Phossy jaw, formally known as phosphorus necrosis of the jaw, was a severe occupational disease of the 19th and early 20th centuries. It primarily impacted the jawbone, causing its gradual decay and destruction, leading to significant pain and deformity.
How Phossy Jaw Developed
Phossy jaw arose from prolonged exposure to white phosphorus, a highly toxic chemical also known as yellow phosphorus. This substance was a component in the heads of “strike-anywhere” matches, which became widely popular in the 19th century. Workers in matchstick factories were frequently exposed to its vapor, particularly in dipping centers and drying rooms.
The mechanism by which white phosphorus caused the disease involved its conversion within the human body. When inhaled or ingested, white phosphorus combined with water and carbon dioxide from respiration, along with certain amino acids, to form potent bisphosphonates. These compounds induced changes in the jawbone cells, leading to their death over months or years of exposure. Poor ventilation in factories exacerbated the issue, trapping toxic fumes and increasing worker exposure.
Recognizing the Signs
Individuals developing phossy jaw experienced initial symptoms such as painful toothaches and swelling of the gums. This pain was persistent and progressive, spreading to neighboring teeth and the jawbone. As the disease advanced, pus formation would develop, penetrating the oral mucosa and leading to fistulas, tooth loss, and recurring abscesses.
Within approximately three months, dead bone, known as sequestrum, would begin to separate from the living bone, with full jaw necrosis occurring within about six months. The affected jawbone could appear rough and brownish-black, and emit a foul odor. A distinguishing and eerie feature was that affected bones could glow with a greenish-white light in the dark. The lower jaw was more commonly affected than the upper jaw, and the condition could also lead to seizures.
Addressing and Preventing the Disease
Early approaches to treating phossy jaw involved topical antimicrobials, conservative removal of dead bone fragments, and surgery. Surgical removal of the afflicted jawbones could save a patient’s life, preventing death from organ failure. Such radical surgeries, while life-saving, resulted in severe facial disfigurement and impaired the patient’s ability to eat, leading to further health issues like malnutrition.
The recognition of the disease’s devastating impact spurred significant social and legislative efforts for prevention. European countries began banning white phosphorus in matches, with Finland being the first in 1872, followed by Denmark in 1874 and France in 1897. Public outrage and labor activism, such as the London matchgirls strike of 1888, also highlighted the dangers. These efforts culminated in the International Berne Convention of 1906, a multilateral treaty that prohibited the use, manufacture, import, and sale of white phosphorus in matches. This international agreement, which entered into force in 1912, effectively eradicated the disease by eliminating the primary source of exposure.
Phossy Jaw Today
Due to historical legislative and industrial reforms, phossy jaw as an occupational disease is now exceedingly rare. Modern occupational hygiene practices have eliminated the working conditions that caused this condition in the past. The worldwide ban on white phosphorus in match production effectively removed the main causative agent.
Despite its historical eradication, a related condition known as medication-related osteonecrosis of the jaw (MRONJ), sometimes called “bis-phossy jaw,” has been observed in the 21st century. This condition is primarily associated with the side effects of certain phosphorus-based drugs called bisphosphonates, used to treat osteoporosis and some cancers. While similar in presentation, modern medical advancements offer better treatment strategies and prevention methods for MRONJ.