What is BRONJ?

No, it is not a nickname for some famous athlete. It is a medical acronym that stands for Bisphosphonate-Related Osteonecrosis of the Jaw. It is a situation that can develop after oral surgery in some patients that have been treated with a class of drugs called Bisphosphonates. These drugs are sometimes used to treat diseases such as multiple myeloma, osteoporosis, or others. One of the side effects that can occur is that after oral surgery the extraction site may not heal normally and there may be pain, swelling, infection, drainage, and an area of exposed, dead(necrosed)bone not covered by gum tissue. A bad taste or odor from this area is quite common as well.

Why does this occur? These drugs are used to help people retain bone in their body for certain diseases as previously mentioned. One of the side effects seems to be that they inhibit the growth of certain cells in our body called osteoclasts that break down old or dying  bone.  In terms of oral surgery, it can keep the bone from healing properly and thus be a real issue as this dead bone can become infected and exposed with no gum tissue covering it.

What can be done? Well, there are certain times when the treating medical doctor will recommend what is called a drug holiday, where the patient comes off the drug for a certain period of time based on the dosage, method of administration, and time period they were on it for before doing any extensive oral surgery.  Sometimes a blood test called a CTX test is performed that may help predict the risk for this side effect as well.

Once BRONJ does occur, treatment can be very difficult based on how severe the damage is. Usually a specialist is advised to try and help these individuals. The best bet is to make sure your dentist knows all the medications that you are on at your appointments and seek regular dental preventive care to try and minimize the chances of needing any type of oral surgery. Though the highest risk is with those patients who have received these types of drugs intravenously there is still a possibility that taking these medications orally can also cause this problem.

(The information contained in this article is strictly for educational purposes and is not meant to replace the professional knowledge or advice of your personal dentist.)