Skip to main content

The phosphorous necrosis of the jaws and what can we learn from the past: a comparison of “phossy” and “bisphossy” jaw

Abstract

Introduction

The osteopathology of the jaws associated with bone resorption inhibitors is a current topic that engages a variety of clinical specialists. This has increased after the approval of denosumab for treatment of osteoporosis and skeletal-related events in patients with solid malignancy. Early after the first publications, there is a possible connection between phosphorous necrosis of the jaws, a dreadful industrial disease mentioned, and bisphosphonate-induced pathology. The nineteenth century was the prime time for phosphorus necrosis of match factory workers.

Results

This occurrence provides an interesting insight into the medical and surgical profession in the nineteenth century. There are striking parallels and repetition of current and old ideas in the approach to this “new disease.” There are similar examples in case descriptions when compared with today’s patients of bisphosphonate-related osteonecrosis of the jaws (BRONJ).

Discussion

Phosphorus necrosis was first described in Austria. Soon after this, surgeons in German-speaking countries including well-known clinicians Wegner (1872) and von Schulthess-Rechberg (1879) pioneered the analysis, preventative measures, and treatment of this disease. The tendency at this time was to approach BRONJ as a “special kind of osteomyelitis” in pretreated and metabolically different bone. Not only the treatment strategy to wait until sequestrum formation with subsequent removal and preventative measures but also the idea of focusing on the periosteum as the triggering anatomical structure may have been adopted from specialists in the nineteenth century. Therefore, phosphorous necrosis of the jaw is an excellent example of “learning from the past.”

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115

    PubMed  Article  Google Scholar 

  2. Ruggiero SL, Dodson TB, Assael LA et al (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg 67:2

    PubMed  Google Scholar 

  3. Hellstein JW, Marek CL (2005) Bisphosphonate osteochemonecrosis (bis-phossy jaw): is this phossy jaw of the 21st century? J Oral Maxillofac Surg 63:682

    PubMed  Article  Google Scholar 

  4. Marx RE (2008) Uncovering the cause of “phossy jaw” circa 1858 to 1906: oral and maxillofacial surgery closed case files—case closed. J Oral Maxillofac Surg 66:2356

    PubMed  Article  Google Scholar 

  5. Lorinser FW: Necrose der Kieferknochen in Folge und Einwirkung von Phosphordämpfen. In Oesterreichisch Medizinisches Jahrbuch (ed. Wien 1945:257)

  6. Hellstein JW, Marek CL (2004) Bis-phossy jaw, phossy jaw, and the 21st century: bisphosphonate-associated complications of the jaws. J Oral Maxillofac Surg 62:1563

    PubMed  Article  Google Scholar 

  7. Gendrin AN et al.: Recherches sur les maladies des ouvriers employes a la fabrication des allumetes chimiques. In Academie des Sciences (ed., 1846)

  8. Meyer-Hofmeister JC: Die Phosphorzündholzfabriken des Cantons Züirch mit Rücksicht auf die in denselben beobachteten Gesundheitsverhältnisse der Arbeiter. Schweizerische Zeitschrift fr Medicin, Chirurgie und Geburtshilfe 1947

  9. Myers ML, McGlothlin JD (1996) Matchmakers’ “phossy jaw” eradicated. Am Ind Hyg Assoc J 57:330

    CAS  PubMed  Article  Google Scholar 

  10. Kocher T (1893) Zur Kenntnis der Phosphornekrose. Ministry of Trade and Agriculture, Switzerland

    Google Scholar 

  11. von Schulthess-Rechberg JA (1879) Über die Phosphornekrose und den Ausgang ihrer Behandlung. In Department of Surgery (ed. Zurich University of Zurich)

  12. Hofmokl J (1871) Über die Resection des Ober- und Unterkiefers mit Rücksicht auf 88 darauf bezügliche Krankheitsfälle, welche auf der chirurgischen Klinik von Dumreichers 1852–1870 beobachtet und operirt worden sind. Medical Yearbooks, Vienna

    Google Scholar 

  13. Wegner G (1872) Einfluss des Phosphors auf den Organismus. Virchows Archiv. Bd. 55

  14. Ali-Erdem M, Burak-Cankaya A, Cemil-Isler S et al (2011) Extraction socket healing in rats treated with bisphosphonate: animal model for bisphosphonate related osteonecrosis of jaws in multiple myeloma patients. Med Oral Patol Oral Cir Bucal 16:e879

    PubMed  Article  Google Scholar 

  15. Sonis ST, Watkins BA, Lyng GD et al (2009) Bony changes in the jaws of rats treated with zoledronic acid and dexamethasone before dental extractions mimic bisphosphonate-related osteonecrosis in cancer patients. Oral Oncol 45:164

    CAS  PubMed  Article  Google Scholar 

  16. Reid IR, Bolland MJ, Grey AB (2007) Is bisphosphonate-associated osteonecrosis of the jaw caused by soft tissue toxicity? Bone 41:318

    CAS  PubMed  Article  Google Scholar 

  17. Bertoldo F, Santini D (2007) Lo Cascio V: Bisphosphonates and osteomyelitis of the jaw: a pathogenic puzzle. Nat Clin Pract Oncol 4:711

    CAS  PubMed  Article  Google Scholar 

  18. Kumar SKS, Gorur A, Schaudinn C et al (2010) The role of microbial biofilms in osteonecrosis of the jaw associated with bisphosphonate therapy. Curr Osteoporos Rep 8:40

    PubMed  Article  Google Scholar 

  19. Lesclous P, Abi Najm S, Carrel J-P et al (2009) Bisphosphonate-associated osteonecrosis of the jaw: a key role of inflammation? Bone 45:843

    CAS  PubMed  Article  Google Scholar 

  20. Kassolis JD, Scheper M, Jham B, Reynolds MA (2010) Histopathologic findings in bone from edentulous alveolar ridges: a role in osteonecrosis of the jaws? Bone 47:127

    PubMed  Article  Google Scholar 

  21. Mawardi H, Giro G, Kajiya M et al (2011) A role of oral bacteria in bisphosphonate-induced osteonecrosis of the jaw. J Dent Res 90:1339

    CAS  PubMed  Article  Google Scholar 

  22. Hirt L: Die äusseren Krankheiten der Arbeiter Leipzig 1878:117ff

  23. Jacobsen C, Metzler P, Rossle M et al.: Osteopathology induced by bisphosphonates and dental implants: clinical observations. Clin Oral Investig 2012. doi:10.1007/s00784-012-0708-2

  24. von Bibra E, Geist L: Die Krankheiten der Arbeiter in den Zündhlzfabriken, insbesondere das Leiden der Kieferknochen durch Phosphordämpfe. Vom chemisch-physiologischen, medicinischen-chirurgischen und medicinisch-polizeilichen Standpunkt bearbeitet. 1847

  25. Fedele S, Porter SR, D'Aiuto F et al (2010) Nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw: a case series. Am J Med 123:1060

    CAS  PubMed  Article  Google Scholar 

  26. Haltenhoff G: De la periostite et de la necrose phosphorique. In Department of Surgery (ed. Zurich University of Zurich 1866)

  27. Gevorgyan A, Enepekides DJ (2008) Bisphosphonate-induced necrosis of the jaws: a reconstructive nightmare. Curr Opin Otolaryngol Head Neck Surg 16:325

    PubMed  Article  Google Scholar 

  28. Lesky E (1966) Die Phosphornekrose, klassisches Beispiel einer Berufskrankeheit. Wien Klin Wochenschr 37:601

    Google Scholar 

  29. Brock G, Barker K, Butterworth CJ, Rogers S (2011) Practical considerations for treatment of patients taking bisphosphonate medications: an update. Dent Update 38:313

    PubMed  Google Scholar 

  30. Fehm T, Felsenberg D, Krimmel M et al (2009) Bisphosphonate-associated osteonecrosis of the jaw in breast cancer patients: recommendations for prevention and treatment. Breast 18:213

    CAS  PubMed  Article  Google Scholar 

  31. Ferlito S, Puzzo S, Liardo C (2011) Preventive protocol for tooth extractions in patients treated with zoledronate: a case series. J Oral Maxillofac Surg 69:e1

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

The authors do not have any conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C. Jacobsen.

Additional information

The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see http://www.textcheck.com/certificate/gbqxzp.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Jacobsen, C., Zemann, W., Obwegeser, J.A. et al. The phosphorous necrosis of the jaws and what can we learn from the past: a comparison of “phossy” and “bisphossy” jaw. Oral Maxillofac Surg 18, 31–37 (2014). https://doi.org/10.1007/s10006-012-0376-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10006-012-0376-z

Keywords

  • Phosphorous necrosis
  • Sequestrum
  • Infection
  • Bone resorption inhibitors
  • Periosteum