Osteonecrosis of the Jaw



Osteonecrosis of the jaw is a rare but serious condition in which the cells in the jawbone start to die.

Osteonecrosis of the jaw can be caused by bisphosphonates, medicines used to strengthen bones:

  • Actonel (chemical name: risedronate)
  • Aredia (chemical name: pamidronate disodium)
  • Bonefos (chemical name: clodronate)
  • Boniva (chemical name: ibandronate)
  • Fosamax (chemical name: alendronate sodium)
  • Zometa (chemical name: zoledronic acid)

Researchers think that osteonecrosis of the jaw may develop because bisphosphonates stop the body from repairing microscopic damage to the jawbone that can happen during routine dental procedures or from everyday wear and tear. But it’s still not clear why this happens in some people and not in others.

Because some breast cancer treatments can cause bone loss (osteoporosis), many women being treated for breast cancer also take a bisphosphonate.

Xgeva (chemical name: denosumab) can also cause osteonecrosis of the jaw. Xgeva is used to reduce bone complications and bone pain caused by advanced-stage breast cancer that has spread to the bone.

Symptoms of osteonecrosis of the jaw include:

  • pain, swelling, redness, or other signs of infection in the gums
  • gums or sockets that don’t heal after dental work
  • loose teeth
  • numbness or a heavy feeling in the jaw
  • draining
  • having bone become visible in your mouth

Managing osteonecrosis of the jaw

Osteonecrosis of the jaw is usually treated with antibiotics, oral rinses, and removable mouth appliances (retainers).

Because osteonecrosis of the jaw is rare, doctors can’t predict who will develop it. If you’re taking a bisphosphonate, tell your dentist right away. Certain dental procedures, such as having a tooth extracted or a root canal, can make osteonecrosis of the jaw worse. You and your dentist can work out a dental treatment schedule that keeps your teeth healthy and minimizes your risk of osteonecrosis of the jaw.

Tips to minimize your risk for osteonecrosis of the jaw:

  • Schedule a dental exam and cleaning before you begin breast cancer treatment. Tell your dentist that you’re about to start treatment and discuss setting up regular dental check-ups during your treatment period.
  • Tell your oncologist about any dental procedures you have planned, such as extractions or dental implant insertion, before you start treatment for breast cancer.
  • Have your dentist check and adjust removable dentures as needed during treatment.
  • Tell your dentist and oncologist if you have bleeding gums, pain, signs of infection in your mouth, or any unusual feeling in your teeth or gums.
  • Maintain excellent oral hygiene (brush and floss after every meal) to reduce the risk of infection.

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