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Osteonecrosis of the Jaw

(ON of the Jaw; ONJ)

By

Stuart B. Goodman

, MD, PhD, Stanford University

Last full review/revision Jun 2020| Content last modified Jun 2020
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Osteonecrosis of the jaw is an oral disorder that involves exposure of the jaw bone.

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

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

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

  • Treatment is best done by an experienced oral surgeon.

Osteonecrosis of the jaw may occur spontaneously or after tooth extraction or trauma. (Radiation therapy to the head and neck can cause a similar disorder called osteoradionecrosis). Sometimes, a bone infection (osteomyelitis) in the jaw is misdiagnosed as osteonecrosis of the jaw.

Osteonecrosis of the jaw has rarely 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. Osteonecrosis of the jaw 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.

Symptoms

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

Diagnosis

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

Osteonecrosis of the jaw is diagnosed when a person is evaluated by a dentist, oral surgeon, or sometimes a doctor.

Treatment

  • Removal of dead bone

  • Use of antibiotics and mouth rinses

Because osteonecrosis of the jaw is challenging to treat, an oral surgeon with experience treating it should be consulted. Treatment of osteonecrosis of the jaw typically involves scraping away some of the damaged bone, taking antibiotics by mouth, and using mouth rinses. After treatment, people should follow up with the oral surgeon who will evaluate healing and ensure the area is being kept clean with proper oral hygiene.

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

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