Summary about Disease
Osteonecrosis of the jaw (ONJ) is a rare but serious condition characterized by the progressive destruction and death (necrosis) of bone in the jaw. It often manifests as exposed bone in the mouth that does not heal. While it can occur spontaneously, it's most commonly associated with the use of bisphosphonates, a class of drugs used to treat osteoporosis and some cancers, and other antiresorptive or antiangiogenic medications. Dental procedures, such as tooth extractions, can trigger or exacerbate the condition.
Symptoms
Exposed bone in the jaw (mandible or maxilla) that persists for more than eight weeks.
Pain, swelling, or inflammation in the jaw.
Loose teeth.
Numbness or a heavy feeling in the jaw.
Drainage or infection in the gums.
Non-healing extraction sockets.
Causes
The precise cause of ONJ isn't fully understood, but the following factors are strongly implicated:
Bisphosphonates: These medications (e.g., alendronate, risedronate, zoledronic acid) inhibit bone resorption and are used to treat osteoporosis and bone metastasis in cancer.
Other Antiresorptive or Antiangiogenic Medications: Denosumab (another osteoporosis drug), bevacizumab, sunitinib, and other medications that interfere with bone remodeling or blood vessel formation can also increase the risk.
Dental Procedures: Tooth extractions, dental implants, and other invasive procedures can initiate or worsen ONJ.
Poor Oral Hygiene: Pre-existing dental disease and poor oral hygiene increase the risk.
Trauma: Injury to the jaw can sometimes contribute.
Other Risk Factors: Cancer, chemotherapy, radiation therapy to the head and neck, anemia, diabetes, and corticosteroid use may increase susceptibility.
Medicine Used
Treatment focuses on managing symptoms, preventing further bone damage, and controlling infection. There is no single cure.
Antibiotics: To treat or prevent secondary infections.
Oral Rinses: Antibacterial mouthwashes (e.g., chlorhexidine) to maintain oral hygiene.
Pain Medication: Analgesics to manage pain.
Surgical Debridement: Removal of dead or infected bone (in some cases).
Teriparatide: In some cases, this parathyroid hormone analog, which stimulates bone formation, may be used.
Drug Holiday (with physician's approval): In some cases, temporary discontinuation of bisphosphonates or other implicated medications may be considered after consulting the prescribing physician.
Pentoxifylline and Tocopherol: Some studies suggest a potential benefit from these medications.
Is Communicable
No, osteonecrosis of the jaw is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Good Oral Hygiene: Maintain meticulous oral hygiene, including regular brushing, flossing, and dental checkups.
Inform Healthcare Providers: Tell your dentist and physician if you are taking bisphosphonates or other antiresorptive/antiangiogenic medications.
Dental Evaluation Before Starting Medications: Undergo a thorough dental evaluation and complete any necessary dental work (e.g., extractions) before starting bisphosphonate therapy, especially at higher doses.
Minimize Invasive Procedures: Avoid unnecessary dental procedures while on bisphosphonates or other high-risk medications.
Consider Drug Holiday (with physician's approval): If possible and medically appropriate, discuss a temporary discontinuation of bisphosphonates with your physician before undergoing invasive dental procedures.
Prompt Treatment of Dental Problems: Seek prompt treatment for any dental issues, such as infections or loose teeth.
How long does an outbreak last?
The duration of ONJ can vary significantly. In some cases, with prompt treatment, it may be managed and stabilized. However, it can be a chronic condition that persists for months or even years. Complete healing is not always achievable, and ongoing management may be necessary.
How is it diagnosed?
Diagnosis is typically based on:
Clinical Examination: Visual inspection of the oral cavity, looking for exposed bone in the jaw.
Medical History: Review of the patient's medical history, including medication use (especially bisphosphonates or other implicated drugs) and any prior dental procedures.
Radiographic Imaging: X-rays, CT scans, or MRI scans to assess the extent of bone involvement and rule out other conditions.
Biopsy: In some cases, a biopsy of the affected bone may be performed to confirm the diagnosis and rule out other possibilities.
Timeline of Symptoms
The onset and progression of symptoms can vary, but a general timeline might look like this:
Early Stages:
May be asymptomatic.
Jaw pain or tenderness.
Loose teeth.
Delayed healing after dental procedures.
Intermediate Stages:
Exposed bone in the jaw.
Inflammation and swelling.
Drainage or infection.
Numbness or a heavy feeling in the jaw.
Advanced Stages:
Worsening pain and infection.
Extensive bone destruction.
Pathological fracture of the jaw (rare).
Important Considerations
Multidisciplinary Approach: Management of ONJ often requires a collaborative approach involving dentists, oral surgeons, physicians, and other healthcare professionals.
Individualized Treatment: Treatment plans should be tailored to the individual patient's specific situation, taking into account the severity of the condition, underlying medical conditions, and medication use.
Prevention is Key: Prevention strategies, such as good oral hygiene and careful consideration of dental procedures in patients at risk, are crucial.
Prognosis: The prognosis for ONJ can vary. While some cases can be managed effectively, others can be challenging to treat and may result in long-term complications.
Informed Consent: Patients should be fully informed about the risks and benefits of bisphosphonates and other medications associated with ONJ, as well as the potential risks of dental procedures.