Current therapyBisphosphonate Osteochemonecrosis (Bis-Phossy Jaw): Is This Phossy Jaw of the 21st Century?
Section snippets
Historical aspects and nomenclature
History may help us in our endeavors to diagnose and treat bisphosphonate associated effects of the jaws. White phosphorus, the cause of phossy jaw, appears to have had similar skeletal effects as bisphosphonate therapy. Phossy jaw has interesting historical aspects and was known by several nomenclature variations. Phosphorus necrosis was perhaps the most common and proper term used in publication. However, “phossy” jaw was also commonly used and appears to have been the term used most often in
Phossy jaw review
Phossy jaw was first described in the mid portion of the 19th century, when it became apparent that workers in the matchmaking industry were being afflicted with an unusual necrosis of the jaws. Lorinser first reported these cases in 1845.24 The victims were often young and otherwise healthy. Eventually, the workers were diagnosed with what became known as phossy jaw or phosphorus necrosis. The morbidity and mortality associated with phossy jaw were significant. Severe pain and deformity were
Modern bis-phossy jaw findings and further review
In comparing modern cases of bis-phossy jaw with osteoradionecrosis, we are also seeing differences. In the last year, 20 cases of osteomyelitis in patients with a history of breast cancer, prostate cancer, or multiple myeloma have been reviewed at the University of Iowa Surgical Oral Pathology Laboratory (Iowa City, IA). Bisphosphonates were confirmed or suspected as cofactors in these cases. A review showed that bacteria were commonly associated with the non-vital bone fragments. In addition,
Therapy and prevention
First, as related to the above sequence, we as oral health care providers should be able to apply the criteria we currently use in patients before artificial replacement of large joints, head and neck radiation, bone marrow transplant, and organ transplant patients. Second, at least in the case of widespread metastatic disease, nuclear medicine scans of the jaws should be available on most patients being worked up for such metastatic diseases. We must immediately require nuclear medicine
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