Are you having problems with your jawbone? Let's talk about Osteonecrosis of the Jaw (ONJ)!

Have you ever experienced a sore in your mouth that doesn't heal after a tooth extraction or dental surgery, leaving your jawbone exposed? Or do you have constant, unexplained pain and swelling in your mouth, especially in the jaw area? This could be a condition we're going to talk about today called Osteonecrosis of the Jaw (ONJ) , a condition that's a bit unexpected but very important to be aware of. Don't worry, let's talk about it simply.

What is this onychomycosis of the jaw (ONJ)?

Simply put, ONJ is when the cells in your jawbone die . This is because the bone is not getting enough blood supply. Think about it, every part of our body needs blood to survive. So if the blood supply to a part of the jawbone stops, the cells there will slowly start to die. Doctors also call this condition "osteonecrosis ." "Osteo" means bone, and "necrosis" means death. Sometimes it is also called "avascular necrosis," which means death due to lack of blood supply through blood vessels.

What usually happens is that a small wound or hole forms in the gums, exposing the jawbone. When this is exposed, the bone begins to die because it has no blood supply.

How common is this condition?

ONJ is actually not that common. However, it can be seen in people who take certain types of drugs (we'll talk about them later) that are used to strengthen bones as a treatment for certain types of cancer (metastatic cancer). This means that about two out of every 100 cancer patients who take such drugs have a chance of developing it. People who don't have cancer and don't take such drugs can also develop it, but it's much less common.

Are ONJ and osteomyelitis the same thing?

Both of these are painful conditions that affect the jawbone. But ONJ and osteomyelitis are two different things. Osteomyelitis is a bone infection caused by bacteria or fungi. When this infection reaches the jawbone, it can cause symptoms similar to ONJ. However, osteomyelitis often causes a fever , while ONJ usually does not. Doctors can only diagnose an infection by doing blood tests.

So is this the same as osteoradionecrosis?

No, that's a different story. Osteoradionecrosis is a condition that can develop in people who have had radiation therapy for head or neck cancer. Radiation therapy can damage the blood vessels that supply blood to the bones. The bones then die without blood. This is especially true if you have had a tooth extracted after radiation therapy.

What are the symptoms of jaw bone death?

If you've recently had something done to your teeth (e.g., a tooth extraction, a tooth filling), you may experience pain in the area where it was done. Some people may not have any symptoms at first.

Common symptoms of ONJ include:

• Jaw pain
• Loose teeth
• Mouth sores - especially those that don't heal
• Pus-like discharge from the gums and mouth
• Swollen gums
• Sometimes the jawbone is exposed through the gums (Exposed bone)

Imagine, you have a tooth extracted, or had a minor surgery on a tooth. But if the area hasn't healed properly even after several weeks, and there's a piece of bone sticking out of it, it could be ONJ.

Why does onychomycosis of the jaw (ONJ) ​​occur?

ONJ often occurs after a tooth extraction, dental implant, or other jawbone surgery. Normally, the gum tissue should heal quickly and cover the bone. However, in ONJ, this does not happen and the jawbone is exposed. Then, the exposed bone is deprived of blood flow, and bone cells begin to die.

However, very rarely, ONJ can develop without any obvious cause.

Who is at higher risk of developing ONJ?

Although anyone can develop ONJ, some people are at higher risk.

• Bisphosphonates: These are a type of medication that is given to slow down bone loss and strengthen bones. People who take bisphosphonates intravenously (IV) to reduce bone damage caused by metastatic cancer and prevent fractures are at higher risk. Studies have shown that people who take oral bisphosphonates for conditions like osteoporosis have a lower risk.
• Being over 65 years of age.
• Chemotherapy treatment.
• Having diabetes (Diabetes Mellitus).
• A facial fracture or injury.
• Periodontal disease, especially severe periodontitis.
• Long-term use of corticosteroids.
• Some viral infections, such as shingles.
• Smoking.
• Wearing dentures (especially ones that don't fit properly).

How is this ONJ condition diagnosed?

Your dentist or oral surgeon may suspect ONJ based on your symptoms.The most important thing is to see a dentist as soon as you feel you have a problem, especially if you have the risk factors mentioned above.

If the jawbone has been exposed for more than 8 weeks, it is a key sign of ONJ. The sooner you are diagnosed and treated, the more likely you are to save your jawbone and teeth.

What are the stages of ONJ disease?

ONJ can be divided into four stages (0 to 3). Stage 0 is the least severe, and stage 3 is the most severe. Your doctor will tell you which stage you have when you are diagnosed.

• Stage 0: You are taking intravenous bisphosphonates, have jaw pain, but no exposed jaw bone. There are no other symptoms of ONJ. At this stage, your symptoms may be caused by another gum disease, such as periodontitis .
• Stage 1: The jawbone is exposed, but there is no pain or other symptoms.
• Stage 2: The jawbone is exposed, and there are signs of pain, swollen gums, and infection.
• Stage 3: All the symptoms of stage 2 are present, plus bone death has spread to the sinuses and other parts of the face.

How is this ONJ condition treated?

ONJ is treated by oral surgeons and prosthodontists, who specialize in complex dental and jaw conditions. Treatment options vary depending on the stage of the disease.

Treatment for Stage 0

During this stage, the doctor monitors the symptoms and helps control them.

• Antibiotics
• Antiseptic mouth rinse
• Pain relievers

Treatment for Stage 1

Here, the doctor scrapes away the exposed dead bone cells. This is called "debridement." This prevents further bone death and helps the gums heal over the bone. You will then be given antibiotics, painkillers, and a special mouthwash.

Treatment for Stage 2 and Stage 3

In this stage, surgery is required to remove the dead jawbone and the teeth attached to it. Some healthy tissue is also removed to make sure that no diseased cells remain. In stage 3, a separate surgery may be performed to remove the dead bone that has spread to the nasal cavities. After surgery, you will need to use a special mouthwash, antibiotics, and painkillers.

Can we protect ourselves from ONJ?

Yes, to some extent it is possible.

• Maintain good oral health: Brush, floss, and floss daily.It is very important to continue going for dental checkups.
• If you have gum disease, get it treated properly.
• Most importantly: If you are taking anti-resorptive medications (e.g. bisphosphonates), be sure to tell your dentist. He or she can then choose less invasive treatments for your dental problems. For example, if you need to have a tooth extracted, it is better to do a root canal treatment instead.

Remember, informing your dentist about the medications you are taking can greatly reduce the risk of ONJ.

What does the future hold for someone with ONJ?

Early diagnosis and treatment can help prevent ONJ from getting worse and preserve the jawbone. In the early stages, many people recover with nonsurgical treatment. However, if the disease becomes severe, it can lead to loss of jawbone and teeth.

When should you see a doctor?

If you have any of these symptoms, see a doctor, especially a dentist, immediately:

• Bleeding, redness, or swelling of the gums.
• Difficulty swallowing food.
• Jaw pain.
• Loose teeth.

What questions should you ask your doctor?

You can ask the doctor questions like these:

• What can I do to protect myself from ONJ?
• How often should I get my teeth cleaned?
• Why did I develop ONJ?
• What stage of ONJ am I in?
• Will I need surgery?

Finally, things to remember...

Losing teeth and jawbone is a scary thing. But if you're at risk for ONJ due to cancer treatment or other reasons, it's important to work with a trusted dentist. Your dentist can teach you how to maintain good oral hygiene at home. They can also treat tooth and gum problems without increasing your risk of ONJ.

If you experience any unusual symptoms such as jaw pain, loose teeth, difficulty eating, talking, or swallowing, see a dentist right away. Acting quickly can go a long way in protecting your teeth, bones, and gums.

` Jaw bone death, ONJ, jaw pain, dental problems, gum disease, bisphosphonates, cancer treatment