The clinical presentation described in this case series should alert the physician to the possibility of BON. [ncbi.nlm.nih.gov]

[…] is similar to primary chronic osteomyelitis May represent a reactive alteration of bone initiated and exacerbated by chronic overuse of the masticatory muscles, predominantly the masseter and digastric Patients usually present with a history of parafunctional [pathologyoutlines.com]

H ere we present five cases of osteonecrosis of the jaw associated with bisphosphonate use. [mja.com.au]

A 67-year-old woman (patient 2) with metastatic breast cancer treated with pamidronate and later zoledronate presented with a nonhealing extraction socket. [ajnr.org]

• Dentist

  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. [breastcancer.org]

  Update your medical history with your dentist to include the cancer diagnosis and treatments. Have your dentist check and adjust dentures as needed to avoid soft-tissue injury. [yourdentistryguide.com]

  Inform your dentist that you are taking bis-phosphonates especially if you plan to have a dental procedure Maintain good oral hygiene, attend regular dental visi ts and report any oral problems to your dentist. [exodontia.info]

• Severe Pain

  ‘Those in darkness drop from sight’: the manufacture of phosphorus matchsticks caused horrendous upper jaw pathologies among many employees, not to mention severe pain. Some even died of it. [technischesmuseum.at]

  pain,” says Joel S. [onclive.com]

  This makes it difficult for people to eat, speak or brush their teeth, and it often causes severe pain. Many different treatments are currently used for BRONJ. [cochrane.org]

  He complained of increasingly severe pain in the right mandible that radiated anteriorly and of swelling and purulent discharge. He had been diagnosed with renal cell carcinoma and had undergone removal of his right kidney. [dentistryiq.com]

• Intravenous Administration

  In South Australia in 2003, about 14 000 patients received prescriptions for the potent second- and third-generation nitrogen-containing bisphosphonates, with about 10% having intravenous administration. [mja.com.au]

  Most reported cases were caused by intravenous administration of bisphosphonates. There are a few case reports of osteonecrosis of the jaw caused by continuous oral administration. [elynsgroup.com]

  Although BRONJ is a serious adverse event especially after intravenous administration, Aminobisphosphonates improve cancer control and increase long-term survival. [bmcgastroenterol.biomedcentral.com]

• Weakness

  The jaw bones can become exposed in the mouth or through the facial skin and the weakness may even lead to jaw fracture. [ucsfhealth.org]

  These areas of build-up are weak and unstable and can easily break or collapse. [oncolink.org]

• Malaise

  PubMed Google Scholar Hauzeur JP, Malaise M, Gangji V: Osteonecrosis in inflammatory bowel diseases: a review of the literature. Acta Gastroenterol Belg. 2009, 72: 327-334. [bmcgastroenterol.biomedcentral.com]

• Abdominal Pain

  The most frequently reported adverse events included: Abdominal pain Acid regurgitation Constipation Diarrhea Dyspepsia (indigestion) Musculoskeletal pain Nausea Overall, the most reported side effect was abdominal pain. [drugwatch.com]

  The patient in the described case also had Crohn’s disease (regional enteritis, regional ileitis), an autoimmune gastrointestinal disease that primarily affects women and has common symptoms of severe abdominal pain, vomiting, diarrhea, weight loss, and [dentalaegis.com]

• Poor Oral Hygiene

  The alerts also recommend a dental examination with appropriate preventive dentistry in patients with risk factors such as cancer, chemotherapy, corticosteroids and poor oral hygiene prior to initiating treatment with bisphosphonates. [sciencedaily.com]

  Poor oral hygiene, periodontal disease, poorly fitting dentures and a history of dental disease, invasive dental procedures, e.g. tooth extractions. [ema.europa.eu]

  People with poor oral hygiene before or after radiation therapy are also at higher risk. So are people who develop dry mouth after radiation therapy. [cancer.ca]

  Poor oral hygiene is a common risk factor in osteonecrosis of the jaw in osteoporosis and in cancer. [pharmaco-vigilance.eu]

• Jaw Disease

  The disease is "osteonecrosis of the jaw" (ONJ) and the medication in question is a family of drugs known as "bisphosphonates". [uab.edu]

  Osteonecrosis of the Jaw is also known as avascular or aseptic necrosis of the mandible or maxilla, Jaw Death, Dead Jaw Disease or Bisphossy Jaw. [topdentists.com]

  Bisphosphonates in bone diseases. Pharm World Sci 1998 ; 20 : 206 –13 ↵ Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. [ajnr.org]

• Ulcer

  Other conditions may present in a similar manner, and these include spontaneous sequestration or lingual mandibular sequestration and ulceration, which is characterised by exposed necrotic bone at the level of the mylohyoid ridge of the lingual mandible [bmj.com]

  Oral ulceration with bone sequestration. Aust Dent J. 2003; 48 (1):61–4. [ PubMed ] [ncbi.nlm.nih.gov]

  MRONJ is a painful process and before osteonecrosis becomes clearly evident the patient may present with the following symptoms and signs 2 : periodontal disease and non-healing mucosal ulcers loose teeth soft tissue infections Established MRONJ manifests [radiopaedia.org]

• Tingling

  […] necrosis symptoms which may be present before the development of exposed bone inside the mouth include: sudden change in the health of mouth or gum tissue failure of the gums to heal from minor trauma or scrapes jaw pain, tooth pain or mouth pain burning, tingling [youhavealawyer.com]

  The following symptoms can be present before the occurrence of exposed jaw bone: A sudden change in the health of mouth or gum tissue Gums that do not heal from minor scrapes or wounds Tooth, jaw or mouth pain Localized pain, tingling, burning or numbness [lawsuitlegal.com]

  Migliorati recommended first thoroughly evaluating a patient’s history, including history of medications; oral complaints (pain, discomfort, tingling/paresthesia, bad breath, pus, swelling); dental history; and past treatment of an oral problem, including [ascopost.com]

  Some patients may report numbness or tingling in the jaw or a "heavy" feeling jaw. ONJ may have no symptoms for weeks or months and may only be recognized by the presence of exposed bone. [oncolink.org]

• Paresthesia

  Migliorati recommended first thoroughly evaluating a patient’s history, including history of medications; oral complaints (pain, discomfort, tingling/paresthesia, bad breath, pus, swelling); dental history; and past treatment of an oral problem, including [ascopost.com]

  The most common sign of BRONJ is bone exposure, and patients usually complain about pain, hypoesthesia, paresthesia, fistula, abscess, swelling, and trismus [ 4 ]. [journals.plos.org]

Treatment outcome was poor (33% and 25% responded to treatment in MM group and non-MM group, respectively). Treatment modality did not affect the treatment outcome. [ncbi.nlm.nih.gov]

[…] any invasive dental treatment while you are taking these treatments. [cancerresearchuk.org]

[…] has no active treatment). [cochrane.org]

JAW NECROSIS TREATMENT Treatment for osteonecrosis of the jaw only has a minimal effect on the symptoms and problems caused by the dead jaw condition. [youhavealawyer.com]

This decision can be influenced by the general health and cancer prognosis of the patient, a patient quality-of-life evaluation, and the patient’s initial response to cancer therapy. “The earlier the diagnosis, the easier the management,” said Dr. [ascopost.com]

What Is the Prognosis for Avascular Necrosis? The underlying cause as well as the amount and location of bone affected by avascular necrosis to some degree determine the outcome. [emedicinehealth.com]

What is the prognosis of aseptic necrosis? Aseptic necrosis causes a serious injury to affected bone. Frequently, this leads to permanent destruction of the adjacent joint. [medicinenet.com]

Even though the risk cannot be eliminated, prognosis usually is good for patients with osteonecrosis of the jaw from oral bisphosphonates. [aafp.org]

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was the initially described entity, but MRONJ is now the preferred term as other medications besides bisphosphonates have been implicated as etiological agents 5,6. [radiopaedia.org]

[…] avascular necrosis; it is the leading hypothesis in ONJ pathophysiology Soft Tissue Toxicity: Multiple cell types have exhibited increased apoptosis or decreased proliferation after exposure to bisphosphonate medications in vitro Immune Dysfunction Etiology [pathologyoutlines.com]

Data that links the incidence of osteonecrosis of the jaw and its etiologic factors are limited, and the incidence of osteonecrosis of the jaw in the general population (ie, those not taking bisphosphonates) is unknown. [emedicine.medscape.com]

Treatment The treatment should be tailored to the individual patient according to the etiological factors involved and the severity of the disease process. [dr-jacques-imbeau.com]

prior trauma, corticosteroid therapy, immune-compromised state predisposing to increased risk of infection, possible vascular insufficiency and an underlying hypercoagulable state secondary to underlying malignancy have been implicated as possible etiologic [druginjurylaw.com]

This significant difference in dose in the two types of patient accounts for a good part of the epidemiological differences between osteonecrosis of the jaw in osteoporosis and in oncology, and this must be taken into account in patient information, in [pharmaco-vigilance.eu]

Epidemiology For oral bisphosphonates used to treat osteoporosis, the number of spontaneous reports of ONJ submitted to their manufacturers indicates a reporting rate of less than 1 per 100,000 patient treatment years. [iofbonehealth.org]

Epidemiology Frequency The true incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has yet to be determined. [emedicine.medscape.com]

Pathogenesis The underlying pathophysiological mechanisms behind ONJ have yet to be elucidated. [iofbonehealth.org]

Pathophysiology of the disease has not been fully elucidated but theories include: Inhibition of osteoclastic bone resorption and remodeling: Antiresorptive drugs inhibit osteoclast differentiation and function and increase apoptosis, all leading to [pathologyoutlines.com]

The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) reached conclusions on the currently available evidence on four main areas: definition and diagnosis of ONJ related to bisphosphonates; possible underlying pathophysiological [gov.uk]

Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev, 27: 165–76, 2001 PubMed CrossRef Google Scholar Abrahm JL, Banffy MB, Harris MB. [link.springer.com]

[…] men and women initiating or taking glucocorticoids Zoledronic acid 8 (Reclast®); IV Prevention and treatment of postmenopausal osteoporosis Increase bone mass in men with osteoporosis Prevention and treatment of osteoporosis in men and women expected [ada.org]

However, there is no evidence that this helps prevent ONJ in oncology patients. [oncolink.org]

The painful exposed jaw bone can persist for years in many cases, and most experts recommend treatment with antibiotic and preventative actions to avoid jaw infection. [youhavealawyer.com]

Preventing or delaying skeletal-related events can preserve quality of life and reduce healthcare costs. [news.cancerconnect.com]

They are used in low oral doses to treat osteoporosis and to prevent fractures. They are used in high IV ( intravenous ) doses in cancer to prevent complications when it spreads to bone. They have been used for over 10 years. [exodontia.info]