Seymour Office

Understanding Osteonecrosis of the Jaw: Causes, Symptoms, and Treatments

If you’ve never heard of osteonecrosis of the jaw (ONJ), you are not alone. ONJ is a rare but serious condition that causes the jawbone to weaken and die. This condition is caused by various factors, including medications, dental procedures, and cancer treatments.

This blog post will discuss the causes, symptoms, and treatments for ONJ.

What Is Osteonecrosis of the Jaw?

Osteonecrosis of the jaw (ONJ) is a condition where the jawbone is exposed and not covered by gums. Bone weakens and dies, leading to a variety of complications. The cause of ONJ is not entirely understood, but several risk factors are associated with the condition, including radiation therapy, chemotherapy, and dental procedures.

What Are the Causes of ONJ?

Understanding the main culprits behind ONJ can be key to more effective prevention and treatment. Here are some of the significant causes and risk factors associated with this condition:

  • Medications. Certain drugs, known as antiresorptive drugs, play a significant role in the occurrence of ONJ. These include bisphosphonates and monoclonal antibodies, often prescribed in cases of osteoporosis and certain types of cancer for preserving bone density. Unfortunately, these medications can disrupt natural bone healing, instigating conditions like ONJ. Medication-related osteonecrosis of the jaw (MRONJ) is a specific type of ONJ caused by antiresorptive drugs.
  • Dental Procedures and Surgeries. Dental procedures involving the jawbone, especially dentoalveolar surgeries and tooth extractions, can allow ONJ to develop. Any surgical intervention distorting the jaw bone might lead to poor healing scenarios, paving the way for ONJ.
  • Cancer Treatment and Related Medications. Patients undergoing intense cancer treatment regimens, particularly breast cancer and solid tumors, run a heightened risk of developing ONJ. This risk is exacerbated when treatment involves high-dose intravenous antiresorptive medications.
  • Poor Oral Health. Chronic dental conditions like periodontal disease and dental infection can contribute significantly to the development of ONJ. Chronic inflammation, untreated infections, and deteriorating gum health can further compromise bone healing.
  • Age and General Health Conditions. Older individuals present a higher risk of ONJ. Besides age, patients with certain systemic conditions, including diabetes and anemia, are more prone to osteonecrosis.
  • Bad Habits and Lifestyle Factors. Smoking and heavy alcohol consumption, along with poor nutrition, can pose an additional risk of ONJ. Both smoking and alcohol dampen the body’s healing mechanisms, including bone regeneration, which can lead to complications like ONJ.

What Are the Signs and Symptoms of ONJ?

Becoming aware of osteonecrosis of the jaw’s early symptoms and signs allows for speedy intervention and, consequently, more effective treatment. So, let’s look at these warning signals more closely:

  • Loose Teeth. If there’s no apparent cause, like an accident or gum disease, yet you experience increasingly loose teeth, it may be an early sign of ONJ.
  • Poor Healing. Noticing poor or slow healing after dental surgery or tooth extraction? It could signal that your body is dealing with a greater issue, possibly ONJ.
  • Numb or Heavy Feeling. A chronic, unexplainable sense of heaviness or numbness in your jaw, requiring you to constantly ‘check’ it, could be a symptom.
  • Exposed Bone. This is a clear-cut warning sign of ONJ. The exposure usually lasts for more than eight weeks. Identifying a pale or yellowish portion of the exposed jaw bone is key to effective healing.
  • Infection Signs. Chronic or recurrent jaw infections are a common early symptom of ONJ. Other signs of infection could include pus discharge, foul taste, or bad breath.
  • Pain and Discomfort. Persistent or worsening pain in the jaw or mouth can be an ONJ symptom. This discomfort could extend to nearby areas, like the neck or sinus.
  • Swelling and Redness. General inflammation, characterized by swelling, redness, or noticeable warmth around the jaw, could signal ONJ.
  • Gum and Soft Tissue Changes. Check for abnormal appearances in the oral cavity, like gum recession exposing dead bone or necrotic patches.

Detecting these symptoms early can lead to faster diagnosis and more effective treatment, reducing the possible complications that ONJ might pose if left unchecked.

What Are the Treatment Options for ONJ?

Understanding Osteonecrosis of the Jaw: Causes, Symptoms, and Treatments

Osteonecrosis of the Jaw (ONJ) can be managed effectively with proper treatment. Treatment choice depends largely on the severity of the condition and the patient’s overall health. 

Here are some treatment options you can consider:

  • Medication. Drug therapies form the cornerstone in managing ONJ symptoms and conditions. Depending on the case, these may include oral antibiotics, pain medications to manage discomfort, and antiseptic mouth rinses for general cleanliness and infection prevention.
  • Conservative Treatment. In the early stages of ONJ, or for patients with complicating health factors, “conservative” treatment is often envisaged. This approach focuses on maintaining oral hygiene, managing discomfort, and avoiding further invasive dental procedures.
  • Surgical Intervention. In the advanced stages of ONJ, oral surgery may be required. These can involve debriding or removing the dead bone in the jaw to encourage healing.
  • Application of Growth Factors. These proteins aid tissue healing. Topical or local applications of growth factors for people with ONJ are increasingly being investigated as a novel strategy to support natural wound healing and bone replacement.
  • Hyperbaric Oxygen Therapy (HBOT). Although research is ongoing, HBOT, which involves breathing 100% oxygen under increased atmospheric pressure, shows promise in helping manage ONJ. It reportedly enhances the healing process, especially post-surgery.
  • Teriparatide Therapy. In some unique cases, teriparatide – a drug normally used for osteoporosis – can stimulate bone formation.

Preventive Dental Care to Prevent ONJ

Preventive dental care is a crucial part of the management and prevention of osteonecrosis of the jaw (ONJ), a severe bone disease that affects the jaws. ONJ can cause a range of symptoms, including pain, swelling, infection, and exposed bone. It’s most commonly associated with the use of certain medications like bisphosphonates and denosumab, used to treat osteoporosis and cancer, but can also occur after dental procedures or due to radiation therapy for cancer.

Here are some preventive dental care measures that can help manage and prevent ONJ:

  • Regular Dental Check-ups, Regular dental visits allow a dentist to monitor your oral health and spot any potential problems early. This is particularly important for people at risk of ONJ, such as those taking bisphosphonates or undergoing cancer treatment.
  • Good Oral Hygiene. Maintaining good oral hygiene by brushing and flossing daily can help prevent infections and other conditions that might contribute to ONJ.
  • Avoiding Invasive Dental Procedures. If possible, invasive dental procedures such as extractions, implants, or periodontal surgery should be avoided or done with caution in people at high risk of ONJ, as these procedures can trigger the condition.
  • Pre-Treatment Dental Assessment. For patients who are about to start medications known to increase the risk of ONJ or undergo cancer treatment, a comprehensive dental examination and appropriate preventive dentistry before starting the treatment can help reduce the risk.
  • Education. Dentists should educate patients about the signs of ONJ, such as pain, swelling, loose teeth, or exposed bone, and instruct them to seek immediate care if these symptoms occur.
  • Regular Reviews. Regular reviews of the condition of the oral cavity in high-risk patients can help detect early signs of ONJ and initiate appropriate treatment promptly.

What Are the Risks of Osteonecrosis if Left Untreated?

  • Bone Collapse. When the area of the bone affected by osteonecrosis loses its blood supply, it can cause the bone to die, which can eventually lead to the bone collapsing.
  • Osteoarthritis. If the bone and surrounding joint collapse, you might develop severe arthritis in the affected joint. This can lead to difficulty with movement and chronic pain.
  • Limited Mobility. As the disease progresses, you may have trouble using the affected joint, impacting your ability to walk if the leg is involved or use your hands effectively if the upper extremity is involved.
  • Joint Replacement. In severe cases, this risk of osteonecrosis can lead to the need for joint replacement surgery.
  • Pain. Even before the bone collapses, patients may experience pain in the affected area. The pain may be mild at first and then become more severe as the disease progresses.
  • Decreased Quality of Life. Chronic pain, limited mobility, and the need for joint replacement can significantly impact a person’s quality of life.

Final Thoughts

Osteonecrosis of the jaw is a rare but serious condition that can be caused by a variety of factors. While there is no cure for ONJ, there are treatments that can help manage the symptoms and prevent complications. If you are at risk for ONJ, it is essential to maintain good dental health and inform your dentist of any medications you are taking.

Your journey to healthy oral health and overall wellness starts here and now. With this guide, you can take action to prevent, detect, and effectively treat ONJ, potentially saving you or a loved one from danger. Contact us now to book an initial consultation.