Osteonecrosis of the Jaw: Causes, Risks, and What You Need to Know

When the jaw bone starts to die, it’s not just a dental issue—it’s a medical red flag. Osteonecrosis of the jaw, a condition where bone tissue in the jaw breaks down due to lack of blood supply. Also known as medication-related osteonecrosis of the jaw, it’s most often linked to powerful drugs used to treat cancer or osteoporosis. This isn’t something that shows up overnight. It creeps in after dental work, infection, or long-term use of certain medications—and once it starts, it’s hard to reverse.

The biggest culprits? Bisphosphonates, a class of drugs that slow bone loss and are commonly prescribed for osteoporosis and bone metastases. Drugs like zoledronic acid and alendronate are lifesavers for many, but they can also shut down the jaw’s natural repair system. Even more concerning? Denosumab, a similar drug used for bone health that carries the same risk. Both can cause the jaw bone to lose its ability to heal after trauma, like a tooth extraction or even aggressive brushing. It’s not rare—studies show up to 1 in 100 people on long-term bisphosphonates develop this, especially if they have poor dental health or smoke.

What does it feel like? Pain, swelling, loose teeth, or exposed bone in the mouth that won’t heal. Many people ignore it at first, thinking it’s just a toothache or gum infection. But if you’re on one of these drugs and your mouth isn’t getting better after a week, it’s not normal. The risk goes up with time—people on these meds for more than three years are at the highest risk. And it’s not just oral surgery that triggers it. Even routine cleanings can be dangerous if your dentist doesn’t know you’re on these drugs.

Here’s the thing: you don’t have to stop your medication. But you do need to be proactive. Talk to your doctor and dentist together before any dental procedure. Get a full dental checkup before starting bisphosphonates or denosumab. Avoid invasive work if you can. And if you notice any unusual symptoms—don’t wait. Early detection means less damage and better outcomes.

The posts below cover real-world stories and science-backed advice on how these drugs affect your body, what signs to watch for, and how to protect yourself without giving up the treatment you need. You’ll find practical tips from people who’ve been through it, and clear explanations from medical experts on how to manage the risks. This isn’t about fear—it’s about awareness. And knowing what to look for could save your jaw—and your quality of life.