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Osteonecrosis of the Jaw (ONJ)

(ON of the Jaw)

By Marvin E. Steinberg, MD

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Osteonecrosis of the jaw is an oral lesion involving bare mandibular or maxillary bone. It may cause pain or may be asymptomatic. Diagnosis is by the presence of exposed bone for at least 8 wk. Treatment is limited debridement, antibiotics, and oral rinses.

Osteonecrosis of the jaw (ONJ) has no unanimously accepted definition or etiology but is generally held to be an oral lesion involving bare mandibular or maxillary bone

ONJ may occur spontaneously or after dental extraction or trauma, radiation therapy to the head and neck (osteoradionecrosis), or high-dose IV bisphosphonate therapy (eg, for cancer treatment). ONJ may be a refractory osteomyelitis rather than true ON, particularly when associated with bisphosphonate use.

There is no evidence that routine use of oral bisphosphonates for treatment or prevention of osteoporosis increases risk of ONJ. Currently, otherwise appropriate bisphosphonate use should not be discouraged. However, it seems reasonable to do any necessary oral surgery before beginning bisphosphonate therapy and to encourage good oral hygiene while patients are taking bisphosphonates ( 1).

Symptoms and Signs

ONJ may be asymptomatic for long periods. Symptoms tend to develop along with signs, although pain may precede signs. ONJ usually manifests with pain and purulent discharge from exposed bone in the mandible or, less often, the maxilla. The teeth and gingiva may be involved. Intraoral or extraoral fistulas may develop.

Diagnosis

  • Clinical evaluation

Osteonecrosis of the jaw is diagnosed when exposed, necrotic bone is present in the maxilla or mandible for at least 8 wk.

Treatment

  • Limited debridement, antibiotics, and oral rinses

Once established, ONJ is challenging to treat and should be managed by an oral surgeon with experience treating ONJ. Treatment of ONJ typically involves limited debridement, antibiotics, and oral rinses ( 1).

Surgical resection of the affected area may worsen the condition and should not be the initial treatment.

Treatment reference

  • 1. Edwards BJ, Hellstein JW, Jacobsen PL, et al : Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: An advisory statement from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 139:1674–1677, 2008.

* This is the Professional Version. *