For many years, we have believed that osteonecrosis of the jaw (ONJ) was strongly associated with dental implant surgery. People who were at high risk for this complication were urged to get removable dentures rather than get dental implants. However, a new study shows that more people develop ostenecrosis of the jaw because of poor denture fit than because of dental implants.

Older woman sitting with younger girl while showing off her smile

What Is Osteonecrosis of the Jaw?

ONJ is a condition where the jawbone doesn’t heal, and may begin to die after an injury, including a surgical procedure. The reason this happens is linked to the natural process of bone resorption.

In normal bone maintenance, the body is constantly rebuilding your bones by removing old bone and adding new bone. Bone healing requires both parts, too, as damaged bone is removed and replaced by new, healthy bone. This process is controlled by two types of cells: osteoblasts (which build bone), and osteoclasts (which remove bone). ONJ occurs when osteoblasts stop working, and the process of osteoclasts continues.

This has been linked to many potential causes. One that’s very straightforward is radiation therapy, which kills osteoblasts, but not as many osteoclasts. When people have a bone injury after radiation therapy, the osteoclasts go around destroying the bone, but no new bone is built.

Ironically, the condition seems to happen more for people who are taking medications designed to suppress the osteoclasts so the osteoblasts can build more bone. Bisphosphonates are a common medication that does this, and it’s associated with ONJ. Another one is a RANKL inhibitor. RANKL (receptor activator of nuclear factor-kappa B ligand) is a protein that stimulates the production of osteoclasts. It was a study of RANKL inhibitors that showed dentures can also cause ONJ as well as dental implants.

Poorly Fitting Dentures Lead to ONJ

This new data comes from an extension of a previous placebo-controlled clinical trial of the RANKL inhibitor denosumab. For the initial trial, women were placed on either denosumab or a placebo for three years. In the extension, all women received denosumab. Women were asked to report their invasive dental procedures during the next 7 years. About 45% of women in the trial had invasive dental procedures during the follow-up period.

Though invasive dental procedures were common, ONJ was rare, with only 5.2 cases per 10,000 patient years. When these cases came up, they were mostly related to dental extractions or poorly fitting dentures, according to the study authors. In fact, although 212 of the study subjects received dental implants, only one developed ONJ. This person not only healed, they didn’t lose their dental implant.

Why Poorly Fitting Dentures Can Trigger ONJ

The concern about dental-implant-linked ONJ centers on the need for bone healing after a dental implant procedure. However, these concerns neglect the fact that dentures also trigger the body to remodel bones. When bone isn’t being used, the body naturally resorbs what it sees as unnecessary bone. Poorly fitting dentures can accelerate the process by putting adverse pressure on the jawbone. This process, already low in osteoblast production, could easily turn into runaway bone loss when medications or radiation therapy interferes with the normal balance between the two bone cells.

Good Denture Fit Protects Your Jaw

This study gives more evidence that poorly fitting dentures aren’t just uncomfortable, they’re unhealthy. It’s not just bone loss that they’ve been linked to, either, they might increase cancer risk.  If you are looking for great-fitting dentures that can help you maintain good oral health, you are looking for FOY ® Dentures.

Please contact a local FOY ® Dentures dentist today for an appointment to learn more about the benefits of FOY ® Dentures.