Jump to content

Phossy jaw

This article's lead is ready for translation. Click for more information.
From WikiProjectMed
Phossy jaw
Other names: Phosphorus necrosis of the jaw; Lucifer's jaw[1]
28 year old match factory worker following surgical removal of the jaw for phossy jaw[2][3]
SpecialtyOccupational health and safety
SymptomsSevere jaw pain, jaw abscesses[4]
ComplicationsLiver or kidney problems[1]
Usual onsetOver years[5]
CausesWhite phosphorus[4]
Diagnostic methodX-rays[1]
PreventionSubstitution of red phosphorus, dental care[5][1]
TreatmentSurgical removal of the jaw[5]
FrequencyCommon from 1858, rare by 1906[5]

Phossy jaw, also known as phosphorus necrosis of the jaw, was a workplace related condition resulting from exposure to white phosphorus.[4] Symptoms included severe jaw pain and jaw abscesses.[4] Other symptoms may include breath that smells like garlic, bleeding from the lungs, and neurological problems.[5][6] Onset was over years.[5] Complications may include liver or kidney problems.[1]

The cause was long-term exposure to white phosphorus, also known as yellow phosphorus, historically used in making matches.[4][1] It was generally due to the vapor form.[1] It may also occur in certain chemical and fireworks manufacturing.[1] X-rays may show bone damage.[1]

Treatment involved surgical removal of the jaw.[5] Preventive efforts included improved ventilation and reducing hours of exposure.[7] During the 1900s many countries banned most use of white phosphorus, with red phosphorus working aswell in matches and being less toxic.[5][1] Proper dental care may also be helpful.[1]

Phossy jaw was most commonly seen from 1858 and became rare by 1906.[5][8] As children commonly worked in the industry they were most often affected.[8] It is currently very rare.[8] While first described in 1838,[7] awareness of the condition was raised in 1869 by Alice Hamilton, the mother of occupational medicine.[8] A similar condition is bisphosphonate-related osteonecrosis of the jaw.[9]

Signs and symptoms

Drawing from 19th century of phossy jaw

Those with phossy jaw would usually begin suffering painful toothaches and swelling of the gums. The pain was characterized as "persistent yet progressive ... spreading to neighboring teeth and jawbone".[10] Over time, pus formation developed penetrating the oral mucosa with the formation of fistula, tooth loss, and recurrent abscesses.[10] Further progression led to the formation of sequestrum (dead bone that has separated from living bone) after three months and necrosis of the jaw within six months.[10] The distinguishing feature of this disease was the eventual separation of the sequestrum which was described as porous and light in weight.[11][12] The lower jaw was more commonly affected than the upper jaw.[12] Affected bones glowed a greenish-white colour in the dark.[13][14] The condition also affected the brain, provoking seizures in some long-term cases.[15]

Cause

Match industry

White phosphorus was the active ingredient of most matches from the 1840s to the 1910s. Concern over phossy jaw contributed to the London matchgirls strike of 1888, and although this strike did not end the use of white phosphorus, William Booth and The Salvation Army opened a match-making factory in 1891 that used the much safer, though more expensive, red phosphorus.[16] The Salvation Army also campaigned with local retailers to get them to sell only red phosphorus matches.[16]

However it was not until the use of white phosphorus was prohibited by the international Berne Convention in 1906 and its provisions were implemented in national laws over the next few years that industrial use ceased.[17]

Bisphosphonates

A related condition, medication related osteonecrosis of the jaw (MRONJ), has been described as a side-effect of amino-bisphosphonates, a class of phosphorus-based drugs that inhibit bone resorption and are used widely for treating osteoporosis, bone disease in cancer and some other conditions.[18] BON, sometimes called "bis-phossy jaw",[19] is primarily associated with the use of intravenous bisphosphonates in the treatment of cancer. The percentage incidence of BON from this use is approximately 1000 times higher than the incidence of BON caused by the use of oral bisphosphonates.[20]

Mechanism of action

In phossy jaw patients, the forensic evidence suggested the conversion of yellow phosphorus to potent amino bisphosphonates by natural chemical reactions in the human body. Yellow phosphorus has a simple chemistry; when combined with H2O and CO
2 molecules from respiration and some amino acids such as lysine, bisphosphonates result.[12]

Diagnosis

The feature that appears first, pain in the teeth and jaw, and abscesses. Changes are visible on the jaw bones on X-rays. The sequestra, the parts of the bone that die and break off, are light in weight and yellow to brown in color. Thus phossy jaw can be clearly demarcated from similar entities by radiographs. In radiographs, the sequestra present a typical worm-eaten appearance similar to a pumice stone. Sequestra appear osteoporotic and decalcified. Separation of the dead bone from the surrounding bone appears clearly demarcated in the radiographs.[11]

Treatment

Treatments included topical antimicrobials, conservative debridement of sequestra and surgery.[21] Surgical removal of the afflicted jaw bones could save the patient; otherwise, death from organ failure would follow. The disease was extremely painful and disfiguring to the patient, with dying bone tissue rotting away accompanied by a foul-smelling discharge. Removal of the jaw bone also had serious effects on patients' ability to eat, leading to further health concerns including malnutrition.

History

The first case of phossy jaw was diagnosed in 1838 by Friedrich Wilhelm Lorinser, a doctor in Vienna.[7] The patient was a female Viennese matchstick maker who had been exposed to the phosphorus vapors over a five-year period.[22][23] He named the disease "Phosphorimus chronicus".[10] In 1844 Lorinser reported 22 cases of phossy jaw and established the toxic effects of white phosphorus in matchsticks.[24]

Society and culture

Europe

In 1872, the Grand Duchy of Finland, part of the Russian Empire, was the first country to place an absolute ban on the manufacture, use and sale of white phosphorus in matches; this was followed by Denmark in 1874 and France in 1897. In Great Britain, a ban on white phosphorus matches became effective on 1 January 1910.[22][24] The international association for labor legislation, an international conference, met at Berne, Switzerland, in 1906 and pledged to prohibit the manufacture, importation and sale of white phosphorus matches. This treaty was signed by Finland, Denmark, France, Switzerland, Luxembourg, Italy, the Netherlands and Germany, in what is considered as the first international attempt to ban an industrial product.[22][24][25]

United States

Phossy jaw was publicized by the American Association for Labor Legislation, whose secretary, John B. Andrews, began investigating the disease in 1909 and found more than 100 cases. This report was published in the Bulletin of the Bureau of Labor. The White Phosphorus Match Act of 1912, signed by President William Howard Taft on April 9, 1912, required manufacturers who used white phosphorus to register with district collectors of internal revenue and to file periodic notices and returns, levied a tax of two cents per hundred matches and required makers of white-phosphorus matches to affix revenue stamps to the matchboxes.[22][24][25]

Asia

Russia placed a heavy tax on white phosphorus matches in 1892 which was doubled in 1905. By 1906, the production of white phosphorus matches had been reduced to one match in every fifty.[22] India and Japan banned the use of white phosphorus in 1919 after the United States, followed by China's ban on white phosphorus usage in match production in 1925.[24]

See also

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Bingham, Eula; Cohrssen, Barbara (31 July 2012). Patty's Toxicology, 6 Volume Set. John Wiley & Sons. p. 844. ISBN 978-0-470-41081-3.
  2. ↑ De Ponte, Francesco Saverio, ed. (2012). Bisphosphonates and osteonecrosis of the jaw: a multidisciplinary approach. Milan ; New York: Springer. doi:10.1007/978-88-470-2083-2. ISBN 978-88-470-2082-5. OCLC 773978688.
  3. ↑ Thompson, William Gilman (1914). The Occupational Diseases: Their Causation, Symptoms, Treatment and Prevention. D. Appleton and Company. p. 353. Retrieved 7 March 2025.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Wan, JT; Sheeley, DM; Somerman, MJ; Lee, JS (2020). "Mitigating osteonecrosis of the jaw (ONJ) through preventive dental care and understanding of risk factors". Bone research. 8: 14. doi:10.1038/s41413-020-0088-1. PMID 32195012.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Friss, Robert (8 March 2018). Essentials of Environmental Health. Jones & Bartlett Learning. p. 336. ISBN 978-1-284-12397-5. Retrieved 5 March 2025.
  6. ↑ Hathaway, Gloria J.; Proctor, Nick H. (3 December 2014). Proctor and Hughes' Chemical Hazards of the Workplace. John Wiley & Sons. p. 583. ISBN 978-0-471-26883-3.
  7. ↑ 7.0 7.1 7.2 Jacobsen, C. "The phosphorous necrosis of the jaws and what can we learn from the past: a comparison of "phossy" and "bisphossy" jaw" (PDF). Archived (PDF) from the original on 27 November 2022. Retrieved 27 November 2022. Archived 27 November 2022 at the Wayback Machine
  8. ↑ 8.0 8.1 8.2 8.3 Friis, Robert H. (2015). Occupational Health and Safety for the 21St Century. Jones & Bartlett Publishers. p. 15. ISBN 978-1-284-04603-8.
  9. ↑ Otto, Sven (27 November 2014). Medication-Related Osteonecrosis of the Jaws: Bisphosphonates, Denosumab, and New Agents. Springer. p. 205. ISBN 978-3-662-43733-9.
  10. ↑ 10.0 10.1 10.2 10.3 Jacobsen, C; Zemann, W; Obwegeser, J. A; Grätz, K. W; Metzler, P (2014). "The phosphorus necrosis of the jaws and what can we learn from the past" (PDF). Oral and Maxillofacial Surgery. 18 (1): 31–7. doi:10.1007/s10006-012-0376-z. PMID 23271457. S2CID 22798482. Archived (PDF) from the original on 2024-05-15. Retrieved 2025-02-15. Archived 2024-05-15 at the Wayback Machine
  11. ↑ 11.0 11.1 Hughes, J. P; Baron, R; Buckland, D. H; Cooke, M. A; Craig, J. D; Duffield, D. P; Grosart, A. W; Parkes, P. W; Porter, A (1962). "Phosphorus Necrosis of the Jaw: A Present-Day Study: With Clinical and Biochemical Studies". British Journal of Industrial Medicine. 19 (2): 83–99. doi:10.1136/oem.19.2.83. JSTOR 27721724. PMC 1038164. PMID 14449812.
  12. ↑ 12.0 12.1 12.2 Marx, Robert E (2008). "Uncovering the Cause of "Phossy Jaw" Circa 1858 to 1906: Oral and Maxillofacial Surgery Closed Case Files—Case Closed". Journal of Oral and Maxillofacial Surgery. 66 (11): 2356–63. doi:10.1016/j.joms.2007.11.006. PMID 18940506.
  13. ↑ "Workshops of Horror". New Zealand Department of Labour. Archived from the original on 20 June 2007. Archived 20 June 2007 at the Wayback Machine
  14. ↑ Chustecka, Zosia (2005). "Bisphosphonates and jaw osteonecrosis". Medscape. Archived from the original on 2021-10-21. Retrieved 2025-02-15. Archived 2021-10-21 at the Wayback Machine
  15. ↑ Pollock, RA; Brown TW, Jr; Rubin, DM (September 2015). ""Phossy Jaw" and "Bis-phossy Jaw" of the 19th and the 21st Centuries: The Diuturnity of John Walker and the Friction Match". Craniomaxillofacial Trauma & Reconstruction. 8 (3): 262–70. doi:10.1055/s-0035-1558452. PMC 4812794. PMID 27053988.
  16. ↑ 16.0 16.1 Fact and fiction about Salvation Army history. salvationarmy.org.au Archived August 19, 2008, at the Wayback Machine
  17. ↑ Phossy jaw Archived 2008-05-16 at the Wayback Machine. Rootsweb.com. Retrieved on 2018-04-12.
  18. ↑ Durie BG; Katz M; Crowley J (July 2005). "Osteonecrosis of the jaw and bisphosphonates". N. Engl. J. Med. 353 (1): 99–102, discussion 99–102. doi:10.1056/NEJM200507073530120. PMID 16000365.
  19. ↑ Abu-Id, Mario H; Warnke, Patrick H; Gottschalk, Joachim; Springer, Ingo; Wiltfang, Jörg; Acil, Yahya; Russo, Paul A.J; Kreusch, Thomas (2008). ""Bis-phossy jaws" – High and low risk factors for bisphosphonate-induced osteonecrosis of the jaw". Journal of Cranio-Maxillofacial Surgery. 36 (2): 95–103. doi:10.1016/j.jcms.2007.06.008. PMID 18234504.
  20. ↑ Cartsos VM, Zhu S, Zavras AI (January 2008). "Bisphosphonate use and the risk of adverse jaw outcomes: a medical claims study of 714,217 people". J Am Dent Assoc. 139 (1): 23–30. doi:10.14219/jada.archive.2008.0016. PMID 18167381.
  21. ↑ Hellstein, J. W; Marek, C. L (2004). "Bis-phossy jaw, phossy jaw, and the 21st century: Bisphosphonate-associated complications of the jaws". Journal of Oral and Maxillofacial Surgery. 62 (12): 1563–5. doi:10.1016/j.joms.2004.09.004. PMID 15573361.
  22. ↑ 22.0 22.1 22.2 22.3 22.4 Lee, R. Alton (1966). "The Eradication of Phossy Jaw: A Unique Development Of Federal Police Power". The Historian. 29: 1–21. doi:10.1111/j.1540-6563.1966.tb01764.x.
  23. ↑ "The Return of the Dreaded Phossy Jaw". RDH Magazine. July 2009. Archived from the original on 2022-11-30. Retrieved 2025-02-15. Archived 2022-11-30 at the Wayback Machine
  24. ↑ 24.0 24.1 24.2 24.3 24.4 Myers, M. L; McGlothlin, J. D (1996). "Matchmakers' "phossy jaw" eradicated". American Industrial Hygiene Association Journal. 57 (4): 330–2. PMID 8901233. Archived from the original on 2018-10-09. Retrieved 2025-02-15.
  25. ↑ 25.0 25.1 "Phosphorus Poisoning in the Match Industry in the United States". JAMA. 303 (22): 2303. 2010. doi:10.1001/jama.2010.696.


Retrieved from "https://mdwiki.org/w/index.php?title=Phossy_jaw&oldid=1479542"