“Rotting jaw” is a colloquial term for a serious condition known medically as osteonecrosis of the jaw (ONJ). This condition involves the death of bone tissue in the jaw, which can lead to significant complications. It is a severe bone disease that can affect both the upper jaw (maxilla) and the lower jaw (mandible).
What is Jaw Necrosis?
Jaw necrosis, or osteonecrosis of the jaw (ONJ), is a condition where the jawbone loses its blood supply, causing bone cells to die. This can result in exposed bone in the mouth that does not heal, making it susceptible to infection. The condition is sometimes referred to as Medication-Related Osteonecrosis of the Jaw (MRONJ) or Radiation-Induced Osteonecrosis of the Jaw (RIONJ) when linked to specific causes.
The progression of ONJ often involves the gum tissue failing to heal after a dental procedure, leaving the jawbone exposed. Without adequate blood flow, the exposed bone tissue begins to die, which can lead to further bone loss.
Common Causes of Jaw Necrosis
Medication-related osteonecrosis of the jaw (MRONJ) is a recognized cause, often associated with specific medications. Bisphosphonates, used to treat osteoporosis and certain cancers, are commonly implicated. These drugs work by inhibiting osteoclasts, cells responsible for bone resorption, which can impair the jawbone’s ability to repair itself and affect blood vessel formation.
Examples include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), zoledronic acid (Reclast, Zometa), and denosumab (Prolia, Xgeva). The risk is higher with intravenous administration and higher doses, often seen in cancer treatments, compared to lower oral doses for osteoporosis. Trauma to the jaw, such as tooth extraction, can initiate MRONJ in patients on these medications due to impaired bone healing.
Radiation-induced osteonecrosis of the jaw (RIONJ) can occur after radiation therapy for head and neck cancers. Radiation damages blood vessels and bone cells, compromising bone healing and leading to bone death. This condition is characterized by exposed, irradiated bone that does not heal for at least three months, without signs of tumor recurrence. The risk of RIONJ increases with higher radiation doses. The mandible is more commonly affected than the maxilla due to its relatively lower blood supply and increased bone density, which absorbs more radiation.
Beyond medications and radiation, severe infections like osteomyelitis or significant trauma to the jaw can also contribute to localized necrosis. Rare systemic conditions like sickle cell disease or Gaucher disease, which impair blood flow, may also contribute to ONJ.
Identifying the Signs
A hallmark symptom of jaw necrosis is the presence of exposed bone in the mouth that persists for eight weeks or longer. Patients may experience pain, swelling, or numbness in the jaw. Other signs include loose teeth, pus or discharge from the affected area, or persistent bad breath (halitosis). Lesions in the mouth that fail to heal after dental procedures, such as tooth extractions, are also common indicators.
Difficulty chewing or speaking may also arise as the condition progresses. Eating and drinking may become difficult, and pain and pus may be present.
Managing and Treating Jaw Necrosis
Non-surgical management of jaw necrosis focuses on controlling infection and alleviating pain. This can include regular oral hygiene practices, such as the use of antimicrobial mouth rinses, and the administration of antibiotics to combat infection. In some cases, minor removal of loose bone fragments may be performed.
When non-surgical methods are insufficient, surgical intervention may be considered. This can involve debridement, which is the removal of the dead bone tissue. In more severe cases, bone reconstruction might be necessary to restore jaw function and appearance. However, surgery is often viewed as a measure of last resort, especially for patients with osteoporosis, as it can sometimes hinder bone healing.
A multidisciplinary approach is common, involving collaboration among dentists, oral surgeons, oncologists, and other specialists to develop a comprehensive treatment plan. The primary goals of treatment are to alleviate pain, control any existing infection, prevent the condition from worsening, and ultimately improve the patient’s quality of life.
Preventing Jaw Necrosis
Preventing jaw necrosis, especially for individuals at higher risk, involves proactive measures related to oral health and communication with healthcare providers. Maintaining good oral hygiene, including regular brushing and flossing, is a primary preventative step. Routine dental check-ups are also important for early detection.
For patients about to start medications known to increase the risk of ONJ, such as bisphosphonates, a thorough dental evaluation before treatment is recommended. Inform all healthcare providers, including dentists, about medications and medical history. If possible, avoiding invasive dental procedures while on high-risk medications, or planning them carefully with a specialist, can help reduce the risk. General health practices, like smoking cessation and limiting alcohol, also contribute to overall oral health.