Phosphorus necrosis vanished after the prohibition of use of white phosphorus in matches. In the context of the modern disease – BONJ (bisphosphonate-associated osteonecrosis of the jaw), it is not a simple matter of banning the prescription of bisphosphonates. First, the drug is effective in managing skeletal complications; second, BONJ does not affect all patients exposed to the drug. To date, the cause of BONJ remains largely unknown and is considered incurable. Patients are managed with symptomatic treatment, consisting of mouthwash, antibiotics and surgical removal of necrotic bone.
Due to its occurrence in only a subset of patients, it is likely that the development of BONJ is associated with genetic variations among individuals. In this regard, it has become a subject of the UCL Grand Challenge of Global Health to identify a particular part of BONJ-causing gene by comparing the whole genome among subjects exposed to bisphosphonates, including both BONJ patients (case) and non-BONJ individuals (control). The identified gene will be utilised as biomarkers and subsequently help develop effective prevention and management strategies.
I decided studying BONJ for my PhD mainly because of my previous clinical experiences. As a dentist, I have encountered cases of severe jaw pain and facial disfigurement, but it is most upsetting to learn in my master project that there were patients who still suffered from jaw pain when they passed away from cancer. With support from the Grand Challenge Studentship in Biomedicine, I wish to play a greater role in helping patients in a more fundamental manner by furthering the profession’s understanding in the genetic variations among patients suffering from BONJ. As BONJ and phosphorus necrosis are one and the same, the research therefore brings the exciting prospect of not only finding the cause of the 21st Century disease, but also the historical phossy jaw at the same time.