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Osteonecrosis of the Jaw

(ON of the Jaw; ONJ)

By Marvin E. Steinberg, MD, Professor Emeritus, Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania

Osteonecrosis of the jaw is an oral disorder that involves exposure of the jaw bone.

  • Osteonecrosis of the jaw (ONJ) can occur after tooth extraction, injury, radiation therapy, or for no apparent reason.

  • ONJ has occurred in some people taking high doses of bisphosphonate drugs intravenously, particularly if they have cancer or undergo oral surgery.

  • To help prevent ONJ, any necessary oral surgery should be done whenever possible before a person takes bisphosphonates.

  • Treatment is best done by an experienced oral surgeon.

The disorder may occur spontaneously or after tooth extraction, trauma, or radiation therapy to the head and neck (in which case the disorder is called osteoradionecrosis). ONJ actually may be a bone infection (osteomyelitis) and not osteonecrosis.

ONJ has recently been noticed in some people who have received high doses of bisphosphonates by vein, particularly if they have cancer or undergo oral surgery while receiving the drugs. ONJ has not been linked with the routine use of bisphosphonates taken by mouth as treatment for osteoporosis. Thus, people should still use oral bisphosphonates as prescribed. However, when possible, any necessary oral surgery should be done before use of bisphosphonates is begun. People should also continue good oral hygiene while taking bisphosphonates.


ONJ is usually painful, and pus may be discharged from the mouth or jaw area. However, some people have no symptoms.


  • Evaluation by a dentist, an oral surgeon, or a doctor

ONJ is diagnosed when a person is evaluated by a dentist, oral surgeon, or sometimes a doctor.


  • Removal of dead bone

  • Use of antibiotics and oral rinses

Because ONJ is challenging to treat, an oral surgeon with experience treating ONJ should be consulted. Treatment of ONJ typically involves scraping away some of the damaged bone, taking antibiotics by mouth, and using mouth rinses.

Removing the whole affected area with surgery may worsen the condition and is not the first choice of treatment.