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ONJ Treatment Options
Management of Osteonecrosis of the Jaw
While there is no definitive way to treat ONJ, the following are recommendations. See the Additional Resources section for the American Dental Association and other scholarly recommendations.
• Consultation with an oral surgeon or dental oncologist. It is very important to have good communication between all your doctors and dentists. Particularly if you have been treated for cancer.
• A nonsurgical approach may prevent further osseous injury.
• A removable appliance may be used to cover and protect the exposed jaw bone.
• A protective stint may be on benefit for ONJ patients with exposed bone that causes trauma to adjacent tissues and in patients where the osteonecrotic site is repeatedly traumatized during normal oral function.
• A thin vinyl vacuformed or acrylic mouth guard may be used provided that it does not further traumatize the osteonecrotic site and can be kept free of bacterial plaque and debris.
• Patient Monitoring - All ONJ patients should be monitored every 3 months, or more frequently if ONJ symptoms continue or worsen. If temporary softtissue liners are used, patients should be seen every 3 months to closely monitor any potential tissue damage.
• Antibiotic Therapy - Intermittent or continuous antibiotic therapy has been shown to be beneficial; cultures should be collected to determine the appropriate antibiotic therapy. The goal of antibiotic therapy is to prevent secondary soft-tissue infection, pain, and osteomyelitis. At this time, the duration of antibiotic therapy and the benefits of oral antiseptic rinses have not been defined, but improved pain control and mucosal disease control have been observed anecdotally with this management strategy.
The decision to treat with an antibiotic is a clinical judgment that should be made by an oral maxillofacial surgeon or other dental specialist in consultation with the treating physician/oncologist. Cultures should be collected to determine the appropriate antimicrobial intervention. These should include assessment of aerobic, anaerobic, viral, and fungal species. The type of culture to collect for testing depends on the concerns for specific types of microbes. Several antimicrobial pharmacologic therapies have been recommended and oral rinses of 0.12% chlorhexidine gluconate (Peridex, Zila Pharmaceuticals, Inc., Phoenix, Arizona) or minocycline hydrochloride (Arestin, Orapharma, Inc., Warminster, Pennsylvania) in periodontal pockets also may be useful.
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