Osteonecrosis Of The Jaw (ONJ): Symptoms, Causes, and Treatments


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November 18, 2021



What is osteonecrosis of the jaw? How to know if you have this? Osteonecrosis of the jaw or ONJ is often an oral lesion involving the jawbone. This can be a painful condition that requires immediate medical attention. Keep reading to learn more about osteonecrosis of the jaw, including its causes, symptoms, treatments, and more.


Osteonecrosis of the Jaw

Osteonecrosis of the jaw (ONJ) is a rare condition. It includes the loss or disruption of a small section of the jaw bone.osteonecrosis of the jaw

It tends to be a severe condition since its pain can be difficult to treat. In fact, ONJ seems to be related to long-term treatment with medications used to address bone disease in myeloma and other cancers.


Causes of ONJ

Osteonecrosis of the jaw is a rare and severe side effect of some medications that target the bone. Usually, these drugs are bisphosphonates and denosumab. You might get these prescriptions if you have:

  • Cancer that has spread to the bone
  • Osteoporosis or osteopenia
  • Breast cancer
  • Multiple myeloma or other cancers.

Most of the time, this condition is associated with cancer or cancer treatments. However, ONJ can also happen in people who recently had dental surgery while treating their cancer. Or even if you’re wearing dentures or other dental appliances, jaw bone issues like this may happen.


Consideration When Deciding Whether To Take Bisphosphonates or Denosumab

It is essential to consider both the small danger of having ONJ and the advantages of bone protection when taking bisphosphonates or other related drugs. This medication can help prevent broken bones because of osteoporosis or cancer weakening your bones.

At times, the side effect of broken bones is very serious. In fact, they can prevent you from doing some activities or can be life-threatening. The benefits of these medicines may outweigh the small risk of having ONJ. However, it is better to discuss this medication with your doctor.


The Relationship Between Bisphosphonates and ONJ

The specific explanations on why ONJ is connected to the long-term utilization of some bisphosphonate medications are not entirely understood.

The bisphosphonates function by binding to calcium and lessening the movement of the bone cells that creates a bone breakdown in myeloma. ONJ happens because bisphosphonates interrupt natural bone remodeling and influence the healing process after injury or simply daily trauma that occurs to the mouth tissue.

In addition, the jawbones appear to be especially prone to osteonecrosis. The bone in the mouth is usually covered by a limited layer of tissue. That is why it can become more easily exposed, especially in invasive dental treatments. Therefore, individuals with otherwise poor oral health appear to be in more serious danger.


Risk Factors

Osteoporosis patients and cancer patients are both at a high risk of developing ONJ. In any case, most of the issues occurred in individuals with myeloma. The risk of ONJ developing in myeloma is likewise closely associated with:

  • Age, mainly in the elderly
  • Long time use of bisphosphonates
  • Getting an invasive dental procedure such as tooth extraction while undergoing osteoporosis treatment or cancer treatment like radiation therapy
  • Diabetes
  • Smoking
  • A history of poor dental health
  • Poor-fitting oral appliances



Symptoms of osteonecrosis of the jaw can range from very mild to severe. In fact, ONJ resembles an area of exposed bone in your mouth. Common symptoms can include:

  • jaw bone painThe man suffers from jaw pain.
  • swelling or pain in the mouth
  • loosening of teeth
  • poor healing or infection of the gums
  • non-healing of a tooth socket after removal of teeth
  • numbness or the feeling of heaviness in the jaw
  • an area of exposed bone in the mouth
  • discharge of pus

If you have severe symptoms like an infection in your jaw bone, go to a medical clinic immediately. Also, keep in mind that you need to inform your doctor and dentist if you experience any other dental symptoms.



Doctors might use x-rays to diagnose osteonecrosis of the jaw. Treatments may incorporate pain relief medication, antibiotics, or oral rinses. Minor dental procedures might be necessary to eliminate injured tissue and decrease sharp edges of the bone. In addition to this, physical therapy practice may also help treat some painful symptoms related to osteonecrosis. Usually, surgery is the last option since it may aggravate the condition.

Suppose an individual with myeloma is on bisphosphonate medications and develops ONJ. In that case, the doctor will examine every individual case of ONJ and choose whether the bisphosphonate treatment should be stopped and for how long. In fact, the frequency and type of bisphosphonate medication may also change.



Here are some tips to prevent or reduce the risk of developing ONJ :

  • Get a routine dental examination and any necessary invasive dental procedures before starting on bisphosphonate therapy.
  • Order your custom mouthguards here to avoid further jaw fracture.
  • Maintain good oral hygiene, such as brushing your teeth twice a day and flossing daily
  • Make sure dentures or other dental appliances fit correctly and do not rub on your mouth
  • Use prescribed mouthwashes
  • Visit your dentist regularly for checkups and cleanings
  • Dental surgery must be avoided if possible when on bisphosphonates.

Suppose invasive dental treatment is essential. Then, in that case, an oral surgeon with experience in osteonecrosis should be the one to handle this case. A few doctors might suggest you stop bisphosphonate medications before dental treatment. Then, retake the prescription once healing is complete. In any case, other regular dental procedures such as fillings, cleaning, and scaling, etc., are generally okay.



Denosumab and bisphosphonates: Different mechanisms of action and effects.


Radiation Therapy to Treat Cancer.


How Long a Person Can Live With Multiple Myeloma?


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