Osteonecrosis of the Jaw

Osteonecrosis of the jaw is a severe bone disease that occurs when there is a loss of blood to the bone. The primary symptom of osteonecrosis of the jaw (ONJ) is exposure of the bone through the gums that doesn’t heal for several weeks. This exposure may occur spontaneously or more likely following an invasive dental procedure such as extraction in patients with certain risk factors. Patients at risk for developing osteonecrosis of the jaw include:

  • Patients receiving radiation therapy to the head and neck to treat cancer.
  • Patients on long-term steroid therapy.
  • Certain cancer patients with metastasis to the bone who use IV Bisphosphonates to decrease pain and the risk of bone fracture.

Although these patients have the highest risk to develop osteonecrosis of the jaw, other risk factors are advanced age, diabetes, gum disease, and smoking.

The long-term risk of developing osteonecrosis of the jaw for those patients using oral bisphosphonates in treating osteoporosis is unknown at this time, but it certainly seems less than those patients on IV therapy.

Osteonecrosis

Various treatment options for osteonecrosis of the jaw have been explored; however, severe cases of ONJ still require surgical removal of the affected bone. A thorough history and evaluation of pre-existing problems and possible sites of dental infection are required to help prevent the condition.

The American College of Prosthodontists maintains a position statement on Medication-Related Osteonecrosis of the Jaw.