Osteonecrosis of the Jaw

What is Osteonecrosis of the Jaw?

Osteonecrosis of the Jaw (ONJ) occurs when an area of jawbone is not covered by the gums resulting in a lack of blood supply to the jaw and eventually jaw bone death. This condition must last for more than eight weeks to be called ONJ.

Who is at Risk for ONJ?

ONJ most often develops after an invasive (surgical) dental procedure, such as dental extraction. ONJ also may occur spontaneously over boney growths in the roof or inner parts of the mouth. ONJ has been found to occur in patients with herpes zoster virus infections, those undergoing radiation therapy of the head and neck (radiation osteonecrosis), osteomyelitis (bone infection), and in persons taking steroid therapy chronically.

Patients taking medicines that are classified as bisphosphonates (used for the treatment of loss of bone density) may develop ONJ after taking the medication for as little as 12 months. The risk increases the longer bisphosphonates are taken. Most cases occur after prolonged therapy (more than five years) but again are very rare. Study results vary from less than 1 in 100,000 patients getting ONJ from bisphosphonate therapy to 1 patient in 263,158. The risk of ONJ in patients on bisphosphonates who have invasive dental work may be higher.

The risk of developing ONJ also depends on the medical condition the bisphosphonate is being used to treat. For example, cancer patients have a higher risk for developing ONJ, particularly if they receive treatment intravenously (IV). The doses of IV bisphosphonates used to treat cancer can be ten times higher or more than the doses used for osteoporosis. The risk of developing ONJ is low for osteoporosis patients who do not have cancer and are treated with osteoporosis medications.

Cancer patients receive IV bisphosphonates as often as every three – four weeks, while osteoporosis patients receive only a single IV dose yearly. As a result, the risk of ONJ in cancer patients is much higher than when these same medications are used for osteoporosis treatment.

Besides cancer, other risk factors include advanced age, steroid use, diabetes, gum disease, and smoking.

What are the Treatment Options for Osteonecrosis of the Jaw?

While the treatment of Osteonecrosis of the jaw (ONJ) is challenging, it is a condition that we treat.

The treatment of ONJ is a combination of conservative management and surgical resection aimed to alleviate symptoms and restore jaw function and aesthetics. Conservative management includes antibiotic injections, debridement, irrigation, and hyperbaric oxygen (HBO2) therapy. In order to achieve optimal surgical results, radical resection and immediate free flap reconstruction have been recommended in the surgical management of ONJ. This procedure utilizes bone, tissue, and skin from a donor site to reconstruct the jaw.


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