Osteonecrosis of the jaw is a condition where part of the jaw bone becomes exposed through the gums. This rare but potentially serious condition may happen after some oral surgery, like tooth removal, or as the result of taking certain medications.

If you’ve recently had a tooth extracted or take drugs called bisphosphonates, long lasting pain in the mouth can be a warning sign of osteonecrosis of the jaw (ONJ). Without treatment, the exposed bone in the jaw may die.

Keep reading to find out more about the symptoms of ONJ, the treatment options, and the ways you may prevent it from developing in the first place.

ONJ results from improper healing of the gums after some dental procedure or medication use. That said, it can also happen at random to anyone with bony growths that push through the gums.

“Necrosis” means death. In the case of ONJ, the jaw becomes exposed, and the bone doesn’t receive adequate blood supply. The exposed bone may die without treatment.

To be diagnosed as ONJ, a person must experience the following symptoms for 8 weeks or longer.

Symptoms include:

  • mouth pain
  • swelling of the soft tissues and gums
  • pus/drainage
  • exposed jaw bone
  • trouble chewing
  • loose teeth

The most common cause of ONJ is poor healing after oral surgery, like a tooth extraction.

Other possible causes include radiation therapy as part of cancer treatment or bone infections (osteomyelitis). When ONJ is caused by medication use (bisphosphonates, steroids, etc.), it’s referred to as medication-related osteonecrosis of the jaw (MRONJ).

In people with no known risk factors, ONJ may be caused by the herpes zoster virus. When this condition affects the mouth, it’s also known as oral shingles. It causes blisters in the mouth and on the tongue, along with other symptoms.

Diagnosis of ONJ involves a physical examination to look at the affected area of the mouth and the exposed bone. The other main criterion for diagnosis is that the condition has lasted more than 8 weeks.

Your doctor will also determine what stage you’re in before prescribing treatment:

  • Stage 0 ONJ: No sign of necrotic (dead) bone, but there are symptoms of changes related to ONJ.
  • Stage 1 ONJ: Bone is exposed and necrotic, but you don’t have other symptoms (asymptomatic).
  • Stage 2 ONJ: Bone is exposed and necrotic, and you have pain, redness, thick discharge, or other signs of infection.
  • Stage 3 ONJ: Bone is exposed and necrotic, and you have signs of infection that have spread to your face or sinuses.

Many cases of ONJ can be treated conservatively. Treatments involve using topical medications to address infection and discomfort, such as:

  • mouth rinses (stage 1, stage 2)
  • antibiotics (stage 2)
  • pain medications (stage 0, stage 1, stage 2)

For the most serious cases or later stages, your doctor may prescribe teriparatide. This treatment is an injectable drug that stimulates bone growth (it’s also used in treating osteoporosis).

Jaw surgery is also a treatment option for people with stage 3 ONJ. Surgery typically involves removing the dead bone (debridement) and reconstruction using plates or a dental prosthesis called an obturator.

People who take bisphosphonates have a slightly elevated risk of developing ONJ. These drugs are typically used to treat cancer and osteoporosis and include the following:

  • alendronate (Fosamax)
  • risedronate (Actonel and Atelvia)
  • ibandronate (Boniva)
  • zoledronic acid (Reclast)
  • denosumab (Prolia)

Of this group, people who receive these drugs in high doses through intravenous (IV) drip are at the highest risk.

Other people at risk include:

  • older adults
  • people with diabetes
  • people with gum disease
  • people who smoke

The outlook for people with ONJ depends on how soon the condition is identified and treated. Treatment in the early stages can restore oral health without the need for surgery. In later stages, people may need surgery to remove affected portions and reconstruct the jaw or teeth.

Is there any way to prevent ONJ?

Experts share that brushing and flossing regularly, as well as keeping up with routine dental checkups can help lower your risk of developing ONJ. These measures can also help you catch the issue in early stages before it gets more serious.

How will I know if I have ONJ?

Contact your doctor if you experience mouth pain, swelling, or other symptoms that just won’t go away. You’re at risk if you’re taking bisphosphonates, you’ve recently had oral surgery, or you fit into another risk group.

How often should I go to the dentist for cleanings?

You may have heard you should visit your dentist regularly. The American Dental Association’s guidelines have changed to be more individualized versus saying to go once or twice a year. Work with your dentist to determine what schedule of cleanings is right for you and your oral health.

Osteonecrosis of the jaw can be a serious health issue without proper treatment. Speak with a doctor if you have factors in your life that put you at risk and about what signs to be on the lookout for.

A doctor can also help you monitor your oral health and treat early signs of ONJ before it advances to later stages.