Osteonecrosis of the Jaw

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Oral and Maxillofacial Surgeons are beginning to see a growing number of patients with symptoms of osteonecrosis of the jaws, an often painful condition characterized by exposed dead or dying bone in their jaws.  Further investigation revealed a link between these cases and the use of bisphosphonate and other antiresorptive drugs.

 

What are Bisphosphonate Drugs?

Biophosphonates are a class of drugs that prevent the loss of bone mass.  High-potency intravenous bisphosphonates have been shown to modify the progression of malignant bone disease in several forms of cancer, especially breast and frequently prostate cancer.  Oral bisphosphonates are used to treat osteoporosis, osteitis deformans (Pagent’s disease of the bone) and other conditions that lead to bone fragility.

 

What is MRONJ?Osteonecrosis2

Medication Related Osteonecrosis of the Jaw (MRONJ) can be described as an area of bone in the jaw that has died and been exposed in the mouth for more than 8 weeks in a person taking any bisphosphonate or other antiresorptive medication.  Although the exact cause is unknown, MRONJ is considered to be a side effect of bisphosphonate  and antiresorptive medication therapy.

Symptoms of MRONJ include:

  • Exposed bone
  • Localized pain
  • Swelling of he gum tissues and inflammation; and
  • Loosening of previously stable teeth.

MRONJ is usually identified by the appearance of exposed bone in the oral cavity.

 

Risk Factors for MRONJ

While the majority of patients on intravenous (IV) and oral bisphosphonates will not develop MRONJ, it is important to understand the risk factors for the disease.  Three categories of risk factors have been identified for the disease.  They are:

  • Use of bisphosphonates or other antiresorptive medications such as Prolia.  Although this is a common reason for the development of MRONJ, it is the dosage and length of therapy that are the determining factors.
  • Duration or number of treatments with bisphosphonates appears to increase in relation to the number of treatments with an IV bisphosphonate.
  • Dental procedures.  Patients undergoing routine dental surgical procedures, including tooth extraction, periodontal surgery or dental implant placement, while being treated with bisphosphonates comprise about 60% of MRONJ cases.

Oral hygiene is particularly important if you are being treated with bisphosphonates.  It is also crucial that you schedule regular examinations with your family dentist and/or Associates in Oral and Maxillofacial Surgery so that any infections or problems can be identified and addressed early.

Perform a regular self-examination or your mouth for signs and symptoms of MRONJ, such as pain, swelling and exposed bone.  Early detection allows Associates in Oral and Maxillofacial Surgery to diagnosis and treat the condition as quickly as possible.

 

How is MRONJ Treated?

symptoms-of-osteonecrosis-of-the-jaw-2-300x198If you are diagnosed with MRONJ, it is very important that your treatment plan include regular and thorough communications between your physician, family dentist and oral and maxillofacial surgeon.  There is a number of treatment options available to the oral surgeon, who will select the one most appropriate for you.  Treatment may include:

  • Daily irrigation and antimicrobial rinses.
  • Antibiotics to control infection.
  • Surgical treatment to remove the necrotic bone may be advisable in more advanced cases.

Well fitting dentures can be worn if appropriate care is taken to minimize irritation to soft-tissues.  This is particularly important for patients who are receiving IV bisphosphonate therapy.  Dentures should be removed and thoroughly cleaned each night.

 

Conclusion

Bisphosphonates are excellent medications for bone diseases and osteoporosis that help relieve bone pain and prevent fractures.  However, long-term use of bisphosphonates, particularly IV bisphosphonates for metastatic bone disease, may be associated with a small but real risk of developing osteonecrosis of the jaw.  While MRONJ is a new and potentially serious condition, it is important to know that the doctors of Associates in Oral and Maxillofacial Surgery are experienced and knowledgeable in the prevention and treatment of this disease.