About the project
The last updated definition according to the AAOMS (The American Association of Oral and Maxillofacial Surgeons) Position Paper 2022 includes the following:
- Current or previous treatment with antiresorptive therapy alone or in combination with immune modulators or antiangiogenic medications.
- Exposed bone or bone that can be probed through an intraoral or extraoral fistula€ in the maxillofacial region that has persisted for more than 8 weeks.
- No history of radiation therapy to the jaw or metastatic disease to the jaw.
Objectives
The main of the project is to increase the insight into risk factors and treatment-related factors in patients who is on or have been on antiresorptive drugs for osteoporosis or cancer.
Four ongoing projects
- MRONJ in Norway
- MRONJ in Scandinavia
- European expert group on MRONJ ; a collaboration study
- ONJ in West-Africa
1. MRONJ in Norway
Participants
Bente Brokstad Herlofson
Tormod B. Krüger
Hanne Ingstad
Karen Marie Giltvedt
Dag Petter Tingvoll
2. MRONJ in Scandinavia (Norway, Sweden, Denmark)
Participants
Bente Brokstad Herlofson
Cecilia Larsson Wexell, Lund/Malmø, Sverige
Sven Erik Nørholt, Århus, Danmark
Karen Marie Giltvedt, Oslo, Norway
Dag Petter Tingvoll, Oslo, Norway
3. European expert group on MRONJ
Participants
Bente Brokstad Herlofson, Norway
Cecilia Larsson Wexell, Sweden
Sven Erik Nørholt, Denmark
Sven Otto, Germany
Oliver Ristow, Germany
Thomas Kofod, Denmark
Sanne Werner Møller Andersen
Alberto Bedogni, Italy
Roman Guggenberger, Switzerland
Paul Schumann, Switzerland
Stefano Fedele, UK
Riham Fliefel, Egypt/Germany
Vittorio Fusco, Italy
Anja Liebermann, Germany
Rodolfo Mauceri, Italy
Ourania Nicolatou-Galitis, Greece
Vinod Patel, UK
Giuseppina Campisi, Italy
Suad Al Johani, Saudi Arabia
4. ONJ in West Africa
The research project, “Osteonecrosis of the Jaw in West Africa”, aims to unravel unknown aetiology and possible precipitating factors of a rare form of osteonecrosis of the jaw (ONJ). The project has so far resulted in three published papers. In 2008-2010, sixty cases of extreme ONJ were collected from the hospital ship Africa Mercy, in West Africa. Mainly two types of ONJ were noted; one type associated with facial swelling and pus drainage with exfoliation of dead jaw bone, and one type with fewer symptoms but showing exposed dead ‘greyish’ bone.
The first type of ONJ is suggested to be driven by bacterial infections such as tuberculosis. The precipitating factor of the latter type of ONJ remains unknown. A historical presentation of ONJ, nicknamed “phossy jaw”, has a similar appearance to the greyish ONJ in West Africa, to the “new” complication of antiresorptive treatment “medication-related osteonecrosis of the jaw (MRONJ) reported for the first time in 2003 and to the feared oral complication of radiotherapy for head and neck cancer; osteoradionecrosis (ORN). Phossy jaw was an occupational disease in the 19th and early 20th centuries among matchstick factory workers, due to exposure to white phosphorus. None of the patients in West Africa were knowingly exposed to compounds or treatments related to ONJ or ORN. An unknown causative or initiating, and likely novel, factor is suspected and warrants investigation. By identifying such factors, preventive measures may be developed. This could save lives and improve the quality of a significant amount of people. In addition, it will likely benefit the understanding and treatment of ONJ on a global scale.
Papers so far
Khullar SM, Katebi N, Herlofson BB, Tvedt D, & Olsen BR. (2016). Evidence to support the hypothesis of tuberculosis as a cause of extreme osteonecrosis and osteomyelitis of the mandible in a West African population. International Journal of Oral and Maxillofacial Surgery, 45(12), 1600-1606.
Khullar SM, Tvedt D, Chapman K, & Herlofson BB. (2012). Sixty cases of extreme osteonecrosis and osteomyelitis of the mandible and maxilla in a West African population. International Journal of Oral and Maxillofacial Surgery, 41(8), 978-985. ).
Yang X, Ye AY, Katebi N, Volloch V, Khullar SM, Patel V, Olsen BR. Mycobacterial and Plasmodium ovale-associated destruction of the jaw bones. Oral Dis. 2022 Mar;28(2):452-468. doi: 10.1111/odi.13756. Epub 2020 Dec 29. PMID: 33325564.
Project participants
Dr Shelley Khullar DDS, PhD, FDSRCS, Oslo, Norway (Principal investigator)
Dr Hans Erling Skallevold, DDS, stud.MD, Faculty of Medicine, University of Oslo, Norway
Professor, Chair, Bente Brokstad Herlofson, DDS, PhD, OMS, Faculty of Dentistry, University of Oslo, Unit of Oral and Maxillofacial Surgery, Dept. of Otorhinolaryngology, Oslo University Hospital
Professor Lucy Di Silvio, BSC, PhD, FIMMM, FBSE, Faculty of Dentistry, Oral & Craniofacial Sciences, Professor of Tissue Engineering, King’s College London, Guy’s Hospital, London, UK
Dr Vinod Patel DDS, PhD, FDSRCS, Consultant, Guy’s and St. Thomas NHS Foundation Trust, London, UK
Dr Dag Tvedt, DDS, OMS. Faculty of Dentistry, University of Oslo, Norway
Mr Diallo Oumar Raphiou, MD, OMS, University of Gamal Abdel Nasser, Conakry, Guinea
Hokie W. Jackson, Oral Health Coordinator, Non Communicable Diseases and injuries Division (NCDI), Ministry of Health, Liberia
Dr Anthony M. Tucker, Director, NCDI/MOH, Liberia
Zone Taylor Doe, Deputy Director, NCDI/MOH, Liberia
Professor Bjørn Reino Olsen, MD, PhD, professor of Developmental Biology, Hersey Professor of Cell Biology, Harvard School of Dental Medicine
Dr Marijke Westerduin-Tom, chief dentist, Mercy Ships