Osteonecrosis of the jaw (ONJ) is a rare but severe type of osteonecrosis, which means the death of bones. ONJ occurs specifically in the cells of the maxilla and mandible jaw bones. It is caused by a lack of blood supply to these bones.
ONJ occurs when the jaw bone is exposed and
begins to starve from a lack of blood. Most cases of ONJ happen after a dental
extraction. Generally, ONJ is associated with bisphosphonate, a group of drugs
used to treat osteoporosis and cancer. Study results vary from less than 1 in
100,000 getting ONJ from bisphosphonates to 1 patient in 263,158.
The use of bisphosphonates is the main
cause of ONJ. Researchers think that bisphosphonates can stop the body from
repairing microscopic damage to the jawbone during routine dental procedures or
from everyday wear and tear. But it’s still not clear why this happens in some
people and not in others.
In addition to bisphosphonates, other
factors for developing ONJ include:
- Long-term steroid therapy
- Older age
- Gum disease
- Dental surgery, such as having a tooth extracted or a root canal
- Radiation therapy to the head and neck to treat cancer
- Xgeva to reduce bone complications and bone pain caused by advanced-stage breast cancer that has spread to the bone
Normally, patients with ONJ would
- Pain in the mouth
- Tenderness and redness
- Bad breath
- Loose teeth
- Difficulty eating and drinking
- Lesions after invasive dental procedures
If ONJ was caused by dental surgery, such
as the extraction of a molar, often the wound from the surgery will not heal
properly or at all.
There is no diagnostic test to determine if
an individual is at increased risk for ONJ. Basically, doctors will make a
diagnosis from the presence of exposed bone, lasting more than eight weeks. The
other symptom that helps diagnose is pain in the mouth, which is often related
with infection and swelling.
The treatment should be tailored to the
cause involved and the severity of the disease. The first-line treatment option
for ONJ is surgical removal of the bone. However, studies have shown
conservative treatment to be effective. In most cases, treatment options for
patients with ONJ are the combination of rinses, antibiotics, and oral
Options that can be chosen from include:
This process slowly removes scrapes and
scoops away the affected tissue and bone. It works well for ONJ.
Although this disease is often related to
infection, it is difficult to treat with antibiotics because there is little or
even no blood supply to the bone. So, it is hard for the antibiotics to reach
the potential infection. However, antibiotics are often used to treat mild to
moderate cases of ONJ.
- Oral rinses and painkillers.
In cases of ONJ related to osteoporosis,
conservative treatment with rinses and oral painkillers have proven to be
- Additional surgery.
This is often required because ONJ can
present in multiple sites, and in very rare cases, may reoccur.
Here are some tips to minimize your risk
- Schedule a dental exam and cleaning before taking breast cancer
- Tell your oncologist about any dental procedures you have planned, such
as extractions or dental implant insertion, before you start treatment for
- Have your dentist check and adjust removable dentures as needed
- Tell your dentist and oncologist if you have bleeding gums, pain,
signs of infection in your mouth, or any unusual feeling in your teeth or gums.
- Maintain excellent oral hygiene (brush and floss after every meal)
to reduce the risk of infection.
Generally, good oral hygiene and regular dental care are the best way to lower the risk of ONJ.
Keywords: osteonecrosis of the jaw; ONJ.