Osteonecrosis of the Jaw

Overview

Osteonecrosis of the jaw (ONJ) is a condition that occurs when the bone of the jaw dies and may become exposed in the oral cavity.

Most cases of ONJ occur after a dental procedure, such as a dental extraction.

Causes

There are several possible causes of osteonecrosis of the jaw:

• It can be a rare side effect of taking antiresorptive bisphosphonate medications for a long period of time to reduce risk of bone fracture as a result of osteoporosis, a medical condition in which the bones become brittle and fragile.
• It may occur when antiresorptive medications are given to treat cancer of the bone. A related condition, osteoradionecrosis of the jaw, can be a side effect of radiation therapy in the head and neck.
• ONJ may develop following a dental procedure, particularly removal (extraction) of a tooth or other procedures involving bone surgery. Or it may occur following an injury to the jaw, particularly in patients with periodontal disease, regions of the mouth with no teeth, or trauma from poorly fitting dentures.
• ONJ may occur spontaneously over boney growth in the roof or inner parts of the mouth.

Symptoms

Take note that the bone beginning to weaken and die does not always cause pain.

Diagnosis

Your doctor or dentist will do a visual examination of your mouth to see whether there is any exposed bone. In addition, your dentist may also take an x-ray.

Treatment

Most patients with ONJ who are taking antiresorptive therapy for osteoporosis can be healed with conservative treatment and do not require surgery.

If you are being treated for cancer, your dentist or oral surgeon should work closely with your medical oncologist. If you have been receiving bisphosphonate therapy as part of your cancer treatment, your medical team may consider whether you should continue taking bisphosphonate medications.

Helpful Tips

You can lower your chance for ONJ by doing the following:

• Make sure that you receive regular dental care.
• Maintain good oral hygiene habits to care for your teeth and gums.
• If you are being treated for cancer and your doctor recommends intravenous (IV) therapy with bisphosphonate drugs, be sure to talk to your dentist before you receive this treatment, and that the treatment is closely coordinated between your medical team and your dentist. Make sure you receive a complete dental examination including an x-ray before you begin this treatment. After beginning treatment, be sure to have regular check-ups of your mouth.
• If you need dental treatment that requires bone healing, such as dental extractions, be sure that you have completed this treatment and the tissues in your mouth have healed completely before beginning treatment with bisphosphonate drugs for cancer.

Additional Resources

• Osteonecrosis: Basics
  The NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases provides general information on osteonecrosis.
• Osteonecrosis of the Jaw
  Information from the American College of Rheumatology on osteonecrosis of the jaw including what it is, who gets it, how it is diagnosed and treated, and how to prevent ONJ.