{
  "abstract": "Patients with cancer have a significantly increased risk of osteonecrosis of the jaw compared with the general population (incidence 1%–15% for people with cancer compared with 0.001%–0.01% in people without cancer). 1 The most common cause of osteonecrosis of the jaw is secondary to the use of antiresorptive therapy (zoledronic acid or denosumab) for bone metastases including management of malignant hypercalcaemia (bisphosphonate-induced osteonecrosis). The risk of osteonecrosis varies depending on underlying cancer type2 and by additional risk factors, the most common of which are listed in Box 1; with more than 70% of cases related to dental extractions.3 Osteonecrosis of the jaw can also be secondary to treatment with radiotherapy. Although the incidence of osteoradionecrosis is decreasing over time due to more selective radiation techniques and understanding of risk factors, those with head and neck cancer are at particular risk due to high-dose radiotherapy to the area. Concurrent chemotherapy and continuing to smoke tobacco particularly increase the risk of osteoradionecrosis within this population. Although the distinction in diagnosis is made by the underlying cause (ie, osteoradionecrosis in patients who have had radiotherapy vs bisphosphonate-induced osteonecrosis), the presentation is usually the same. Patients typically present with mucosal pain (or sensation of heaviness/numbness) and ulceration, with exposed bone which does not heal (for more than 8 weeks). Surrounding tissue may also become inflamed and infected.",
  "authors": [
    {
      "affiliations": [
        "Palliative Care, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK"
      ],
      "name": "Nathanael Manley"
    },
    {
      "affiliations": [
        "Specialist Palliative Care Team, North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK",
        "Associate Researcher, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Donna Wakefield"
    },
    {
      "affiliations": [
        "Palliative Care, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK"
      ],
      "name": "Alice Jordan"
    }
  ],
  "title": "Complex pain management in osteonecrosis of the jaw",
  "uid": "7e439291-46e4-5ce0-a5e8-98aeb57a958e"
}