Osteonecrosis and osteoradionecrosis of the Jaw

Some individuals get ONJ

Osteonecrosis of the jaw, commonly called ONJ, occurs when the jaw bone is exposed and begins to starve from a lack of blood. Most cases of osteonecrosis of the jaw happen after a dental extraction. … ONJ is much more common in those patients who use these medications for cancer of the bone treatment.

Most patients with ONJ who are taking antiresorptive therapy for osteoporosis can be healed with conservative treatment. Surgery is not usually required and could contirbute to the poor bone healing. 

Good oral hygiene and regular dental care is the best way to lower the risk of ONJ

ONJ is associated with cancer treatments (including radiation), infection, steroid use, or antiresorptive medications used for osteoporosis. Examples of antiresorptive medications include bisphosphonates such as alendronate (Fosamax); risedronate (Actonel and Atelvia); ibandronate (Boniva); zoledronic acid (Reclast), and denosumab (Prolia).

ONJ is much more common in those patients who use these medications for cancer of the bone treatment. When used for osteoporosis in much lower doses, it is very rare.

While ONJ is associated with these conditions, it also can occur without any identifiable risk factors.

Osteonecrosis of the jaw is a condition in which an area of jawbone is not covered by the gums, a condition of poor healing. The condition must last for more than eight weeks to be called ONJ. When the bone is left uncovered, it does not receive blood and begins to die. ONJ most often develops after an invasive (surgical) dental procedure such as dental extraction. ONJ also may occur spontaneously over boney growths in the roof or inner parts of the mouth.

ONJ has occurred in patients with herpes zoster virus infections, in those who are undergoing radiation therapy of the head and neck (radiation osteonecrosis), osteomyelitis (bone infection), and in persons taking steroid therapy chronically.

Patients taking antiresorptive medications to reduce their risk of bone fracture also may rarely experience ONJ. Why some patients taking antiresorptive medications get ONJ is unknown. It may be due to a decrease in the bone’s ability to repair itself; a decrease in blood vessel formation; or possible effects of infection.

There is no diagnostic test to determine if an individual patient is at increased risk for ONJ, but some factors are known to raise the risk in very rare circumstances. The condition itself is diagnosed only by the presence of exposed bone, lasting more than eight weeks. Patients typically complain of pain, which is often related to infection, soft tissue swelling, drainage, and exposed bone.

Most patients with osteoporosis who develop ONJ are treated conservatively with rinses, antibiotics, and oral analgesics. Studies have shown conservative treatment to be effective. There are case reports of the use of teriparatide in management of ONJ.

Rheumatologists are specialists in musculoskeletal disorders including osteoporosis and therefore are best qualified to review the risks and benefits of antiresorptive therapy for osteoporosis. They can also advise patients about the best treatment options available.

Prevention

A health program of oral hygiene and regular dental care is the optimal approach for lowering osteonecrosis of the jaw risk. Patients should inform their dentists that they are taking potent antiresorptive therapy, such as alendronate (Fosamax), risedronate (Actonel and Atelvia), ibandronate (Boniva), zoledronic acid (Reclast) or denosumab (Prolia).. Dentists should consider conservative invasive dental care in patients taking potent antiresorptive therapies.

For instance, endodontic (root canal) treatment is preferred to dental extraction if the tooth can be saved. If dental extraction is needed, full mouth dental extractions or periodontal surgery should be avoided. (It may be better to assess healing by doing individual extractions.)

Patients with periodontal disease should consider non-surgical therapy before agreeing to surgical treatment. Many patients taking bisphosphonates may undergo dental implants without problems. Although some dentists recommend the use of blood tests to decide who is at risk, this practice is controversial due to a very limited evidence base and should not be used at this time.This is in agreement with current American Dental Association suggestions.

Those on oral bisphosphonates are at low risk for ONJ. If patients detect any mouth pain or problems, they should seek dental care right away. It is not necessary to stop bisphosphonate use before a dental procedure, but it may be best to delay starting the drug therapy until after a scheduled dental procedure.

**Osteoradionecrosis is bone death due to radiation. The bone dies because radiation damages its blood vessels.

Osteoradionecrosis is a rare side effect that develops some time after radiation therapy has ended. It usually occurs in the lower jaw, or mandible. The lower jaw is at risk of osteoradionecrosis because it has a limited blood supply. Very rarely, osteoradionecrosis can start in the upper jaw, or maxilla.

Doctors usually classify osteoradionecrosis based on what tissue it affects, if it responds to treatment and if it has caused a fracture. They give osteoradionecrosis a grade from 1 to 3, usually as a Roman numeral (I, II or III). They use these grades to plan treatment.

Causes

Osteoradionecrosis is caused by radiation therapy to the bone. It may develop years after radiation therapy for head and neck cancers. 

The risk of developing osteoradionecrosis increases when the dose of radiation received is greater than 60 grays. It is also higher if the bone treated with radiation is exposed.

There is also a higher risk of developing osteoradionecrosis if a dental exam and necessary dental repairs aren’t done before radiation therapy. 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.

Damage or trauma to the jaw after radiation therapy, especially within the first year after treatment, can also increase the risk for osteoradionecrosis. Damage or trauma can be caused by:

  • tooth extraction
  • cancer surgery or biopsy
  • denture irritation
  • accidents 

In rare cases, osteoradionecrosis may develop even if there isn’t any trauma or damage to the mouth, teeth or jaw.

Symptoms

Symptoms can vary depending on the grade or extent of the osteoradionecrosis and include:

  • pain
  • swelling
  • a sore, or ulcer, in the mouth or on the jaw
  • difficulty opening the jaw, or trismus
  • an abnormal opening, or fistula, between the jaw and the surface of the body
  • less feeling in the mouth or jaw, or even a complete loss of sensation in the area
  • infection
  • teeth that aren’t aligned properly, which is called malocclusion
  • jaw fracture not related to an accident or other trauma 
  • exposed bone inside the mouth
  • bone sticking out through the skin, which is called sequestrum 

Exposed bones and sequestrum are most often found under the jaw.

Report symptoms to your doctor or healthcare team as soon as possible.

Diagnosis

Your doctor will try to find the cause of osteoradionecrosis. This usually includes doing a physical exam, including a complete head and neck exam. Your doctor may also review your medical records to find out the total dose of radiation you received and the area that was treated.

You may also need the following tests:

  • x-ray of the whole jaw
  • CT scan
  • MRI
  • biopsy of the area to check if the cancer has come back or a second cancer has developed

Find out more about these tests and procedures.

Preventing osteoradionecrosis

Your healthcare team will take steps to prevent osteoradionecrosis. The following measures should be taken before and after radiation therapy.

Before radiation therapy begins

Visit your dentist for a thorough dental exam and teeth cleaning before you have radiation therapy. If you need to have any teeth removed or cavities filled, do so before radiation therapy.

You should also start using daily fluoride treatments. Talk to your dentist or healthcare team about these treatments.

During and after radiation therapy

Be sure to practise good oral care before and after treatment. Keeping the teeth and gums healthy is important for proper healing. Also eat a healthy diet, including foods and beverages that are low in sugar.

Have regular dental exams. Be sure to have any cavities filled or infections in the mouth treated as soon as possible. If a tooth needs to be removed, wait until after radiation therapy is complete. 

Your dentist or healthcare team will recommend fluoride treatments to help prevent cavities. If you have dry mouth, they will also suggest ways to replace saliva and keep your mouth moist.

Managing osteoradionecrosis

Once the extent of osteoradionecrosis is known, your healthcare team can suggest ways to treat it. You will also be given antibiotics if there is an infection in the bone. Other treatment options may include the following measures. 

Surgery

Your doctor may need to do surgical debridement. This means removing dead or infected tissue from around a wound. Dead, or necrotic, bone may also need to be removed. This is called sequestrectomy.

Depending on where osteoradionecrosis develops and how far it progresses, your doctor may need to do surgery to help restore the area.

This may include microvascular reconstructive surgery to restore blood flow to the area.

Bone grafts may be needed to replace the sections of the jawbone that are removed.

Soft tissue grafts can be used to replace muscle and other tissues that have been removed. You may also need dental implants if teeth are removed.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room. It is done in a special chamber where the pressure inside is higher than the normal pressure of the atmosphere.

The higher pressure allows more oxygen to get into your blood, which can help heal damaged and infected tissues.

Hyperbaric oxygen therapy is used in combination with wound care and surgery.

The treatment plan often includes 20 treatments before surgery and 10 more treatments after surgery.

This treatment plan may be adjusted based on your personal situation and how well the osteoradionecrosis responds to the hyperbaric oxygen therapy.

After you finish radiation therapy, your healthcare team may recommend that you have hyperbaric oxygen therapy before you have any teeth removed.

Hyperbaric oxygen therapy may not be available in all centres.

Reference https://www.google.com/amp/s/www.mskcc.org/cancer-care/patient-education/osteonecrosis-jaw-onj%3famp

Thank You Arizona

The good news keeps rolling in

Rare Disease Day is February 29 usually 28 on non leap years.

So as you know I have been working very hard on November 29 being National – Avascular Necrosis Osteonecrosis awareness day and all states have come on board so far but still waiting to hear from maybe 10 states.

They are doing all they can. And I am so pleased many states have issues proclamations for November 29 and many still are in the process.

Today The State of Arizona sent a proclamation for rare disease awareness we got the entire week February 20-27

And they will also be recognizing November 29

So blessed.

Hard work pays off

Thank you State of Arizona

Deb Andio

Founder Avascular Necrosis Osteonecrosis Support Int’l

#Osteonecrisis #AvascularNecrosis

Radionuclide bone scan to diagnose or confirm Avascular Necrosis-Osteonecrosis

Radionuclide bone scan. This nuclear imaging technique uses a very small amount of radioactive material, which is injected into the blood to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

Overview

A bone scan is a nuclear imaging test that helps diagnose and track several types of bone disease. Your doctor may order a bone scan if you have unexplained skeletal pain, a bone infection or a bone injury that can’t be seen on a standard X-ray.

Why it’s done

Images of bone scans depicting hot spots

Hot spots

If you have unexplained bone pain, a bone scan might help determine the cause. The test is very sensitive to any difference in bone metabolism. The ability to scan the entire skeleton makes a bone scan very helpful in diagnosing a wide range of bone disorders, including:

Fractures

Arthritis

Paget’s disease of bone

Cancer originating in bone

Cancer that has metastasized to bone from a different site

Infection of the joints, joint replacements or bones (osteomyelitis)

Impaired blood supply to bones or death of bone tissue (avascular necrosis)

Thank You Proud Moment

Thank you to Youngstown Ohio Mayor Jamael Tito Brown and Senator Michael Rulli and Senate President Larry Obhof

What an honor

Help me raise awareness today and please like and share this post.

Thank You.

1st annual

#AvascularNecrosis #Osteonecrosis

#AwarenessDay #November29

AvascularNecrosis/Osteonecrosis Support Int’l

https://www.vindy.com/news/local-news/2019/11/city-state-recognize-poland-woman-with-rare-disease/

Is Your Hip Pain The Sign of a Rare Condition?

Your hips are largest and most powerful of muscle groups—the glutes, quads, and hamstrings—all connect at the hips, and they allow you to walk, run, climb. The hip joint is crucial to all movement, in sports and day-to-day life, which is why persistent hip pain can be such a pain in the ass literally and often debilitating.

hip

 

Wear and tear on your hip joint can worsen with age. According to the Centers for Disease Control and Prevention, 7 percent of adults in the U.S. suffer from hip pain, the third most common joint pain behind shoulder pain, at 9 percent, and knee pain, at 18 percent. There’s also a growing prevalence of young athletes with hip injuries, especially young women, due to repetitive overuse and acute trauma.

Trauma can sometimes lead to osteonecrosis  in any joint but we are focusing on the hip , and some of the medications given to help inflammation and strengthen bones can also be a cause of osteonecrosis aka avascular necrosis.

Your Hip Pain May be the Sign of a Rare Condition

If you have hip pain don’t always brush it off as arthritis, if it persists, get it checked out to be safe

Persistent or worsening hip pain warrants a visit to your health care provider and possibly a sports medicine specialist or ortho. Some problems, particularly hip stress fractures, are commonly misdiagnosed due to the confusing presentation of symptoms.

 

A thorough evaluation is necessary and often includes X-rays and other studies, such as an MRI or bone scan. As with all injuries, the absence of pain does not mean that all is well. Strength and flexibility deficits must be addressed to allow a healthy return to helping your quality of life.

 

 

Although a person may not initially experience symptoms, hip pain is usually the first indicator. The earlier the diagnosis is achieved, the better the patient’s potential outcome. AVN has four stages that can progress over a period of several months to more than a year. In Stage I, the hip is healthy; in Stage II, the patient experiences mild to moderate pain in direct proportion to the deterioration of the head of the femur (or ball of the hip joint). By Stage III, usually the patient will find it difficult to stand and bear weight on the hip, and joint movement will be painful. During this stage, the ball of the hip has deteriorated to what is called a subchondral fracture and early collapse. Stage IV is a full collapse of the femoral head and degenerative joint disease (DJD).

 

Treatment for AVN is recommended based on the stage of the disease coupled with the age of the patient. In Stage I, medication and crutches may be prescribed to provide relief and enable the bone to heal on its own. This treatment may require the patient to be non-weight-bearing for up to six months. It also has a failure rate greater than 80-percent.

On the horizon treatments are stem cell.

 

Surgical treatment is recommended with a Stage II diagnosis, or very early in a Stage III diagnosis. A procedure, known as a core decompression, typically involves drilling one large hole in the core of the effected bone, with or without a bone graft, to reduced pressure and improve blood circulation in the hip. Another surgical option is the vascularized fibular graft, which takes a healthy piece of bone from the fibula, along with the artery or vein, and transplants and reattaches it into the hip, to help healthy bone grow. Recovery can take several months.

 

Because most patients are diagnosed in late Stage III or IV of the disease, when the bone quality of the femoral head is poor (subchondral fracture) or has collapsed, total hip replacement is the most successful treatment for AVN. This procedure replaces the damaged bone with artificial parts. Recovery takes about eight to twelve weeks. If left untreated, AVN progresses and results in pain and severe debilitating osteoarthritis.

Treatment decisions for AVN are ultimately up to the patient and are based on his or her lifestyle and goals. If you are suffering with hip pain, talk with your primary care doctor about a referral to an orthopedic surgeon

You won’t keep me down ©

Osteonecrosis can be painful you never know when the pain will come or go.

But I do know it’s already taken my job away from me.

I love the optical field. But the pain was too intense.

Well I’m back in school learning something new.

#YourNeverToOldToLearn

 

©Debla2019

You are what you eat©

Finding delicious, wholesome  food is not always easy when you’re eating out at a restaurant, but it’s totally possible when you make it at home I’m Debbie a flexitarian that eats mostly plant based and I am changing my weight and improving my health.I changed my lifestyle to help lower my inflammation and control pain but i will eat fish, chicken etc….just not everyday

Not all my recipes posted are healthy I do like a good old fashioned dinner or snack now and then but its rare.

I am a patient leader advocate and home cook

I have

Avascular Necrosis-Osteonecrosis From Injury

Osteoarthritis

Inherited Blood Clot Disorder

Hashimoto Thyroiditis

http://avascularnecrosiseducation.com

https://flexitarianforlife.wordpress.com/author/chronicallygratefuldebla/

www.ChronicallyGratefulDebla.com

 

veg