Homoeopathy

       

Osteonecrosis of the jaw, commonly called ONJ, occurs when the jaw bone is exposed and begins to starve from a lack of blood. As the name indicates (osteo meaning bone and necrosis meaning death), the bone begins to weaken and die, which usually, but not always, causes pain. ONJ is associated with cancer treatments (including radiation), infection, steroid use, or potent antiresorptive therapies that help prevent the loss of bone mass. Examples of potent antiresorptive therapies include bisphosphonates such as alendronate (Fosamax); risedronate (Actonel and Atelvia); ibandronate (Boniva); and denosumab (Prolia). While ONJ is associated with these conditions, it also can occur without any identifiable risk factors.

Fast facts

• ONJ may occur in patients taking strong antiresorptive therapies such as bisphosphonates or RANKL inhibitors. ONJ has not been reported with other antiresorptive therapies such as SERMs or calcitonin. SERMs include therapies like raloxifene (Evista).
• The risk of ONJ in patients taking bisphosphonates may depend on the dose of medication, the length of time it is taken and the medical condition for which the bisphosphonate is prescribed. As a result, cancer patients taking higher doses of bisphosphonates, particularly by IV, are at higher risk.
• The number of ONJ cases in patients taking bisphosphonates by mouth is estimated to be between 1 in 1,000 and 1 in 100,000 for each year of exposure to the medication.
• Most patients with ONJ who are taking antiresorptive therapy for osteoporosis can be healed with conservative treatment and often do not require surgery.
• Most cases of ONJ happen after a dental extraction.
• Good oral hygiene and regular dental care is the best way to lower the risk of ONJ.

What is ONJ?

ONJ is a condition in which an area of jawbone is not covered by the gums. The condition must last for more than eight weeks to be called ONJ. ONJ has occurred in patients with herpes zoster virus infections, in those who are undergoing radiation therapy of the head and neck (radiation osteonecrosis), osteomyelitis (bone infection) and in persons taking steroid therapy chronically. Patients taking antiresorptive therapy to reduce fracture risk also may experience ONJ. In this latter case, ONJ most often develops after an invasive (surgical) dental procedure such as dental extraction. ONJ also may occur spontaneously over boney growths in the roof or inner parts of the mouth.

What causes ONJ?

Why some patients taking antiresorptive therapy get ONJ is unknown. It may be due to: 1) a decrease the bone’s ability to repair itself; 2) a decrease in blood vessel formation; or 3) possible effects of infection.

Who gets ONJ?

ONJ associated with bisphosphonate use, also referred to as BON, may develop in patients after taking the medication for as little as 12 months. The risk increases the longer bisphosphonates are taken. Most cases occur after prolonged therapy (more than five years).
For osteoporosis patients who do not have cancer and who are treated with osteoporosis medications, the risk of ONJ is low. Study results vary from less than 1 in 100,000 getting ONJ from bisphosphonate therapy to 1 patient in 263,158. One recent study suggested no increased incidence of ONJ with osteoporosis medication. However, the risk of ONJ in patients on bisphosphonates who have invasive dental work such as dental extraction may be higher. The risk of ONJ in patients taking denosumab (Prolia) is less well studied.
Cancer patients are at particular risk for ONJ. The doses of IV bisphosphonates used to treat cancer can be 10 times higher or more than the doses used for osteoporosis. Furthermore, cancer patients receive IV bisphosphonates as often as every 3-4 weeks, while osteoporosis patients receive only a single IV dose yearly. As a result, the risk of ONJ in cancer patients varies, but it is higher. Even with many risk factors, the incidence of ONJ in some European countries for cancer patients receiving IV bisphosphonates and other cancer treatments may be as high as 1 in 10 patients. ONJ has been most commonly observed in cancer patients with multiple myeloma and breast cancer.
Besides cancer, other risk factors include advanced age, steroid use, diabetes, gum disease and smoking.

How is ONJ diagnosed?

There is no diagnostic test to determine if an individual patient is at increased risk for ONJ. The condition itself is diagnosed only by the presence of exposed bone, lasting more than 8 weeks. Patients typically complain of pain, which is often related to infection, soft tissue swelling, drainage and exposed bone.

How is ONJ treated?

Most patients with osteoporosis who develop ONJ are treated conservatively with rinses, antibiotics and oral analgesics. In the IV trial in osteoporosis mentioned above, both cases resolved within months on such conservative treatment. There are case reports of the use of teriparatide in management of ONJ.

Prevention

A health program of oral hygiene and regular dental care is the optimal approach for lowering ONJ risk. Patients should inform their dentists that they are taking potent antiresorptive therapy. Dentists should consider conservative invasive dental care in patients taking potent antiresorptive therapies.
For instance, endodontic (root canal) treatment is preferred to dental extraction if the tooth can be saved. If dental extraction is needed, full mouth dental extractions or periodontal surgery should be avoided. (It may be better to assess healing by doing individual extractions.)
Patients with periodontal disease should consider non-surgical therapy before agreeing to surgical treatment. Many patients taking bisphosphonates may undergo dental implants without problems. Although some dentists recommend the use of blood tests to decide who is at risk, this practice is controversial due to a very limited evidence base and should not be used at this time.
Those on oral bisphosphonates are at low risk for BON. However, they are not without risk. Any problems developing in the mouth should signal the need for dental review. There is no data to suggest that bisphosphonates should be stopped prior to a dental procedure. However, patients about to start bisphosphonate therapy should consider waiting until any immediate invasive dental surgery is completed.

Points to remember

• Up to 1 out of every 2 women over 50 will break a bone (such as wrist, spine or hip) due to osteoporosis in their lifetime. Each year, about 250,000 will break a hip due to osteoporosis. Of these, up to 24% will die, and less than 25% regain full function. Vertebral (spine) fractures, which occur twice as often as hip fractures, also cause back pain and increased mortality.
• Up to 1 out of 4 men over 50 will break a bone due to osteoporosis in their lifetime. Each year, about 80,000 men will break a hip.
• Oral or IV bisphosphonates have been shown to prevent 50-70% of vertebral fractures in postmenopausal women and 40-50% of hip fractures in clinical trials. Denosumab (Prolia) has been shown to reduce vertebral fractures in 70% of postmenopausal women and 40% of hip fractures.
• Given the risk of osteoporotic fracture, and the low risk of ONJ associated with potent antiresorptive therapy use, the benefit of preventing osteoporotic fracture clearly far exceeds the risk of ONJ.

                                                           
Homoeopathic Treatment for Caries
 It is a bone affection (disease), which means decay. Or caries is an inflammatory decay of bone or teeth, usually associated with pus formation. It is referred with various names- for example, caries of teeth, caries of spinal bone, or spinal tuberculosis, caries of cervical bones, etc.
 Causes Tuberculosis of bones, degeneration of bones, after bruise or contusion of bones or after fracture of bones, weak brittle bones are the causes of caries of bone. It is also due to the deficiency of vitamin D in the body.
 Cures
 1. Caries of Teeth. Angustura, Calc. fl, Calc. p, Fluor ac, Hekla, Kreos, Sil, Staph, Syphilinum.
 2. Caries of Bones. Arg. m, Aurum, Asaf, CalcA, Calc. p, Con, lod, Phos, Sil, Symph, Syphilinum.
 1. Angustura-30, 200. . In caries or necrosis of bones', especially long bones, lower jaw and Tibia bone (shin bone) pain with crackling of joints, bone crumbles to pieces, great craving for coffee aversion to solid food, over sensitiveness, and stiffness of muscles and joints, pain in legs on walking. Caries of bone with painful ulcer which is very painful and affects the bone, tenesmus even with soft stool, rofuse, copious flow of urine with cold extremities, be given in 30 or 200 potency.
 2. Arg. met. 30. . In caries of bones, of joints and cartilages, with pain in knees weak trembling legs, swelling of ankles, scrofulous caries of bones with white swelling, rheumatic, arthritic, bruised pains in joints, tenderness, tearing pressure and pain in bones. Urine profuse frequent turbid, diabetic with gradual emaciation, desires cool open air. Give in the morning and evening with some gaps during its curative action.
 3. Asaf-oetida-6, 30. . Inflammation and caries of bones, of soft parts of bones with ulcers, softening (degeneration) of bones, uIcers very sensitive to touch due to hardness around edges, which bleed easily with thin, foetid or offensive pus. Drawing pains in bones worse during rest at night. It suits well in cases of deep ulcers with caries of bones, especially syphilitic subjects, fatty people who are having disteneded bloated heavy tympanitic abdomen full with gas, bone pains worse at night, warm weather, better in open air, pressure and from motion.
 4. Aurum. met.  In caries of cervical bones, bones of the palate, cries of mastoid process (the prominence on the mastoid portion of the temporal bone just behind the car, mastoid process consists of mastoid bone, air space, extending in a backward and downward direction from the mastoid antrum i.e.  an air space between the mastoid process). In caries and necrosis of nasal bone causing foetid purulent bloody discharge with in gums, in caries of teeth, bones with bone pains worse at night, tearing boring, burning, stitching pains in bones in syphilitic subjects, with feel as if they were broken foul discharges'. In caries of teeth, with loose teeth in their sockets, gums foetid breath, bone pains worse at night. In diabetic patient with high blood pressure
 5. Calc.c. 30, in caries of spinal bones and teeth with tardy, delayed development of bones, non-appearance of teeth, sweating of head and body worse during sleep at night. Curvature of spine or long bones, exostosis and caries of the bones, softening of bones (wasting away of bones) caries of teeth in children with enlarged belly and thin legs."
 6. Calc. Phos-30. . In caries of bones, worse after fracture or non-union of bones, with the result, they become soft or are wasted away. Curature of spines and long bones with diarrhoea and emaciation, caries of hip-joint and heel with suppuration and stitching pain due to the pus formed. Fistulus ulcers in bones discharging pus with small pieces of bones.
 7. Calc. fl. 30. . In osteosarcoma (cancerous hard tumour of bone) with suppuration be given in alternation with Calc-phos, head remedy for caries and necrosis of teeth with loss or softening of enamel, teeth become loose in their sockets.
 8. Capsicum - 30. . In caries of mastoid process with great burning smarting, tearing pains in the car, worse when coughing, sneezing.
 10. Fluoric acid-30. . In caries with suppuration of long bones, pains in bone, worse at night, with extreme weakness or prostration, offensive discharge from the cars nose, due to necrosis of bones, discharges thin and excoriating, caries and necrosis in psoric or syphilitic subjects, caries of teeth, with dental fistulae. Patient is worse from heat and warmth, hot drinks, better in cold season, while walking.
 11. Heckla-lava-3x, 6x, in caries of teeth, jaws with gum abscess or in osteitis, periostitis, exostosis, osteo-sarcoma, and rachitis, or in Nodosities and necrosis of bones. Ulceration of nasal bones.
 12. Iodum-30. . In Osteo-malacia (A morbid softening- wasting of bone) lod. 30 in alternation with Calc.c. 30 may be given to cure osteomalacia, nightly bone pains, arthritic pains in joints with swelling and general emaciation.
 13. Phosphorus-30. . Head remedy for caries of bones, necrosis of lower jaws with tearing pains in bones, worse at night, from least touch, warmth of the bed - hip-joint disease, caries of Tibia with oozing of watery pus. It complements Sil in bone diseases or when Sil. fails to complete the cure or when progress Is arrested. In diseases of teeth, with bleeding from dental sockets, after extraction of teeth, teeth turned grey, with caries necrosis of jaws and bleeding gums.
 14. Merc. Sol. 30 decaying and loosening of teeth, bleeding gums, pus formed in gums, in caries of teeth, bones with bone pains worse at night, bones feel as if they were broken.
 15. Silicea-30 - 200. . In caries necrosis and ulceration of bones, with fistulous openings discharging offensive pus, swelling around fistulous opening with bluish red appearance, very sensitive to touch, caries of bones in T.B.  subjects, or having scrofulous history of bone. Patient is worse by cold better by warmth always sits in the sun to warm up the body. In curvature of hones, rickets and diseases of hi-joint. Phosphorous comes for help if sil-fails.
 17. Staphy-30. . In syphilitic caries, with arthritic nodes in broken down patient, painful ulcers with scanty watery discharge, bone easily breaks down under pressure, shooting tearing boring pains in bones, during caries of bones. In caries of teeth, when teeth become black, looseness of teeth in gums with pus formation at their roots, worse by least touch, aching after eating or drinking. Teeth turn black and crumble away.
 18. Symphy-30, 200. . In fracture of bones, which are irritable at point of fracture, or in wounds of bones, or in periostitis- traumatica.
 19. Syphilinum.-200, in curvature and caries of cervical bones, spinal bones, with constant pain in bones worse at night, with utter prostration and debility in the morning, shifting rheumatic pains worse at night. In ulcerations of mouth nose genitals skins with succession of abscesses, caries of nasal bones, ear bones, in syphilitic teeth decayed subjects. In ulceration of gums with smarting and burning, excessive flow of saliva, which runs out of the mouth- during sleep at night.
                                                                     Source from Dr.Gupta