Osteonecrosis of the jaw used to be a rare condition, but recently it has become more common due to the use of bisphosphonates to treat osteoporosis and related conditions. In bisphosphonate-related osteonecrosis of the jaw (BRONJ), you may initially experience common TMJ symptoms, such as headaches, jaw pain, and neck pain.
A new case study shows that when diagnosed at this stage, a multidisciplinary treatment plan including TMJ treatment and the aid of a physician and physical therapist can lead to very good results.
What Is BRONJ?
Bisphosphonates are used to treat osteonecrosis because they change the way your body routinely remolds your bones by removing and adding bone tissue. It inhibits the removal of bone tissue, allowing the additive process to take over. Sometimes, though, this results in a condition where parts of your bone die, probably because of a loss of blood supply.
The result affects not just bone, but surrounding soft tissues, too, and in later stages you will have exposed bone in your mouth, extensive decay of bones, and may suffer bone fractures.
Early Diagnosis and Management
In early stages, BRONJ can have the same symptoms as TMJ. In the current case study, the patient went to a TMJ dentist complaining of headaches, jaw pain, neck pain, and face pain.
There were no visible sores in her mouth, and she felt pain when the dentist touched her temporomandibular joint, muscles that help close the jaw, and muscles in the neck.
She had had arthritis in one of her jaw joints, and had been taking bisphosphonates for two years.
CT scans, MRI, and dental x-rays revealed that she had jawbone decay as well as soft tissue damage that showed the early stages of BRONJ.
Variety of Treatments Lead to Success
The case study emphasizes a cooperative approach to treatment. Although a TMJ dentist coordinated treatment and utilized a bite splint to help reduce pressure, she was also treated by a physician and worked with a physical therapist. She stopped taking bisphosphonates, and necrotic tissue was removed from her jaw joint.
With these treatments, the patient’s headaches and jaw pain went away. Her daily pain went from an 8 on a scale of 10 to a 0 or 1. Her bone regrew a hard outer layer. With 7-year follow-up, this case study confirms the long-term success of the treatment.
This is a reminder that we shouldn’t try to self-diagnose and avoid medical treatment even if we think we have a minor issue. You never know what the real cause of your discomfort may be.
