Focus On: Bone-Related Oral and Maxillofacial Conditions

Steven B. Kupferman, DMD, MD, and Jay K. Lee, DDS, MD
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Steven B. Kupferman, DMD, MD, and Jay K. Lee, DDS, MD, discuss the management, diagnosis, and treatment of bone-related oral and maxillofacial conditions.

 

Q: How prevalent is osteonecrosis and osteoporosis in dentistry?

A: Osteoporosis is the most common bone disease in humans. It can affect any bone in the body, including the jaw. Osteoporosis is very common, affecting 1 in 2 women and 1 in 4 men. However, this bone condition is not a part of normal aging. Certain drugs used to treat this condition can cause parts of the jawbone to become dead and exposed, known as osteonecrosis of the jaw.

Osteonecrosis is a rare condition. As oral surgeons, we see these cases often. A finding by the National Organization for Rare Disorders states that osteonecrosis is most common among people in their 30s and 40s, including both men and women, but any age is at risk. About 10,000 to 20,000 people develop osteonecrosis each year in the United States.

Q: How does osteonecrosis affect daily living?

A: We use our jaws for everything. Some osteonecrosis cases are asymptomatic. Other times, patients can experience excruciating discomfort and catastrophic bone failure. In patients with osteonecrosis, the jawbone slowly dies to the point where the jaw will break because it is no longer solid. It can be painful to eat or fully open the mouth, and loose teeth can be infected to the point of the patient becoming[SC: needing to be?] hospitalized. Sometimes, you are able to see the dead bone inside the patient’s mouth. These factors greatly reduce a patient’s quality of life and ability to perform normal tasks.

Q: What are the major contributors to osteonecrosis?

A: Major contributors include bone infections, medications used to treat bone cancer or osteoporosis, and undergoing head and neck radiation. Minor contributors include smoking, tobacco chewing, autoimmune diseases and medications used to treat them, arthritis, and poor oral hygiene.

Q: What treatments are available to treat this condition? Is anything new available? 

A: Treatment for osteonecrosis, osteoporosis, osteoradionecrosis, and osteomyelitis depends on the stage of the condition. We can treat early stages with antibiotics and antiseptic mouth rinses and use oral analgesics to manage pain. We like to educate patients on proper oral hygiene techniques and how to optimize bone health through a nutritious diet with high amounts of vitamin D and calcium.

More aggressive stages can benefit from “Jaw in a Day,”[SC: can this be lowercase?] a fairly new treatment that involves removing the dead pieces of bone and harvesting bone from the leg or another part of the body and transplanting it into the jaw. We then insert dental implants and attach a prosthesis for secure, functioning results that look natural.

Q: What is the science behind the treatment?

A: Medications and radiation therapy can cause hypoxemia hypovascularity, which is [SC: a condition?]where less blood supply and oxygen reach the bone. This is especially true with medications that cause bone turnover. With osteoporosis, bone-eating cells are more active than bone-building cells. Medications can slow down these bone-eating cells while the disease ultimately stops bone turnover. 

In some cases, a small dental infection or tooth extraction causes the body to not have adequate blood supply and oxygen for bone repair. As a result, the bone becomes necrotic. Osteonecrosis of the jaw is more common in the maxillary bone than the mandible because there are more blood vessels in the mandible.

Q: What ways can this condition be prevented? 

A: As health professionals, we stress the importance of bone health throughout every stage of life, starting in childhood. What you eat, drink, and do affects your bones. A well-balanced diet, getting enough calcium and vitamin D, and regular exercise are all ways to improve bone health. Smoking and alcohol consumption increase the risk of developing osteoporosis because they compromise bone health and weaken the bones’ mechanical properties. 

Attending regular checkups with a dentist and an oral surgeon is key. It is ideal to have the condition identified before a patient undergoes medication or radiation therapy for cancer. When patients come to us, we can begin managing their condition sooner, leading to a better outcome.

Q: Any further comments?

A: Medical and dental technologies have evolved greatly. Just 5 years ago, the only option for some individuals with these conditions was to have their teeth extracted and replaced with dentures and have their jaws wired shut. Today, our access to technology and advanced equipment allows us to rebuild someone’s entire jaw in one surgical procedure. We use CBCT imaging in our practice to monitor bone health throughout all stages of treatment and perform surgery with precision. 

When an oral and maxillofacial abnormality is discovered, dentists should  refer the patient to an oral surgeon for evaluation, diagnosing, and treatment planning. We value our relationships with referring offices. With these positive connections, we deliver better experiences and make dentists feel confident about the care we provide to their patients.

Dr. Kupferman received his dental degree from the Harvard School of Medicine and his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Dr. Lee received his dental degree from UCLA and his medical degree from the University of Texas Southwestern Medical Center. They are board-certified and fellows of the American College of Surgeons and the American Academy of Craniomaxillofacial Surgeons. Drs. Kupferman and Lee are both clinical faculty members of the Division of Otolaryngology at Cedars-Sinai Medical Center and practice oral surgery in Los Angeles. They can be reached at front-office@la-coms.com or on their website at la-coms.com.

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