You have microscopic evidence of ischemic osteonecrosis
(literally, "dead bone from poor blood flow"😉, a bone marrow
disease with either dead bone or bone marrow that has been
slowly strangulated or nutrient-starved. There are a number
of local and systemic problems capable of producing this
bone disease (Table 1), but more than 4 of every 5 patients
with osteonecrosis have a problem, usually inherited, of
excessive production of blood clots in their blood vessels
(Table 2). These are not normally picked up with routine
blood studies. Bone is particularly susceptible to this
problem and develops greatly dilated blood vessels,
increased, often painful, internal pressures, stagnation of
blood, even infarctions (completely blocked vessels). This
hypercoagulation problem might be suggested by a family
history of stroke and heart attacks at an early age (less
than 55 years), hip replacement or "arthritis" (especially
at an early age), and deep vein thrombosis. Chronic fatigue
syndrome and fibromyalgia are also associated with excess
coagulation and are frequently found in patients with
osteonecrosis, but the significance of this association is
not yet known. The jaws have a special problem with this
disease because, once damaged, the diseased bone is poorly
able to withstand low-grade infections from tooth and gum
bacteria. Also, when a dentist works on a tooth he or she
uses strong chemicals (vasoconstrictors, e.g., epinephrine)
designed to make local blood vessels smaller and thus keep
the local anesthetic in place longer. For someone who
already has a problem with poor blood flow through the jaws,
this may be disastrous.
Regardless of the underlying cause, the bone develops either
a fibrous marrow (fibers can live in nutrient starved
areas), a greasy, dead fatty marrow ("wet rot"😉, a very dry,
sometimes leathery marrow ("dry rot"😉, or a completely
hollow marrow space ("cavitation"😉. Any bone can be
affected, but the hips, knees and jaws are most often
involved. Pain is often severe but about 1/3 of patients do
not experience pain. The body has trouble healing itself
from this disease, but about 1/3 of cases do indeed heal
themselves. For the others, experience has shown that
surgically removing the damaged marrow, usually by scraping
with curettes, will eliminate the problem (and the pain) in
almost 3/4 of patients with jaw involvement. Repeat
surgeries, usually smaller procedures than the first, may be
required, and almost a third of jawbone patients will need
surgery in one or more other parts of the jaws because the
disease so frequently has "skip" lesions, i.e. multiple
sites in the same or similar bones, with normal marrow
between. In the hip, at least half of all patients will get
the disease in the opposite hip over time; this phenomenon
occurs in the jaws as well. Recently, it has been found that
some osteonecrosis patients respond to anticoagulation
therapies.