Osteonecrosis of the Jaw Associated with Methamphetamine or Cocaine Abuse

Clinical features:

(1) onset of osteonecrosis of the jaw

(2) history of methamphetamine and/or cocaine

(3) exclusion of other diagnoses

(4) other signs of drug abuse including poor oral health

Possible mechanisms:

(1) vasoconstriction with ischemia

(2) exposure to red or white phosphorus (vapors or drug contaminant from methamphetamine production)

(3) self-extraction of teeth

Differential diagnosis:

(1) osteomyelitis of the jaw

(2) other causes of medication-related osteonecrosis of the jaw (MRONJ)