Osteonecrosis of the jaw, or ONJ, affects from one to two percent of people who take specific bone cancer medications, but it’s less prevalent among those who take the same medications as a treatment for osteoporosis. Although ONJ can negatively impact an individual’s quality of life, the disease isn’t usually fatal. Since it can be present for quite a while without exhibiting any symptoms, individuals may have ONJ for a while without being aware of it, or they may think it’s temporomandibular joint syndrome. Please continue reading for more information about ONJ and when you should consult your dentist about your symptoms.
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What Is Osteonecrosis Of The Jaw?
Osteonecrosis of the jaw occurs due to a lack of blood supply to the jaw bone because the gums aren’t covering the bone. Osteo is a Greek word that means bone, and necrosis means death, so osteonecrosis of the jaw means the death of the jaw bone, which results in little to no blood reaching the jaw bone. There are four stages of ONJ:
- Stage 1: Asymptomatic. Exposed bone that may or may not cause pain and may not be infected and may have a single lesion that’s less than 0.5 cm.
- Stage 2: Mild. Exposed bone and some necrosis and obvious infection, with multiple lesions that are less than 0.5 cm.
- Stage 3: Moderate. The conditions of stages 1 and 2, but with the addition of a single lesion that’s less than 1 cm.
- Stage 4: Severe. Lesions can occur singly or in multiples in sizes ranging from less than 1.0 cm to greater than 2.0 cm.
Although the death of the bone isn’t inevitable when the condition receives proper treatment, the bone will invariably weaken, and the individual may have pain. In osteonecrosis of the jaw, the jaw bone becomes exposed rather than being protected by the gums as it should be. When this condition persists for more than eight weeks, the jaw bone dies because one function of the gums is to deliver the blood supply to the jaw bone. Only when the condition persists for more than eight weeks is it considered ONJ. Since ONJ can be present asymptomatically, you should consult your dentist if you notice your gums receding from your teeth. As with any dental condition, the sooner you seek treatment, the better the outcome will be.
There are various reasons why osteonecrosis of the jaw will develop, and it’s usually predicated on the individual’s physiology and immune system response. Thus, given the same set of conditions and circumstances, one individual may develop ONJ, and one may not. An individual’s immune system response may play a factor in this, but researchers haven’t developed a definitive answer as yet. It appears more frequently in those patients who:
- Are taking antiresorptive medication
- Are undergoing chronic steroid therapy
- Are undergoing radiation therapy for their neck and head
- Have a herpes zoster virus infection
- Have osteomyelitis, which is a bone infection
The reasons for the onset of ONJ as a response to the antiresorptive medications aren’t clear at present. However, researchers speculate that it may be due to a decrease in the formation of blood vessels or an infection.
What Are The Osteonecrosis Of The Jaw Symptoms?
Early osteonecrosis of the jaw may exist for a long time without any symptoms, although pain is sometimes one of the osteonecrosis of the jaw early symptoms. A purulent discharge from the maxilla or the mandible may be obvious osteonecrosis of the jaw symptoms, as can a jaw bone infection. Osteonecrosis of the jaw can also adversely affect the teeth and gums and may cause fistulas and lesions to develop.
Sometimes, the symptoms of ONJ are the same as the symptoms of temporomandibular jaw syndrome, or TMJ, although the two are entirely different ailments. ONJ symptoms can include a headache, jaw pain, and neck pain, which are the same as the symptoms of TMJ, except TMJ doesn’t cause a jaw infection. If you think you’re developing temporomandibular joint syndrome, be sure to schedule an appointment with your dentist to verify that you don’t have ONJ.
What Medications Can Cause Osteonecrosis Of The Jaw?
Many people never develop osteonecrosis of the jaw, but those who have cancer treatments involving specific medications and those who have some specific immune disorders or conditions may be at higher risk of developing ONJ.
The specific antiresorptive medications that can precipitate ONJ are as follows:
- Alendronate, brand name Fosamax
- Denosumab, brand name Prolia
- Ibandronate, brand name Boniva
- Risedronate, brand names Actonel and Atelvia
- Zoledronic acid, brand name Reclast
Oral bisphonates, when used to treat osteoporosis, appear to pose a low risk for the patient to develop ONJ. The same drugs, however, when used to treat cancer dramatically increase the patient’s risk for developing ONJ. Factors that influence a patient’s likelihood of developing osteonecrosis of the jaw include:
- Periodontal disease
Those who receive higher doses of bisphosphonate drugs due to treatment for cancer are at a higher risk of developing the disease than those who receive the lower doses that are administered as a treatment for osteoporosis.
ONJ often occurs after an invasive dental surgical procedure or subsequent to trauma, but it also occurs when there are apparently no underlying causes. Researchers speculate that it may be due to a decreased ability to heal or as a side effect of a jaw infection.
How Is ONJ Diagnosed?
Although there’s no specific diagnostic test for determining risk, osteonecrosis of the jaw is diagnosed by the presence of an exposed jaw bone that has persisted for eight weeks or more. You may have no visible sores in your mouth, but your dentist can determine if you have ONJ. When treated at this early stage, there’s a very good prognosis.
There’s often pain, swelling, drainage, a jaw infection, and an uncovered maxilla or mandible. If your mandibular condyle is affected, you may need an MRI for a proper diagnosis. Edema, in combination with sclerosis, will help to affirm a positive MRI. At present, the definitive cause of ONJ is unknown since it can occur without warning and when the patient has no identifiable risk factors.
What Are The Treatment Options For ONJ?
The initial treatment options for osteonecrosis of the jaw are typically conservative and include antibacterial mouth rinses, antibiotics, and limited debridement. Since surgical intervention often makes the condition worse, it’s not used unless the initial treatment protocol isn’t effective. Sometimes, the initial treatments for osteonecrosis of the jaw early symptoms are the same as the treatment for temporomandibular joint syndrome since the symptoms of early osteonecrosis of the jaw can be the same. If you have a jaw bone infection, then you’ll probably receive a prescription for antibiotics.
Can Jaw Bone Loss Be Reversed?
At the present time, jaw bone loss reversal is beyond the capabilities of medical science. However, if you have lost bone due to periodontal disease or ONJ, we can perform a bone graft. A bone graft will stimulate growth in the local bone cells, and eventually, your graft will be replaced by your own healthy bone tissue.
How Can ONJ Be Prevented?
A regimen of good oral hygiene is the best method for preventing osteonecrosis of the jaw. Keep your teeth and gums healthy by following the guidelines established by the American Dental Association for good oral health. Brush and floss at least twice daily, and use an antibacterial mouthwash at least once each day. Avoid sugary snacks and drinks, and brush after each meal or snack. If that’s not feasible, then rinse your mouth well with plain water.
If you are having a dental surgical procedure, be sure to inform your oral surgeon or dentist if you’re taking antiresorptive drugs, and include:
- The reason you’re taking them
- The names of the drugs
- The dosages of each drug
- The frequency with which you take each drug
- Any side effects you’re having from the drugs
Need A Diagnosis?
If you or a family member think you have osteonecrosis of the jaw and need a diagnosis, be sure to call Smile Angels of Beverly Hills at (310) 201-9001 or if you need urgent care, then call (424) 253-5152. Dr. Bruce Vafa DDS is one of the best in the area for dental treatments, and we can help you. We’re located at 8500 Wilshire Blvd, Suite 709 in Beverly Hills, California 90211. We’re open Monday through Sunday at varying hours, and we offer a dental consultation.
Although osteonecrosis of the jaw isn’t fatal, it’s a serious disorder that shouldn’t be ignored. If you’re worried about financing, don’t be. We want our patients to be able to afford the dental treatment that they need, so we accept most dental insurance plans, most major credit cards, and we provide a variety of financing options that have low monthly payments. Your teeth and your oral health are vital to your physical health, so if you need dental treatment, then call our office. We’re one of the best in the area for both adult and pediatric dentistry options.
Call Bruce Vafa DDS at Smile Angels of Beverly Hills today. You’ll be glad you did.