Osteonecrosis of the jaw, or “jaw rot,” is a condition where the jawbone does not receive adequate blood, causing bone tissue to die. This rare but serious issue results in the bone becoming exposed through the gums because the overlying tissue fails to heal properly. The medical term for this is avascular necrosis. While it can occur spontaneously, it is most often seen following specific medical treatments or dental procedures.
Causes and Risk Factors
The development of osteonecrosis of the jaw is linked to certain medications and medical treatments. Medication-related osteonecrosis of the jaw (MRONJ) is associated with drugs used to treat bone loss or cancer, such as bisphosphonates and antiangiogenic therapies. These medications can interfere with the body’s ability to repair and remodel bone. An invasive dental procedure, like a tooth extraction, often acts as a trigger in patients taking these drugs, as the site fails to heal correctly.
Another cause is radiation therapy to the head and neck for cancer treatment, a condition known as osteoradionecrosis (ORN). Radiation can damage the blood vessels that supply the jawbone, reducing its ability to recover from injury. The mandible is more susceptible than the maxilla due to its limited blood supply. Other contributing factors include poor oral hygiene, smoking, ill-fitting dentures that cause trauma, and pre-existing periodontal disease.
Signs and Symptoms
The signs of osteonecrosis of the jaw can vary, and some individuals may not have symptoms in the early stages. A defining characteristic is the presence of exposed jawbone in the mouth that fails to heal over. This exposed bone may appear pale or yellowish, and the area around it can become painful with swelling in the surrounding soft tissues and gums.
Teeth in the affected area might become loose, and there can be difficulty with chewing. Some individuals report a feeling of numbness or a persistent “heavy jaw” sensation. Common signs of infection include pus-like drainage from the gums, a foul taste in the mouth, or bad breath.
Diagnosis and Staging
Confirming a diagnosis begins with a clinical examination by a dentist or oral surgeon. The primary diagnostic criterion is the visual confirmation of exposed bone in the oral cavity that has not healed for at least eight weeks. The provider will assess the extent of the exposure, look for signs of infection, and review a patient’s medical history for risk factors like bisphosphonate use or radiation therapy.
Imaging tests like X-rays and computed tomography (CT) scans are ordered to see how much of the bone is affected. A biopsy might be performed to rule out other conditions but is approached with caution as it can aggravate the necrotic area. Based on these findings, the condition is staged from 0 to 3, guiding subsequent treatment decisions based on the presence of exposed bone, infection, and pain.
Treatment and Management
The management of osteonecrosis of the jaw is tailored to the stage of the condition and focuses on controlling pain, managing infection, and preventing the progression of bone death. A conservative, non-surgical approach is often sufficient in the early stages. This involves using antimicrobial mouth rinses, such as chlorhexidine, to keep the area clean and reduce bacteria. Oral antibiotics are prescribed for infections, and pain medications are used to alleviate discomfort.
In more advanced stages, surgical intervention may be necessary. A procedure called debridement involves the careful removal of the dead, necrotic bone to encourage healing in the surrounding healthy tissue. For severe cases, a surgeon may perform a resection, which is the removal of a larger section of the affected jawbone, followed by reconstructive procedures. A collaborative approach between the patient’s dentist, oral surgeon, and prescribing physician is important for effective management.