Osteonecrosis of the jaw and bisphosphonates

100 years ago the manufacture of matches using yellow phosphorus was subject to an International Convention in Berne (1906), which resulted in substitution of yellow phosphorus for phosphorus sesquisulphide and the control of a disease “phossy jaw.” This was an extensive necrosis, usually of the mandible, which developed after a latent period of anything up to five years after first exposure in those who manufactured matches. Those affected became disfigured, and secondary infection was a common cause of death with a 20% case mortality.¹ The first case was described in 1845,² but it took 60 years to ratify an international convention and introduce laws to control the problem.

It is of interest that the same problem has resurfaced with the use of bisphosphonates.³ The addition of antibiotics and preventive dental care may reduce the severity of the condition but it is likely that the re-emergence of this condition may be controlled only by restriction of the use of biphosphonates in future.