Necrosis of the jaw

Home » Necrosis of the jaw



The incidence of bisphosphonate-related osteonecrosis of the jaw can be reduced by preventive measures.

Early detection and guidance for patients undergoing bisphosphonate therapy

Bisphosphonates are drugs that influence bone metabolism and slow the rate of bone resorption. They are used for treating osteoporosis and other benign bone conditions, as well as in patients with bone metastases of malignant tumours.


Patients suffering from osteoporosis usually receive bisphosphonates as oral medication (weekly tablets) or in some cases as infusions (three-monthly or annually). Bisphosphonates thus reduce the frequency of bone fractures.


In patients with cancer and bone metastases, bisphosphonates (intravenous, four-weekly, at higher concentration) are used to reduce pain, retard the rate of progression of the metastases and lower the frequency of bone fractures.


Bisphosphonates are efficient and highly efficacious drugs which improve sufferers’ quality of life in this regard.


The condition of bisphosphonate-related osteonecrosis reduces the quality of life of the affected patients. To date, it has not proved possible to precisely determine the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). It is certain, however, that this condition is triggered very much less often by an oral administration (tablets e.g. Fosamax and Actonel) than by intravenous bisphosphonates (e.g. Zometa, Aredia, Bonviva and Bondronat).


Current studies indicate a prevalence of around 0.1% for the tablet form and up to 20% for intravenous administration.


The precise causal mechanism that leads to BRONJ is not yet known. However, the latest research findings suggest that inflammation in the mouth and jaw region has a significant impact on the manifestation of the condition. Owing to an acidic pH value (such as occurs with an inflammation), bisphosphonates are released from bone and accumulate locally. The jaw region is particularly prone to inflammation because of the presence of teeth.

The incidence of bisphosphonate-related osteonecrosis of the jaw can be reduced by preventive measures.


Therefore, prior to a planned antiresorptive therapy, a thorough examination should be made as to whether bone infections exist in the tooth and jaw area.


However, even with ongoing antiresorptive therapy with bisphosphonates and denosumab, jaw inflammation Special precautions must be taken into account in surgical procedures to trigger pine necrosis


We will be happy to advise patients facing or undergoing bisphosphonate therapy concerning their personal risk profile (risk of contracting a bisphosphonate-related necrosis of the jaw). And we will be glad to offer guidance in discussing the possible risks of an upcoming implantation in relation to bisphosphonate therapy.


We will also be happy to discuss with you the optimal timing of surgical intervention (including dental implants) with regard to ongoing bisphosphonate therapy. We do not give general recommendations on continuation of bisphosphonate therapy, possible adjustment of existing medication or the necessity of bisphosphonate therapy.


Sollte sich trotz prophylaktischer Maßnahmen eine Kiefernekrose ausgebildet haben, empfehlen wir eine chirurgische Therapie. Unter erfahren sie mehr zur Therapie. Hierbei liegen die Erfolgsraten bei über 90%.

We will, however, be happy to refer you to experts on these issues.