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Brief description of the condition

Exposed avascular bone. Patients taking a bisphosphonate drug (e.g. for osteoporosis) or who have had radiotherapy to the head and neck may be at increased risk of developing osteonecrosis of the jaw. 

Key signs and symptoms

  • Pain 
  • Exposed intra oral bone, with failure to heal in the absence of malignancy 

Initial management

Recommend optimal analgesia (see Appendix 2). 

Advise the patient to rinse their mouth with 0.2% chlorhexidine mouthwash. 

If of recent onset, advise the patient to seek urgent care. If chronic, advise the patient to seek non-urgent care. 

Do not prescribe antibiotics unless there is a discharge. 

Subsequent care

Minimise the need for extractions and avoid minor oral surgery. 

  • Refer to an oral surgeon or oral and maxillofacial surgeon to establish diagnosis.