Dentaltown October 2015 - (Page 28)

special feature A Direc Hit to the Jaw by Elizabeth Fleming, DDS In 1858, workers in matchmaking factories started to complain of pain, swelling, debilitation and painful exposed bone in the mouth. Labeled "phossy jaw," the disorder reached epidemic proportions and had a reported mortality rate of 20 percent. The disorder was linked to yellow phosphorous, the key ingredient in strike-anywhere matches. In the factories, workers-called "mixers," "dippers," and "boxers"-were exposed to heated fumes containing this compound. Many workers developed painful exposed bone in the mouth, whereas their office-based counterparts did not. As proper safeguards were put into place, the phossy-jaw epidemic tapered off in the early 20th century, with only a few cases appearing since.1 S Until now. Some troubling, albeit interesting, cases have appeared more than a hundred years later. The exposed bone and clinical course of today's disease are eerily similar to what our historic counterparts saw in match-factory workers. This time the potential cause is not tied to factory conditions, but instead to people receiving treatment for certain types of cancer. Researchers believe it's due to bisphosphonates used to treat metastatic cancer deposits in bone or osteoporosis. Although yellow phosphorus has a simple chemistry of P4O10, when it's combined with H2O and CO2 from 28 OCTOBER 2015 // dentaltown.com respiration, and with common amino acids such as lysine, the resulting chemical compound is similar to that found in the prescription medications Fosamax or Aredia. In patients with phossy jaw, forensic evidence directly points to conversion of the yellow phosphorus to potent amino bisphosphonates by natural chemical reactions in the human body. The cause of phossy jaw in the late 1800s was actually bisphosphonate-induced osteonecrosis of the jaws, long before clever modern pharmaceutical chemists synthesized bisphosphonates. Today's bisphosphonate-induced osteonecrosis represents the second epidemic of phossy jaw.1 The three stages of osteonecrosis of the jaw (ONJ): 1. Exposed bone, but no symptoms of pain or infection. Treatment consists of chlorhexidine rinses and monitoring the exposed bone by a dentist or oral surgeon. 2. Exposed bone with symptoms of pain and infection. Treatment consists of oral antibiotic therapy and chlorhexidine rinses with superficial debridement of the infected areas of bone. 3. Exposed bone with extensive pain http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown October 2015

On Dentaltown.com
Howard Speaks: Don’t Go it Alone
Professional Courtesy: Great Patient Relationships? F.U.!
Continuing Education Update
Industry News
All on Four’d Out
A Direct Hit to the Jaw: Bisphosphonates and Osteonecrosis of the Jaw in Osteoporosis and Cancer Patients
Five Components to Team Synergy
Practice Solutions: Clear-Aligner Therapy
In Focus: Microphotography using the Dental Operative Microscope
Anesthesia Safety
The Practice that Perseverance Built
What Kind of Payment Plans to Offer?
Are You Providing Five-Star Service?
Am I Being Too Conservative?
You Should Know: Healthy Grid
The Benefi ts of Mini Dental Implants
Denture Stabilization with Small- Diameter Implants
Independence Day
Post-Treatment Management of Orthodontic Patients
How to Track True Treatment Acceptance
CAD/CAM as a Marketing Tool
New Products
Practice Solutions: Voco
Poll
Surgical Crown Lengthening
Product Profi le: Umbie
And Sealants for All
Ad Index
Human Herpesvirus Infections and What They Mean for Dentists
Quick, Conservative and Highly Esthetic Treatment Planning for Severe Anterior Tooth Wear
Dentally Incorrect

Dentaltown October 2015