Patient education: Osteonecrosis of the jaw (The Basics)

What is osteonecrosis of the jaw? — 

This is a problem that happens when part of the jawbone does not get enough blood and dies. It most often affects the lower jaw, called the "mandible."

Osteonecrosis of the jaw is not common. But it can be serious.

What causes osteonecrosis of the jaw? — 

It can be related to:

●Radiation to treat cancer in the head or neck – Radiation damages blood supply in the area. Jaw osteonecrosis from radiation is called "osteoradionecrosis."

●Bisphosphonates or denosumab – These medicines are used in high doses to treat bone disease in people with cancer. They are also used in much lower doses to treat osteoporosis. Osteoporosis is a disease that makes bones weak and increases the chance of a broken bone.

These medicines slow down bone turnover. (This is the normal process of bone continually renewing itself.) They might also affect blood supply to the bone. When they cause jaw osteonecrosis, it is called "medication-related osteonecrosis of the jaw," or "MRONJ."

High doses of these medicines increase a person's risk of osteonecrosis. Since the risk is related to the dose, people with cancer have a higher risk of MRONJ than people being treated for osteoporosis.

Often, osteonecrosis of the jaw happens after a dental injury, surgery, or infection.

What are the symptoms of osteonecrosis of the jaw? — 

Jaw osteonecrosis can cause:

●Areas of bone that can be seen through the gums

●Pain or swelling in the jaw or gums

●Sores or ulcers on the gums

●Trouble opening the mouth fully

●Infected tissue around the bone

●Loose teeth

Sometimes, osteonecrosis only affects a small area of bone. Other times, it spreads and affects nearby skin and tissue.

Will I need tests? — 

Probably. Your doctor or nurse will do an exam and look closely at your jaw, gums, and teeth. They might also do imaging tests, such as:

●X-rays

●CT scans

●MRI

These create pictures of the inside of your jaw and mouth.

How is osteonecrosis of the jaw treated? — 

Treatment might include:

●Removing the dead bone

●Antibiotic pills

●Rinsing with a special antibiotic mouthwash

If a large area is affected, doctors might need to do surgery to remove bone, tissue, and skin. If your jaw osteonecrosis was caused by radiation therapy, you might get a treatment called "hyperbaric oxygen therapy." This involves getting oxygen in a special pressurized chamber.

If your osteonecrosis was caused by a medicine, your doctor might have you stop taking that medicine. But this comes with risks. Your doctor can talk to you about your situation and options.

What can I do on my own? — 

To help prevent or treat osteonecrosis, you should:

●Take good care of your mouth and teeth – This includes brushing and flossing daily. See your dentist regularly for checkups and cleanings. If you wear dentures, make sure they fit properly.

●Avoid smoking – Smoking slows down healing and can make mouth symptoms worse. Your doctor or nurse can help you quit.

●Keep your blood sugar well managed, if you have diabetes.

How can I prevent osteonecrosis of the jaw? — 

The best way to prevent it is to keep your mouth and teeth healthy. If you have cancer and need radiation treatment to your head and neck, or a medicine to treat cancer-related bone disease, you should get a thorough exam of your mouth and teeth.

It's important to see a dentist who has experience caring for people being treated for cancer. If you have any infected teeth or cavities, the dentist will treat these. You will also get instructions about how to care for your mouth and lower the risk of infection.

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