A New Scare- Osteonecrosis of the Jaw

The last couple of days were worrisome.  Dom had a bad tooth and had been taking antibiotics.  Our dentist wanted us to see an oral surgeon yesterday.

He spent a lot of time telling us how Bisphosphonates (In Dom’s case ZOMETA) can lead to “DEAD JAW”.

We could either wait for the tooth to fall out or have a simple extraction.

He went on to say that by pulling the tooth Dom had a 1 in 4 chance of developing Necrosis.

We made an appt. with the surgeon for Monday morning.  He was planning on sedating Dom. 

We were a little leery about the sedation, so drove up to our local dentist who saw us immediately.  (Gotta love small town physicians!).

I handed him the paperwork from the surgeon.

He said, “Hell!  You don’t need to be sedated.  This is a simple extraction.  Come on back, I’ll pull it now!”

So…  We dodged the bullet but we have to keep an eye on his mouth.

Here’s more about Osteonecrosis of the Jaw:

Bisphosphonate-related osteonecrosis of the jaw (ONJ) is characterized by nonhealing exposed bone in the maxillofacial region in patients who have undergone bisphosphonate treatment. The underlying etiology is unclear and may be multifactorial. The diagnosis is primarily clinical. Diagnostic tissue sampling may exacerbate the process and is typically avoided, necessitating other diagnostic approaches. The appearance of ONJ at diagnostic imaging is variable and includes sclerotic, lytic, or mixed lesions with possible periosteal reaction, pathologic fractures, and extension to soft tissues. There is a spectrum of signal intensity changes on T1- and T2-weighted magnetic resonance (MR) images with variable enhancement, findings that may correspond to the clinical and histopathologic stage of the process. Bone scintigraphy is sensitive with increased uptake in the area of the lesion. Although the imaging findings are nonspecific, there appears to be a role for imaging in the management of ONJ. Radiography is relatively insensitive but typically employed as the first line of radiologic investigation. Computed tomography and MR imaging are more precise in demonstrating the extent of the lesion. A number of imaging modalities have revealed lesions that may be associated with bisphosphonate exposure in asymptomatic individuals or in the context of nonspecific symptoms. The risk of these lesions advancing to overt clinical disease is unknown at this time. The radiologist should be aware of ONJ and include it in the differential diagnosis when evaluating patients with a history of bisphosphonate therapy without jaw irradiation, so as to avoid potentially harmful biopsies.

More Here

Dental Care Steps to Prevent and Treat Osteonecrosis of the Jaw

Everyone can benefit from good oral hygiene, but people with cancer need to pay particular attention to their dental health because of side effects associated with certain treatments. 

Osteonecrosis of the jaw (ONJ) involves dead bone in the jaw that becomes exposed after a tooth extraction or, in some cases, from a denture rubbing against the skin in the mouth.1 ONJ may also be caused by radiation of the head and neck, chronic steroid use, herpes infection in very ill patients, uncontrolled infections, and major trauma.2

Scientists do not yet know all the causes of ONJ or how often it occurs.3 The few studies on the risk of developing ONJ suggest the risk is low for patients on bisphosphonate therapy.2 Although ONJ has been uncommon in patients receiving treatments for cancer, including bisphosphonates, chemotherapy, and radiotherapy, researchers believe trauma may limit the ability of teeth and gums to heal due to the effects of bisphosphonate therapy.3,4

“Osteonecrosis can cause severe pain,”  says Joel S. Teig, DMD, a  board-certified oral and maxillofacial surgeon in practice for more than 20 years. “It can spontaneously develop with or without dental treatments, although dental extractions or other dental surgeries, like periodontal surgery and dental implant surgery, can dramatically increase the chance of its development.”

Dr. Teig suggests that patients be aware of potential symptoms of ONJ, such as pain; loose teeth; numbness of the jaw, lips, and chin; fluid or pus drainage; and exposed bone and gums that don’t heal (frequently with dramatic gum recession).  “Initially, just a dull ache or recession of reddened gums may occur,” says Dr. Teig, “but if not recognized and diagnosed for what it is, osteonecrosis and its potentially devastating symptoms can quickly expand.”

Cancer patients should maintain good oral hygiene and have a dental exam with preventive dentistry before treatment with bisphosphonates.5 An expert panel, comprised of oncologists, oral surgeons, and other specialists, published its recommendations in the Journal of Oncology Practice. The panel’s first suggestion was that patients complete any dental treatments and procedures that require bone healing before initiating IV bisphosphonate therapy. The panel concluded that for patients currently receiving bisphosphonates who require dental procedures, there is no evidence to suggest that stopping bisphosphonate therapy will prevent or lower the risk of ONJ. Instead, they recommended frequent dental visits and conservative dental management for these patients. For treatment of patients who develop ONJ, they strongly recommended a nonsurgical approach.6

“The most important thing a metastatic cancer patient who is taking bisphosphonate medications needs to do is to be attentive to his or her oral health. Brushing and flossing of their teeth, along with the use of an antibacterial mouth rinse twice a day can help reduce the chance of developing the need for invasive dental treatments that could potentially stimulate osteonecrosis development,” Dr. Teig stresses. “Metastatic cancer patients must see their dentists regularly for simple cleanings, repair of dental decay, and evaluations to nip potential dental degenerations along with any bony changes seen on x-rays,” Dr. Teig warns.

“The confirmed clinical benefit of bisphosphonates in cancer patients outweighs the potential risk of developing ONJ,” the panel concluded. Trials will be needed to evaluate the true incidence and clearly establish what really causes ONJ in cancer patients.

Increased awareness of this potential problem is the key to prevention and to better treatment for patients with bone metastases.6 Cancer patients who are aware of potential side effects from treatment put themselves in a better position to receive the best possible care.