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Osteonecrosis of the Jaw


The Manual's Editorial Staff

Last full review/revision Feb 2021| Content last modified Feb 2021
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What is osteonecrosis of the jaw?

"Osteo" refers to bone. "Necrosis" is the medical term for dead cells. Osteonecrosis is the death of bone cells. Osteonecrosis of the jaw (ONJ) is the death of some cells in your jawbone. Many people don't think of bone as living, growing tissue but it is.

  • ONJ can happen on its own or after you have a tooth pulled or have a jaw injury

  • You may have pain and pus oozing from your mouth

  • ONJ is treated with antibiotics, mouth rinses, and scraping away the dead bone

What causes ONJ?

Doctors aren't sure why people get osteonecrosis of the jaw. It can happen for no clear reason. But it's more likely after you've had:

  • A tooth pulled

  • A jaw injury

  • Radiation therapy to your head and neck to treat cancer

  • High IV doses of certain bone medicines called bisphosphonates

Bisphosphonates are most often taken by mouth to treat thinning bones (osteoporosis). Taking them this way doesn't seem to increase risk of ONJ. However, high doses given by vein may increase risk, particularly if you then have oral surgery.

What are the symptoms of ONJ?

Usually you'll have:

  • Pain

  • Pus in your mouth or jaw area

How can doctors tell if I have ONJ?

Your dentist or oral surgeon can tell whether you have ONJ based on your symptoms and an exam. There aren't any tests to confirm ONJ.

How can I prevent ONJ?

Before beginning IV bisphosphonate therapy, have a dental examination and get any oral surgery you need done first.

How do doctors treat ONJ?

An oral surgeon will treat ONJ with:

  • Surgery to scrape away the damaged parts of your jaw bone

  • Antibiotics

  • Mouth rinses

Doctors don't recommend taking out large areas of damaged bone as it may lead to even worse necrosis.

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