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Conditions > Osteoporosis > Osteoporosis Treatment > Osteonecrosis of the Jaw
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Osteonecrosis of the Jaw

Drugs linked with osteonecrosis of the jaw

Two years ago, news headlines began telling us that osteoporosis drugs called bisphosphonates were linked with the development of osteonecrosis (bone death) in the jaw. Now researchers at the University of Southern California (USC) School of Dentistry say they have identified an infectious cause of bone death in some people taking the drugs to prevent bone loss – a mix of bacteria and sticky extracellular material, called microbial biofilms.

Their study – which used powerful electron microscopes to examine osteonecrosis jaw bone samples from patients of USC dental clinics who had the unusual problem – is the first study that identifies microbial biofilms in the bone of bisphosphonate patients who have osteonecrosis of the jaw, says lead researcher and USC assistant clinical professor Parish Sedghizadeh. In affected jaws, the images revealed biofilm bacteria sprawling over pitted tissue.

Jaw osteonecrosis occurs when bacteria-laden biofilms infect the jaw after the bone is exposed, typically because of a tooth extraction or injury, he says.

Pioneered by J. William Costerton, director of the Center for Biofilms at the USC School of Dentistry, the biofilm theory has moved scientists beyond thinking of bacteria as free-floating organisms. Instead, bacteria build biofilm communities, attaching to surfaces and communicating and defending against antimicrobial invaders.

While the researchers are still trying to determine why bisphosphonate drugs seem to open the door for biofilm-associated infections of the jaw, knowing the culprit behind the damage is an important step toward controlling it.  "Now that we know that biofilms are behind the infection of the jaw, we are studying ways to effectively treat or prevent the osteonecrosis," Sedghizadeh said. The study was published in the Journal of Oral and Maxillofacial Surgery.

marianne
10 Dec 2011, 09:05
My husband was just diagnosed yesterday w/ONJ after suffering thru since sept. Throat cancer dr. missed it , sinus cancer dr. missed it, pain management dr.tried to get him off pain meds but finially referred him to oral surgeon, who diagnosed it . But get this this- oral surgeon wants him to do hyperbaric therapy first than 2 wisdom teeth extraction. From what i just researched in the last 24 hours - hyperbaric trtmnt not recommended by professionals as there is no evidence it works and definetly should not ever have extrations as it can make it even worse. Going to find new oral surgeon monday. anybody got any answers for us?
Barb
12 Nov 2010, 10:59
This article provides me with the actual terminology of a recent diagnosis, perhaps with this info, my fight for treatment will actually happen? The ability to soft chew lost 5 months ago, a severe TMJ disorder, failed surgeries, a dental nightmare as no dentist will treat a TMJ patient, peritonitis, severe trigeminal neuralgia that need for treatment was disregarded. In pre TMJ surgery time, extensive dental work, root canals that the drilling went too deep, pocket of infection that resulted 2 apeoectomies did not rectify, chin area of lower jaw. Loss of bone mass spoken of for yrs, when desperate to regain functionality of lower jaw to just soft chew, denials of treatment, but statements of extensive loss of bone mass, jaw should've/could break at any time, only scar tissue and sliver thin bone remaining, then referred to as large cyst, most recently referred to as a tumor. A proposed surgery of cyst removal, no specifics given, only that bone would regrow itself in time, 911 dentistry that is as crucial, neuralgia, those aspects not considered or part of treatment. An annoyed senior resident my case was put in hands of refused to answer questions of what surgery involved, treatment plan specifics. I was told I am not the typical patient, many severe and complex situations present, they do not go further than surgery, do not work in conjunction with other depts or doctors, other issues are my problem to find treatment provider, they do not make referals either. I remain infuriated at the metaphor that treating myself is to think of how one would think about preparing a large elephant in order to consume it, after my upset stated at the metaphor, told to think of myself as a large watermelon if the elephant upset me, obviously, one cuts it open, scrapes and scoops, put's it into chunks, chunks are dealt with in pieces to be consumed. I've no desire to deal with supposed wannabe idiot who does not percieve myself as human, or worth having discussion of explanation with. I've described the pain to others as imagining gasoline lit afire and an electrical storm put into liquified form, injected into my face. I exist on Ensure, some oatmeal, down to 83 lbs at 5'7" heigth, am rendered horizontal in bed or on the couch 90% of the time due to extreme pain and debilitation. In speaking with HMO for 911 treatment in lifethreatening situation, she put forth adamant thought that while tumor needs removed, dentistry and neuralgia unimportant to her too, what I need to do is speak with a counselor to assist me in dealing with physical pain, debilitation, heightened anxiety and depression that would accompany the situation of the downward spiral, nobody can handle it on their own. My factual statement to her, had it not been 20 yrs of nonstop borage of treatment denials and no intervention of HMO to locate providers when dilligently pushing for preventing present situation, the negligance factor, I'd not be in this position, verbal BS pacification will not change status, I've handled it totally alone for 20 yrs while being battered by denials and being ignored, my sanity is completely intact, the heightened anxiety is present, but the source is them, I refuse to be labeled negatively so. What I seek is treatment providers who will address the situations, all 911 situations, to not die from what I've valiantly fought to try to prevent, to simply regain stability and functionality of the lower jaw, have dentistry and neuralgia treated, to just regain ability to soft chew, pain level gotten more under control, that is what eases anxiety, not pyscho babble spewers. By her disregarding all literal lifesaving 911 situations, medically necessary treatment of them, what she was guilty of was tossing in another shovel of dirt into the deep open grave they've placed me in while still breathing, something they've had no qualms about doing repetitively so for 20 yrs, I know better than to await the return phone call promised of what means actually having medically necessary treatment. I've never taken meds that contribute to bone loss in the jaw, it is not uncommon in TMJ patients. I do truly hope others have success in recieving treatment of the condition, that the medical community would take it seriously, not disregard it leaving patients in extremely precarious situations. I will agree with the comment that having been diagnosed as crazy would've been something that is treated, though I'll keep my sanity and will, continue to put forth everything I've got and what I don't to "live to defy", refusing to concede, hoping somehow there is resolution somewhere, somehow, that it is not impossible.
Dina Newman
11 Nov 2010, 14:59
This info on ONC could not have come at a most opportune time. Saw my dentist today for what I thought was an ulcer that wouldn't heal. Turns out it is exposed bone on my jaw and have been referred to oral surgeon. Have taken steroids for 30 years (now to 4 mg a day) for lupus & RA. Also took Boniva recently to counteract bone loss from steroids but stopped about 6 mos ago. Am now more informed for my visit with the surgeon. Thanks.
tamlin
14 Jul 2010, 10:53
look,these bacterial and fungal biofilms become systemic via any invasive procedure: anything that breeches the natural barriers to infective and opportunistic pathogens. root canals are a profit taking procedure, the dark side of which is denied. look into medical biofilm and bioelectromagnetics on pubmed.gov.
arghelis bravo
01 Jul 2010, 07:13
IVE BEEN HAVING THIS PAIN IN MY JAW FOR THREE DAYS NOW, I CANT OPEN MY MOUTH AT ALL TO EAT IT HURTS WHEN I STRETCH IT AND HURTS TO SWALLOW, IS THIS DUE TO BONE EXPOSURE OR SOMETHING ELSE. I ALSO HAD A BAD TOOTH AS WELL BUT DONT KNOW PLEASE LET ME KNOW HOW I CAN CONTROL THIS IM TIRED OF THIS. CANT EVEN STRETCH IT OUT
Osteocrazy
21 May 2010, 11:31
Been suffering from this for 12+ years and had to diagnose it myself - Twice! Never taken bisphosphonates...Docs(including dentists and oral surgeons) thought I was nuts - until biopsy proved my theory, not once, but TWICE! Still have exposed maxillary bone where tissue will not grow over, yet no one knows of a treatment to offer? Excluded ALL other possible diseases, etc. through extensive testing. The source of relentless excruciating neuralgia which extends into cervical/thoracic spine and chest area, and severe arthiritis symptoms. I think it is much more common than the medical community is willing to admit, and the cause of some forms of arthritis - mine, at least...have still not given up on finding successful treatment. Willing to be a case study to help others(medical records are quite extensive and this is only health issue ever diagnosed) with this very real problem. At times I've wished I was crazy, there are good meds to treat that! For those of us who suffer from this insidious problem, never give up!
ELHum
27 Apr 2010, 01:12
also - could the biofilm bacteria be associated with pseudomonas strains? These are often associated with osteomyelitis of the temporal bone?
ELHum
27 Apr 2010, 01:06
Ok, finally daignosed after years of complaints with ONJ which is now not only mandibular, but now maxilliar. I was an O.I. patient that had several years of IV pamidronate use. Now get this! Just found out that I now have osteomyelitis of the temporal bone!!!!? The flesh of the external auditory canal, has deteriorated and there is exposed bone as a result of infection. ONJ of the maxilliar bone, now this? What the hell? I am freaking, where does this end and why has everyone been so hesitant to recommend any kind of treatment?
susan gottfried
30 Nov 2009, 10:25
very bad jaw pain. it comes and goes for the last 2 years. but is really bad now. it starts on the right side of my jaw , goes across to my throat and doe=wn in my chest. such pain. I CAN'T HARDLY STAND IT.NI AM GETTING SO DEPRESSED FROM THIS.
Carol Ann
07 Jun 2009, 13:50
Which bacteria are involved in creating these biofilms? Streptococcus mutans, perhaps, the one most responsible for causing dental caries? Thanks.

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