What Is Phossy Jaw

Key Takeaways

• Phosphorus necrosis, or phossy jaw, was an occupational disease suffered by workers in match factories between the 1830s and the early 20th century.
• Sufferers of phossy jaw often ended up permanently disfigured due to both the disease itself and the surgery required to treat it.
• Due to a worldwide ban on white phosphorus in match production, phossy jaw no longer exists.
• The condition serves as a historical example of the importance of workplace safety regulations and other occupational diseases that have now been eradicated.
• Similar forms of jaw necrosis still sometimes occur, and doctors and oral surgeons have to take care to prevent and treat them.

What is Phossy Jaw?

Phossy jaw, or phosphorus necrosis of the jaw, was a potentially deadly condition that used to affect workers in match factories. It was first described in 1839 and was eradicated in the early 20th century.

The disease caused parts of a person’s jawbone, usually the lower jaw, to die gradually (necrosis) and separate from the surrounding bone. This process would occur over several months, causing extreme pain and eventually disfiguring the person.

What Caused Phossy Jaw in the 19th Century?

Phossy jaw was caused by a specific form of phosphorus used to make matches, known as white or yellow phosphorus. This chemical is what allowed the matches to burn when struck.

Workers in the matchstick industry frequently inhaled white phosphorus vapors during manufacturing. Chemical reactions inside the workers’ bodies would create compounds called bisphosphonates.

After months or years of exposure to white phosphorus, these compounds caused changes in the jawbone cells, leading them to die off. Even after leaving the matchstick industry, a person would remain at risk for some time.

Symptoms and Progression

The time from the earliest symptoms to significant jaw necrosis is about 6 months.

At first, a person with phossy jaw might suffer from persistent toothaches and gum swelling, giving way to abscesses and tooth loss. Eventually, the dying jawbone would be exposed to the inside of the mouth.

The decaying mouth tissue emitted a foul odor, and the dead parts of the jawbone glowed in the dark due to the effects of the phosphorus. In some cases, phosphorus poisoning also affected the brain (causing seizures) and led to anemia.

Most sufferers of phossy jaw survived, but only because of medical treatment. Surgical removal of the dead bone was required to prevent death from organ failure.

How Was Phossy Jaw Treated?

Phossy jaw was treated with surgical mouth debridement to remove the dead and dying tissue. Topical medication was also used to kill local bacteria. In some places, factory workers would be given preventive dental care, but this wasn’t enough to eradicate the disease.

Unfortunately, the disease and treatment meant that people with phossy jaw were often permanently disfigured. Talking and eating would also have been more difficult, leading to malnutrition and other complications.

Does Phossy Jaw Still Exist Today?

Phossy jaw was eradicated with improved regulations and business practices in the matchstick industry. Matches are no longer made with white phosphorus. Instead, they’re often made with red phosphorus, a much safer form of the chemical.

However, similar forms of jaw necrosis still sometimes occur due to certain medications.

Understanding Osteonecrosis of the Jaw (ONJ)

Phossy jaw was simply one form of osteonecrosis of the jaw (ONJ). ONJ is a condition that causes the bone cells in the jawbone to die due to poor blood flow to the area. Other forms of ONJ began to be reported in 2003 in people being treated with bisphosphonates for cancer or osteoporosis.

Bisphosphonates may raise ONJ risk. These include:

• Fosamax
• Actonel
• Atelvia
• Boniva
• Reclast
• Prolia

These medications are similar to those created by white phosphorus vapors. However, other medications that treat osteoporosis, bone resorption, or bone cancer can also cause ONJ.

Prevention and Treatment

The main risk factor for medication-related ONJ is tooth extraction. In people taking these medications, the exposure of bone tissue after tooth extraction could lead to ONJ.6

For this reason, doctors generally recommend pausing these medications for 2 months leading up to tooth extraction. Avoiding alcohol and smoking, maintaining good oral hygiene, and antibiotics to prevent infection may also be helpful.

Similarly to phossy jaw, ONJ today can be treated with antiseptic mouthwashes, antibiotics, and surgery. Fortunately, modern treatment can limit the progress of the disease in most cases, allowing people to make a full recovery.