Osteonecrosis of the jaw is also known as ONJ, Dead Jaw Disease, or Jaw Death. It is often extremely painful, is disabling, and can be disfiguring as the condition advances. Osteonecrosis of the jaw is a rare condition where the bones of the jaw actually die from infection and rotting from the infection and exposure.
Osteonecrosis of the jaw more frequently is found in cancer patients who are currently or have been taking oral or intravenous bisphosphonates. Bisphosphonates are prescribed post surgical for prevention of bone loss due to radiation or chemotherapy to prevent invasion of malignant cells into the bone. The bisphosphonate therapy is prescribed in high dose, prolonged therapy.
Patients who have been diagnosed with Osteogenesis Imperfecta, brittle bone disease, are also at high risk as they, too, take high dose, prolonged therapy of bisphosphonates.
Risk of ONJ is heightened in cancer patients who also have gum disease and poor oral hygiene. Patients may also be at risk who have poor oral hygiene and gum disease but have not been diagnosed or treated for cancer.
According to the American Dental Association, nearly 80% of cases of ONJ in cancer patients who have been or are undergoing bisphosphonate therapy occurs after a trauma to the bone, such as a tooth extraction.
Patients with Osteonecrosis of the jaw may at first not exhibit symptoms of the condition. Symptoms may occur only after a mild trauma to the bone. Swelling and inflammation may appear in the soft tissues near the trauma site. Infection can cause pus to form and the area may drain.
Once the site is infected, the bacteria begins to eat away at the soft tissues of the oral cavity and the jaw bone. Tenderness, soreness, or severe pain may occur. A section of the jaw bone may become exposed as the flesh of the gums is destroyed by the bacteria. The bacteria begins to eat away at the bone and prolapse of the jaw may take place, leaving the patient disfigured.
Routine dental examinations are imperative for anyone diagnosed with Osteonecrosis of the jaw. All cancer patients with a history of prolonged use of high dose bisphosphonates should seek routine dental examination. Most dentists will set the patient with ONJ on a three month routine dental examination schedule. In most cases, the patient will be referred to an oral surgeon if the ONJ has advanced. Listed below are some treatment options used in caring for patients with Osteonecrosis of the jaw.
Intermittment or continuous use of antibiotic therapy may be prescribed. Usually the antibiotic is prescribed by an oral surgeon or dental specialist the patient has been referred to. However, many general dentists will prescribe antibiotics at the onset of the condition and particularly before routine cleaning examinations or any invasive dental procedure.
In cases where periodontal disease, gum disease, is involved, the patient may be referred to a periodontist for treatment of the disease who will prescribe the antibiotic therapy.
Regardless of the specialists also involved in treatment, the patient should continue with routine dental examninations by their dentist. The dentist will work closely with any dental specialist or surgeon they have referred the patient to.
A removeable appliance may be used to cover and protect any area where the ONJ has resulted in bone exposure.
In cases where Osteonecrosis of the jaw has resulted in exposed bone that causes trauma to adjacent soft tissues, a protective stint can be of benefit. A protective stint is also beneficial for patients in cases where the site is traumatized during normal daily function.
If a protective stint or removable appliance is used, close monitoring of the site by both the patient and their dentist will be required. It is of major importance the patient notifies the dentist if any change is noticed and keeps all routine appointments.
In advanced cases of Osteonecrosis of the jaw, it may become necessary to surgically remove a section of necrotic bone or tissue. This is potentially fatal and can leave the patient unable to chew solid food. The surgery needs to be performed by an oral surgeon or highly skilled dentist. If improperly treated, the surgery can result in septicemia and be fatal. A general dentist will almost always refer the patient out to a highly skilled oral surgeon. An antibiotic will be prescribed both during and after the surgery.
Patients who have been diagnosed with Osteonecrosis of the jaw should practice good oral hygiene habits, see their dentist for all routine dental examinations, and take any antibiotics prescribed as directed.
American Dental Association, www.ada.org
Osteogenesis Imperfecta Foundation, www.oif.org/site/PageServer