Osteonecrosis of the jaw: prevention and early signs

Osteonecrosis of the jaw is a rare condition in which an area of the jaw bone becomes exposed through the gum and does not heal, often for weeks or months. In breast cancer care, it is linked mainly with bone-directed medicines such as zoledronic acid, other bisphosphonates and denosumab, and occasionally with some other cancer drugs. It is most likely after a tooth extraction, with gum infection or with higher doses used for bone metastases. The risk at the doses used to protect bone in early breast cancer is low. Prevention, through good dental care, and early reporting of symptoms are the most important steps.

Early signs to watch for

Pain, swelling or infection in the gums or jaw, a sore that does not heal, loose teeth, a feeling of heaviness or numbness in the jaw, bad breath, or a visible area of bone in the mouth.

How it is treated

Most cases are managed with antiseptic mouthwashes, antibiotics when there is infection, pain relief and careful dental care. Some need minor removal of dead bone. Many heal or stabilise over time.

What happens to bone treatment

Your oncologist and dental specialist decide together whether to pause bone-directed treatment, weighing the jaw problem against the benefits for your bones and cancer.

Osteonecrosis of the jaw is uncommon, and most people on bone-directed treatment never develop it. The risk is higher with the frequent doses used for bone metastases than with the less frequent doses used in early breast cancer.

Prevention works

A dental check before treatment, good daily mouth care and avoiding extractions during treatment lower the risk considerably.

Healing can be slow

Some cases take months to settle, and a few persist. With good care, most people keep symptoms under control and continue to eat and speak normally.

Decisions about bone treatment are shared

Pausing bone medicine may be considered, but because bisphosphonates stay in bone for years, pausing does not reverse the risk quickly. Your team weighs this against the benefits of continuing.

What this page cannot tell you

It cannot diagnose a jaw problem. See your dentist and oncology team if you notice any symptoms.

A diagnosis can be worrying, but many people manage it well with regular care.

Eating comfortably

Soft, bland foods such as khichdi, curd rice, dal and soups are easier on a sore area. Avoid very hard, spicy or hot foods.

Keeping the area clean

Use antiseptic mouthwash as prescribed and gently clean around the area to prevent infection.

Looking after your mood

A slow-healing mouth problem on top of cancer treatment can be wearing. Talk to your team or a counsellor if it is affecting your mood or appetite.

Regular follow-up

Your dental specialist will review the area regularly and adjust treatment as needed.

If osteonecrosis of the jaw is suspected, a clear plan helps control symptoms and prevent it worsening.

Assessment

A dental or maxillofacial specialist examines the area, and X-rays or scans may show how much bone is involved.

Treatment plan

Most people start with antiseptic mouthwashes, pain relief and antibiotics if there is infection, with regular reviews to check healing.

Keeping symptoms under control

Regular antiseptic rinses, careful brushing around the area, soft foods and prompt treatment of any flare of infection help most people stay comfortable. Many find that the exposed area becomes less troublesome over time, even if it does not fully close, and they are able to eat, speak and go about daily life normally.

Reviewing bone medicine

Your oncologist and dental specialist discuss whether to pause bone medicine, balancing the jaw problem with fracture and cancer risks.