Summary about Disease
Jaw necrosis, also known as osteonecrosis of the jaw (ONJ), is a serious condition characterized by the progressive destruction and death of bone tissue in the jaw. It typically involves exposed bone in the oral cavity that does not heal. It can occur spontaneously but is most often associated with certain medications, particularly bisphosphonates and denosumab, used to treat osteoporosis and cancer, or after dental procedures like extractions. ONJ can lead to pain, infection, and difficulty eating and speaking.
Symptoms
Exposed bone in the jaw that doesn't heal within six to eight weeks
Pain, swelling, or inflammation in the jaw
Loose teeth
Numbness, tingling, or a heavy feeling in the jaw
Drainage or pus from the jaw
Redness of the gums
Difficulty eating or speaking
Causes
Bisphosphonates: Medications like alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Zometa), used to treat osteoporosis and cancer.
Denosumab: A monoclonal antibody medication (Prolia, Xgeva) used for osteoporosis and cancer treatment.
Dental procedures: Tooth extractions, dental implants, and other oral surgeries.
Poor oral hygiene: Can increase the risk of infection and contribute to ONJ.
Cancer and cancer treatments: Radiation therapy to the head and neck, chemotherapy.
Other risk factors: Diabetes, anemia, corticosteroids, tobacco use, alcohol use, periodontitis and certain other medical conditions.
Medicine Used
Antibiotics: To treat or prevent infection.
Pain relievers: To manage pain.
Antiseptic mouth rinses: To maintain oral hygiene.
Bone-stimulating medications: Teriparatide (Forteo) can be used to stimulate bone growth and healing in some cases.
Surgical debridement: Removal of dead or infected bone tissue.
Drug Holidays: Discontinuation of bisphosphonates or denosumab, if medically appropriate and under the guidance of the prescribing physician.
Is Communicable
No, jaw necrosis (osteonecrosis of the jaw) is not a communicable or contagious disease. It cannot be spread from person to person.
Precautions
Good oral hygiene: Regular brushing, flossing, and dental check-ups.
Inform healthcare providers: Tell your dentist and physician if you are taking bisphosphonates or denosumab, or have a history of cancer treatment.
Dental work: Complete necessary dental work before starting bisphosphonate or denosumab therapy, if possible.
Minimize invasive procedures: Avoid unnecessary dental extractions or implants while on these medications.
Monitor for symptoms: Be vigilant for any signs of ONJ, such as exposed bone or pain in the jaw.
Smoking cessation: Smoking increases the risk of ONJ.
Control underlying conditions: Effectively manage diabetes or other medical conditions that may increase the risk.
How long does an outbreak last?
The duration of an ONJ outbreak can vary significantly depending on the severity of the condition, the individual's health, and the effectiveness of treatment. It can range from several months to years. In some cases, it may become a chronic condition. Early diagnosis and intervention are crucial for improving outcomes and shortening the duration.
How is it diagnosed?
Clinical Examination: Visual inspection of the oral cavity for exposed bone.
Patient History: Review of medical history, including medications, dental procedures, and risk factors.
Radiographic Imaging: X-rays, CT scans, or MRI to assess the extent of bone involvement.
Biopsy: In some cases, a bone biopsy may be performed to rule out other conditions and confirm the diagnosis.
Timeline of Symptoms
The onset and progression of symptoms can vary. A general timeline might look like this:
Early Stage:
Pain in the jaw (may be mild or intermittent).
Numbness or tingling in the jaw.
Inflammation or redness of the gums.
Intermediate Stage:
Exposed bone becomes visible.
Increased pain and discomfort.
Loose teeth.
Drainage or pus.
Advanced Stage:
Worsening pain and infection.
More extensive bone involvement.
Difficulty eating and speaking.
Potential for complications like osteomyelitis.
Important Considerations
Prevention is key: Emphasize good oral hygiene and careful consideration of medication use, especially bisphosphonates and denosumab.
Early diagnosis and treatment: Prompt recognition of symptoms and intervention can improve outcomes.
Multidisciplinary approach: Management of ONJ often requires collaboration between dentists, oral surgeons, and physicians.
Patient education: Patients need to be informed about the risks and symptoms of ONJ, particularly if they are taking bisphosphonates or denosumab.
Individualized treatment: Treatment plans should be tailored to the individual patient and the severity of their condition.
Long-term follow-up: Regular monitoring is essential to detect any recurrence or progression of the disease.