As a fresh researcher, I always wonder: how do scientists look for new research areas? Ask the crystal ball? Perhaps looking into history may help…
The most widely accepted BONJ definition is exposed jawbone: it may get infected, gum tissue then becomes red and swollen, and there can be pus oozing from the wound causing bad breath. Extensive dead bone can perforate the roof of the mouth or fracture the lower jaw. Infection can spread from gum to facial tissue, causing abscess and scarring. This tremendously affects normal function, such as eating, speaking and appearance.
Can dentists detect BONJ early? There are some patients complaining of pain mimicking toothache not related to local teeth problems but are indeed caused by early BONJ. In addition, there can be ulcers and loose teeth. These early signs and symptoms do not involve exposed necrotic bone and are known as the “non-exposed variant”.
BONJ was first reported in 2003 and the “non-exposed variant” was introduced in 2008. I am lucky to have my PhD studies supervised by Dr Stefano Fedele who was among the first researchers to look into this and have written a case series involving the largest group of patients so far.
We thought the “non-exposed variant” was something new in BONJ, but similar features in phosphorus necrosis/phossy jaw had been observed as early as 1862! “……The disease, it was noticed, began usually with aching in one of the teeth. At first, this was probably mistaken for ordinary toothache……”, reads a discussion in the Report of Occupations which have to do with Phosphorus. Since the time I read this, I couldn’t wait to learn more from the Victorian time disease. I hope you can gain some inspiration from the history of the field you are working in too.
- Fedele, Stefano, Stephen R Porter, Francesco D’Aiuto, Suad Aljohani, Paolo Vescovi, Maddalena Manfredi, Paolo G Arduino, et al. 2010. “Nonexposed Variant of Bisphosphonate-associated Osteonecrosis of the Jaw: a Case Series.” The American Journal of Medicine 123 (11) (November): 1060–1064.
- Junquera, Luis, and Lorena Gallego. 2008. “Nonexposed Bisphosphonate-related Osteonecrosis of the Jaws: Another Clinical Variant?” Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons 66 (7) (July): 1516–1517.
- Hughes, J. P. W., R. Baron, D. H. Buckland, M. A. Cooke, J. D. Craig, D. P. Duffield, A. W. Grosart, P. W. J. Parkes, and A. Porter. 1962. “Phosphorus Necrosis of the Jaw: A Present-day Study.” British Journal of Industrial Medicine 19 (2) (April): 83–99.