 95% CI − 13.16 to − 3.70; P < 0.001; Cohen’s d = 0.50), while knowledge scores remained unchanged. User satisfaction was high. Qualitative findings indicated that anxiety reduction was driven by decisional reassurance, risk contextualization, and improved confidence in dentist–patient communication rather than increased knowledge. These results suggest that mechanism-informed digital decision support may reduce psychosocial barriers to dental and osteoporosis care in older adults.