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Imaging Osteonecrosis of the Jaw
Imaging osteonecrosis of the jaw can be an important step in identifying and managing this difficult side effect of bisphosphonate or denosumab therapy. As we all know, identifying cancer or a therapy-induced side effect can dramatically increase the odds of success in fixing the problem.
Though research puts the risk of ONJ at about 3% for MM patients, the risk of this debilitating side effect increases the longer the patient undergoes bone strengthening therapy.
What is ONJ (osteonecrosis of the jaw)? How is it treated?
What therapies can heal osteonecrosis of the jaw?
Conservative/Non-Surgical Therapies
Used for early stages or less severe cases:
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Antibiotic Therapy
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Helps manage infection and inflammation.
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Common choices: amoxicillin, clindamycin, or metronidazole.
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Oral Rinses
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Chlorhexidine mouthwash can reduce bacterial load.
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Pain Management
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NSAIDs or stronger analgesics for pain control.
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Drug Holiday (if medication-related ONJ)
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Temporarily stopping bisphosphonates or denosumab under medical supervision.
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Hyperbaric Oxygen Therapy (HBOT)
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Promotes blood vessel formation and healing in the bone.
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Mixed evidence for effectiveness, but may help in osteoradionecrosis or selected ONJ cases.
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🦷 Minimally Invasive and Surgical Therapies
When conservative treatment fails or for more advanced cases:
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Debridement
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Removal of necrotic bone to prevent further spread and promote healing.
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Surgical Resection
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More aggressive surgery to remove dead sections of jawbone, followed by reconstruction if needed.
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Platelet-Rich Plasma (PRP) Therapy
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Enhances healing via growth factors. Can be applied during surgery.
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Bone Grafting / Regenerative Surgery
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For advanced defects, bone grafts may help restore lost bone volume.
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🌱 Emerging & Supportive Therapies
These aren’t primary treatments but can support recovery:
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Low-Level Laser Therapy (LLLT)
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May stimulate bone healing and reduce pain/inflammation.
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Teriparatide (PTH Analog)
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In some cases, especially in osteoporotic patients, this bone-building hormone has shown promise in healing ONJ.
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Nutritional Support
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Ensuring adequate calcium, vitamin D, and protein intake supports bone health.
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The oncologist in the video linked above mentions that there are no therapies shown to heal ONJ. In my experience as a MM survivor struggling with a host of long-term side effects, I have come to believe that oncology knows little about the long-term side effects of the therapies they prescribe.
See the list of therapies above.
Email me at David.PeopleBeatingCancer@gmail.com with questions about your MM treatment and/or your short, long-term and late stage side effects.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Osteonecrosis of the Jaw
“Osteonecrosis of the jaw is a condition in which bone cells die due to various causes. It is classified as drug-induced jaw osteonecrosis, osteoradionecrosis, traumatic, non-traumatic, and spontaneous osteonecrosis. Antiresorptive or antiangiogenic drugs cause drug-induced osteonecrosis. The combination of medications, microbial contamination, and local trauma induces this condition…
Conclusions
There is no unanimous protocol for the treatment of osteonecrosis of the jaw. The goal of the treatment is to relieve pain, eliminate infection, and slow or prevent further progression. More and more new drugs are coming to the market, the use of which can lead to the development of MRONJ.
Osteonecrosis of the jaw can be prevented by appropriate education of the doctors of dental medicine, doctors of medicine, and the patients themselves. As oral surgery poses the greatest risk for the development of osteonecrosis, doctors of dental medicine should be aware of the guidelines for patients undergoing radiation therapy or taking some type of antiresorptive or antiangiogenic therapy.”
The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
“Abstract
“To examine the CT-imaging features of subjects with
- bacterial osteomyelitis (OM),
- osteoradionecrosis (ORN),
- and medication-related osteonecrosis of the jaw (MRONJ)
with histopathological confirmation, and to examine the diagnostic efficacy of panoramic radiography and MRI in detecting these disease features.
150 cases with preoperative CT data were selected: 61 bacterial OM, 19 ORN, and 70 MRONJ. 143 cases underwent panoramic X-ray examination, and 47 underwent MRI. The assessment criteria for imaging findings included: (1) bone resorption, (2) osteosclerosis, (3) clarity of the mandibular canal, (4) periosteal reactions, (5) cortical bone perforation, (6) sequestrum, and (7) pathological fractures.
CT was considered the gold standard for assessing these features. Compared with CT, all panoramic radiographs were detectable for diagnostic features of the disease. Bone resorption was detected in 123 cases (sensitivity 91.1%), and osteosclerosis was detected in 131 cases (sensitivity 98.5%).
With panoramic radiography, most changes to clarity of the mandibular canal and pathological fractures were detected (sensitivities of 87.8% and 68.8%, respectively). However, the sensitivities for detection of periosteal reactions, cortical bone perforation and sequestration were low (19.6%, 17.8% and 19.4%, respectively).
Sensitivity of MRI for detecting periosteal reactions, cortical bone perforation, sequestration, and pathological fractures (27.3%, 73.5%, 35.7%, and 60.0%, respectively) was equivalent or superior to panoramic imaging.
MR-specific characteristics of bone marrow edema were depicted on almost all examinations. Panoramic radiography may be adequate for identifying bone resorption and osteosclerosis.
However, MRI provides more value than panoramic radiography in detecting periosteal reactions, cortical bone perforation, sequestration, and bone marrow edema…”
imaging osteonecrosis of the jaw imaging osteonecrosis of the jaw imaging osteonecrosis of the jaw