What is Osteonecrosis of the Jaw?
Osteonecrosis of the jaw is one among a few severe and debilitating bone diseases. In this condition, the upper and the lower jaw bones are exposed due to lesions, which causes bone death. The jaw bones are exposed through gingiva lesions that do not heal as all other wounds and lesions do. As the bone is exposed; it is starved of blood which leads to bone death if left untreated. The word ‘osteonecrosis’ is greatly indicative of the nature of this ailment. Osteo means bone and necrosis is a synonym for death. As such; osteonecrosis literally means bone death which can occur with the lower or upper jawbone. Read further to know more on the subject.
Causes of Osteonecrosis of the Jaw
There are several factors that play a role in the development of osteonecrosis of the jaw. Some of the commonest causes of osteonecrosis of the jaw include antiresorptive medications, especially bisphosphonates that are prescribed for the treatment of osteoporosis and similar ailments. The use of bisphosphonates for cancer treatment is more likely to lead to osteonecrosis of the jaw in comparison to bisphosphonates prescribed in lower doses for the treatment of osteoporosis. Additional causes of osteonecrosis of the jaw are radiation therapy for cancer treatment, use of steroids and infection.
Symptoms of Osteonecrosis of the Jaw
There are multiple symptoms of osteonecrosis of the jaw. Exposure of the lower or upper jaw bones are the definitive symptoms of this condition, Some of the other common symptoms of osteonecrosis of the jaw include pain and inflammation in the tissue surrounding the exposed jaw bone, bad breath, and even a secondary infection characterized by drainage in some cases.
In the case of osteonecrosis of the jaw subsequent to radiation therapy; the lower jaw is most likely to be exposed. This is an area densely supplied with blood vessels resulting in greater pain, swelling, the bone may be visible to the naked eye and even fractures may occur in some cases. Radiation therapy tends to destroy osteoblasts which are integral to the formation of bone tissue; this gives rise to osteoclast activity. Osteoclast activity is defined by the break down and resorption of bones. Erythema and suppuration along with difficulty in eating and drinking are additional symptoms of osteonecrosis of the jaw.
Diagnosis of Osteonecrosis of the Jaw
There are no diagnostic tests to identify osteonecrosis of the jaw or determine its risk. Physicians rely on the study of symptoms such as jaw bones that are exposed for more than 8 weeks, pain, swelling and drainage, which play a crucial role in making a diagnosis of osteonecrosis of the jaw. These symptoms and clinical examination makes it easy to identify the severity of the condition and plan appropriate treatment.
Treatment of Osteonecrosis of the Jaw
Treatment of osteonecrosis of the jaw is primarily conservative and makes use of rinses, oral analgesics and antibiotics. Pain and discomfort as a result of osteonecrosis of the jaw is managed with painkillers or analgesics, while mouth rinses and antibiotics fight infections. Relevant clinical data shows that conservative treatments of osteonecrosis of the jaw are quite effective and the use of teriparatide is also known to lead to healing. For those prescribed with antiresorptive medications which subsequently leads to osteonecrosis of the jaw; a rheumatologist is the best person to review the use of these drugs, their dosage and or prescribe alternatives.
For severe cases surgical treatment of osteonecrosis of the jaw is considered. Surgical removal of the damaged marrow, by means of curettage and decortication helps in treating the condition and eliminating the pain associated with osteonecrosis of the jaw. Smaller surgeries than the first are likely to be required as almost a third of osteonecrosis of the jaw patients will find that the disease frequently presents itself in the form of multiple lesions. Hence; multiple small surgeries may be needed for the treatment of osteonecrosis of the jaw, in such cases.
Prognosis of Osteonecrosis of the Jaw
The likely course and prognosis of osteonecrosis of the jaw is not all that bleak. As mentioned before; when treated with mouth rinses, antibiotics and analgesics; a cure is within reach.
When left untreated; osteonecrosis of the jaw can lead to bone death of the exposed jaw. This is because the bone is deprived of blood and is starved of nutrients. This bone will ultimately disintegrate. Additionally; if osteonecrosis of the jaw is left untreated there is no relief from pain and associated infections.
For patients who develop osteonecrosis of the jaw as a result of bisphosphonate therapy, the condition may improve after 6 months and completely heal once an individual goes off bisphosphonates. Surgery can also bring about complete healing in many cases.
In conclusion; osteonecrosis of the jaw is not a common ailment, however it can be traumatizing and debilitating. It calls for proactive and immediate medical attention to avoid further complications. With the knowledge of the causes, symptoms, diagnosis, treatment and prognosis of osteonecrosis of the jaw, timely medical advice can be sought and necessary action can be taken.
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