How can they tell the difference between osteonecrosis of the jaw & osteoradionecrosis?
I am in the early stages with a periodontist about puss in my gums. I have not had any dental issues before and get my teeth cleaned twice a year. The periodontist thinks I have osteonecrosis of the jaw from using XGEVA and have caught it early. I saw him in December and will go back in a few days for my second appointment. When my breast cancer came back, it was in my collarbone and 2 nearby lymphnodes. I received radiation to that area and the gum/jaw problem is on the same side as where I was radiated. Does anyone know how they can tell the two apart? From my reading they need to be treated differently but I can't find how you tell which is which.
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Hi @cowgal, we are sorry to hear of the dental concerns you're now facing. Have you been on Xgeva for a long time? Although rare, osteonecrosis of the jaw is a risk that increases with long-term usage of biophosphanates (usually 3 or more years of continuous biophosphanate treatment). As to whether or not your jaw necrosis may be caused by radiation treatments, this would be a good question to ask your radiation oncologist as well as your dental team. The number of radiation treatments (and dosage strength) you've received, and timing of when your dental issues began in relation to your treatments would be important to note while seeking answers.
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Hi @cowgal, Any type of osteonecrosis whatever the cause looks like dead bone on a biopsy. Radiation induced osteonecrosis tends to be deeper in the jawbone than medication induced osteonecrosis in its early stage. Whatever the cause ON deep in the jaw needs to be removed by bone debridement by an oral surgeon.
Oral surgeons treat ON, osteomyelitis (infected jaw bone) or jaw bone cancer, all of which have similar symptoms and require bone removal if not superficial. It can be difficult to find an oral surgeon who deals with complex medical issues. Dental schools or hospitals with oral/maxillofacial surgeons on staff are a good resource. I lucked out when the oral surgeon who extracted a tooth biopsied my jawbone which continued to be extremely painful. He suspected advanced stage ON since I had taken Fosamax but it turned out to be osteomyelitis. He told me I had cancer since that and HIV are its only causes. That’s how my breast cancer was diagnosed.
If you don’t have severe jawbone pain it is probably early stage ON which a periodontist can also treat. If things get worse it would be worth finding an oral surgeon. Hopefully yours will improve.
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Moderators - I have been on XGEVA for 6 years. For the last year or so, I have been getting the shots quarterly rather than monthly. The last of my radiation would have been March 2020 and I am pretty sure that I had radiation levels high enough for it to be a possibility but the RO should be able to tell him exactly what I received. I did tell my periodontist who my RO was so they could contact her if needed. My dental problems started in October.
Maggie15 - Thanks for the information. I am putting together my list of questions for my periodontist appointment tomorrow. I do know that the periodontist has already contacted my MO about the situation and I was already scheduled with my MO for later this month.
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