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Osteonecrosis of the jaw

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Brief description of the condition

Exposed avascular bone. Medication-related osteonecrosis of the jaw (MRONJ) can occur in patients taking an anti-resorptive or anti-angiogenic drug (e.g. for osteoporosis or cancer). Patients who have had radiotherapy to the head and neck may be at increased risk of developing osteoradionecrosis (ORN) of the jaw.

Key signs and symptoms

  • Pain
  • Exposed intra oral bone, with failure to heal in the absence of malignancy

Initial management

Recommend optimal analgesia (see Analgesia).

Advise the patient to rinse their mouth with 0.2% chlorhexidine mouthwash.

Advise the patient to refrain from wearing any dentures that cover the exposed bone.

If of recent onset, advise the patient to seek urgent care. If chronic, advise the patient to seek non-urgent care.

Do not prescribe antibiotics unless there are signs of infection, for example pain, redness or swelling with or without pus.

Subsequent care

Refer to an oral surgeon or oral and maxillofacial surgeon for establishment of diagnosis, investigation of cause, and non-surgical and surgical management as appropriate to the disease stage.53,54

  • The patient’s medication should not be altered prior to specialist assessment.