I remember a patient, let’s call him David. He came into the clinic a few weeks after a tooth extraction, expecting everything to be settling down. But instead, he had this persistent, nagging pain in his jaw. A small area of his gum just wouldn’t heal over, and he mentioned he could even feel a tiny bit of bone if he gently touched it with his tongue. He was understandably worried. That experience really sticks with me because it shows how something like Osteonecrosis of the Jaw, or ONJ as we often call it in the medical world, can really catch you by surprise.
So, what exactly is this Osteonecrosis of the Jaw? It sounds a bit intimidating, I know. “Osteo” means bone, and “necrosis” means death. Essentially, it’s a condition where the bone cells in your jawbone begin to die. This usually happens because the blood supply to a part of your jaw gets cut off or severely reduced. Without that vital blood flow bringing oxygen and nutrients, the bone struggles, and well, it can eventually die. When this occurs, you might actually see the jawbone itself poking through an opening in your gums. It’s not a common problem, thankfully, but it’s certainly a serious one when it does happen.
You might be wondering how often we see this. It’s quite rare. For folks who have cancer and are receiving specific medications to help with bone loss or to ease bone pain from cancer that has spread, the risk is a bit higher – perhaps around 2 out of every 100 people in that group. For individuals who don’t have cancer or aren’t taking these particular medicines, developing ONJ is even rarer.
Sometimes patients ask if ONJ is the same as a bone infection, like osteomyelitis. Both conditions can cause painful bone loss in the jaw, that’s true. But osteomyelitis is caused by bacteria or fungi. A big clue for us doctors is that osteomyelitis often comes with a fever, whereas ONJ typically doesn’t. If we suspected an infection, we’d likely run some blood tests to check.
And then there’s another similar-sounding term: osteoradionecrosis. This is different. It can occur in a small percentage of people, maybe 3% to 10%, who’ve had radiation therapy for head and neck cancers. The radiation itself can damage the tiny blood vessels that supply blood to the bones. If a tooth extraction or another invasive dental procedure is done after radiation therapy to that area, it increases the chances of this type of bone death. So, it’s not quite the same as the Osteonecrosis of the Jaw we’re focusing on today, which isn’t directly linked to radiation treatment.
What Might You Notice? Signs of Osteonecrosis of the Jaw
If you’ve recently had some dental work done, like a tooth pulled, and then develop ONJ, the discomfort might be right there where the procedure took place. But sometimes, there aren’t any clear symptoms at first. A bit tricky, isn’t it? Here’s what you or your dentist might spot:
- A dull, persistent ache or pain in your jaw that just doesn’t seem to improve.
- Teeth that suddenly feel loose in the affected part of your jaw.
- Sores in your mouth or on your gums that aren’t healing, especially if you can see or feel bone.
- A bit of pus-like discharge coming from your gums or in your mouth.
- Swollen, tender gums around a specific spot.
Why Does Osteonecrosis of the Jaw Happen?
So, what kicks off this process? Often, Osteonecrosis of the Jaw appears after some kind of oral surgery – think a tooth removal (extraction), getting a dental implant, or even a dental bone graft. The thinking is that these procedures can sometimes leave a small part of your jawbone exposed. Normally, your gum tissue would heal right over it, no problem. But with ONJ, that healing doesn’t happen as it should. The bone stays exposed, it doesn’t get the blood supply it needs, and those bone cells can start to die. Every now and then, though, ONJ can pop up without any obvious dental procedure preceding it, which can be quite puzzling for everyone.
Who Might Be More at Risk?
Now, anyone could theoretically develop ONJ, but certain things can increase the chances. A significant one we always consider is the use of certain medications called antiresorptive medications, specifically bisphosphonates. These are often given as IV (intravenous, meaning into a vein) treatments. They work to slow down bone loss and increase bone strength, which helps prevent fractures. These IV forms are also used to ease musculoskeletal pain if cancer has spread to the bones, or to protect bones during some cancer treatments. It’s really important to note, and I always emphasize this to my patients, that studies haven’t shown a strong link between the lower-dose oral antiresorptive medicines many people take for osteoporosis and an increased risk of ONJ. That’s often a relief to hear.
Other things that might nudge the risk up a bit include:
- Being 65 or older.
- Undergoing chemotherapy.
- Having diabetes.
- A previous facial fracture or trauma to the jaw.
- Existing gum (periodontal) disease, especially more advanced forms like periodontitis.
- Long-term use of corticosteroids (like prednisone).
- Having had shingles (Herpes Zoster).
- Smoking – it affects healing in so many ways, this is just one more.
- Wearing dentures, particularly if they don’t fit quite right and cause ongoing irritation.
Figuring It Out and Getting It Treated
If you’re worried about any of those symptoms, your dentist or an oral surgeon is the person to see. They can often diagnose ONJ based on a careful examination of your mouth and by listening to your symptoms.
How Do We Diagnose Osteonecrosis of the Jaw?
The key is to get checked out as soon as you notice something isn’t right, especially if you know you have some of those risk factors we talked about. Catching Osteonecrosis of the Jaw early can make a huge difference in protecting your jaw and teeth. Generally, if we see an area of exposed jawbone that has been present for more than eight weeks, that’s a strong indicator of ONJ.
What Are the Stages of ONJ?
ONJ isn’t a one-size-fits-all condition; it can range in severity. We actually “stage” it from 0 (which is the least severe, or even a pre-stage) up to 3 (the most severe). Your healthcare provider will determine the stage at the time of diagnosis.
- Stage 0: This is more of a ‘heads-up’ stage. You might be receiving IV bisphosphonate treatments and have some jaw pain or other non-specific symptoms, but there’s no exposed jawbone visible yet. In this stage, your provider will also consider if other issues, like periodontitis, might be causing your symptoms.
- Stage 1: At this point, your jawbone is exposed, but you might not be feeling any pain or other symptoms. Odd, isn’t it, to have exposed bone without pain?
- Stage 2: Now, the jawbone is exposed, and you’re having symptoms. This usually means pain, swollen gums, and possibly signs of infection like pus.
- Stage 3: This is the most advanced stage. You’d have all the symptoms of Stage 2 ONJ, and the osteonecrosis might have spread further, for example, into your sinuses or other parts of your face.
How Do We Treat Osteonecrosis of the Jaw?
Treating ONJ usually involves specialists like oral surgeons or prosthodontists – these are dental professionals who specialize in managing complex dental conditions affecting the teeth and jaws. The treatment really depends on the stage of the disease.
- Treatments for Stage 0 ONJ: If you’re in Stage 0, your provider may decide to monitor things closely. To ease any symptoms, they might recommend:
- Antibiotics
- An antiseptic mouth rinse
- Pain relievers
- Treatments for Stage 1 ONJ: For Stage 1, your provider might perform a debridement. This means they gently scrape or scrub away the exposed dead bone cells. This treatment aims to prevent more bone loss and help your gums heal over the bone. After debridement, you’ll likely use antibiotics, pain medication, and a prescription mouth rinse.
- Treatments for Stage 2 and Stage 3 ONJ: For these more advanced stages, surgery is often necessary. The oral surgeon would remove the section of dead jawbone and any tooth that’s touching that affected bone. They also typically remove a small margin of healthy tissue around the area to ensure no diseased bone cells are left behind. If you have Stage 3 ONJ and it extends into your sinuses, you might need sinus surgery to remove the dead bone there. After any surgery, you can expect to use a prescription mouth rinse and take antibiotics and pain medication to help with healing.
We’ll always sit down and discuss all the options available to make sure we choose the best approach for you.
What’s the Outlook?
You’re probably wondering what the future holds if you’re diagnosed with Osteonecrosis of the Jaw. The good news is that early detection and treatment can often keep ONJ from getting worse and really helps preserve your jawbone. Most people with the earlier stages of ONJ get better with nonsurgical treatments. Of course, once the condition worsens to more advanced stages, you are at a higher risk of losing sections of your jawbone, as well as some of your teeth, which is why getting attention early is so important.
Can We Prevent Osteonecrosis of the Jaw?
This is a question I get a lot in my practice. While we can’t prevent every single case, there are definitely things you can do. Good old-fashioned oral hygiene is your first line of defense – that means daily brushing and flossing, and making sure you see your dentist for regular check-ups and cleanings. If you have existing gum disease, getting that treated can also help reduce your risk.
And this is really, really important: if you are receiving those antiresorptive medications we talked about (like IV bisphosphonates), please, please make sure your dentist or oral surgeon knows about this before you have any dental work done. They might be able to choose less invasive procedures to treat your dental issue. For example, if a tooth is giving you trouble, your dentist might opt for a root canal instead of extracting the tooth, if possible, to minimize disturbance to the bone. It’s all about careful planning.
When Should You Reach Out to Your Doctor or Dentist?
It’s always better to be safe than sorry when it comes to your health. Give your healthcare provider or dentist a call if you notice:
- Bleeding, red, or swollen gums that don’t seem to be getting better.
- Difficulty chewing your food comfortably.
- Persistent jaw pain that wasn’t there before or is worsening.
- Teeth that feel loose.
- Any sore in your mouth that isn’t healing, especially if you can see or feel bone.
Good Questions to Ask Your Provider
When you see your doctor or dentist, don’t ever hesitate to ask questions. It’s your health, after all, and you deserve to understand what’s going on. You might want to ask things like:
- “What specific things can I do to help prevent Osteonecrosis of the Jaw in my particular situation?”
- “How often should I be coming in for dental cleanings and check-ups?”
- “What do you think might have caused the ONJ in my case?”
- “What stage of ONJ do I currently have?”
- “Is surgery going to be necessary for me, or are there other options we can try first?”
Key Things to Remember About Osteonecrosis of the Jaw
Okay, that was a lot of information to take in! If you remember just a few key things about Osteonecrosis of the Jaw (ONJ), let it be these:
- ONJ is an uncommon but serious condition where jawbone cells die. It often happens after dental procedures if the bone becomes exposed and the blood supply is compromised.
- Certain medications, especially IV bisphosphonates used in some cancer treatments or for other bone conditions, are a key risk factor. Always, always tell your dentist if you’re taking these.
- Symptoms can include persistent jaw pain, loose teeth, non-healing sores with exposed bone, or swollen gums.
- Early diagnosis is so important! See your dentist promptly if you have any concerns.
- Treatment varies depending on the stage and can range from special mouth rinses and antibiotics to surgery to remove the affected bone.
- Good oral hygiene and regular dental visits are your best friends for prevention and overall oral health, and can play a role in managing risk for Osteonecrosis of the Jaw.
Dealing with any health issue can be unsettling, especially something with a complicated name like Osteonecrosis of the Jaw. But please remember, you’re not on your own with this. We’re here to help you understand what’s happening and to navigate the best path forward for your health. Just reach out.