Osteonecrosis of the jaw

Osteonecrosis of the jaw (ONJ), also known as avascular necrosis of the jaw or jaw osteonecrosis, is a condition characterized by the death of bone tissue in the jawbone (mandible or maxilla) due to insufficient blood supply. The condition results in exposed bone in the oral cavity that fails to heal over a period of eight weeks or more, in the absence of prior radiation therapy to the jaw region. ONJ primarily affects the skeletal system, specifically the bones of the jaw, and can also involve surrounding soft tissues of the oral cavity. Key symptoms include exposed, necrotic bone in the jaw, jaw pain or numbness, soft tissue swelling and inflammation, loosening of teeth, drainage or fistula formation, and difficulty eating or speaking. Some patients may initially be asymptomatic before progressing to more severe stages with pain and secondary infection. Osteonecrosis of the jaw is most commonly associated with the use of antiresorptive medications, particularly bisphosphonates and denosumab, which are used to treat osteoporosis, bone metastases, and other skeletal conditions. This medication-related form is often referred to as medication-related osteonecrosis of the jaw (MRONJ). Other risk factors include dental procedures (especially tooth extractions), poor oral hygiene, corticosteroid use, antiangiogenic therapies, diabetes, and immunosuppression. The condition can also occur spontaneously, though this is less common. Treatment of ONJ depends on the stage and severity of the disease. Conservative management includes antimicrobial mouth rinses, antibiotic therapy, pain control, and careful debridement of necrotic bone. More advanced cases may require surgical intervention, including sequestrectomy or resection of necrotic bone segments. Preventive strategies are critical and include comprehensive dental evaluation and completion of necessary dental procedures before initiating antiresorptive therapy. Multidisciplinary care involving oral surgeons, oncologists, and dentists is recommended. Outcomes vary, with some patients achieving complete resolution while others experience chronic or recurrent disease.

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