"Phossy Jaw" - why?

[Canadjun]

The GQ thread on gender-related diseases mentioned phossy jaw, and that reminded me of something that has bugged me for a long time.

WHY did the use of white phosphorus to make matches cause osteonecrosis of the jaw, aka phossy jaw? I understand why women using radium paint on watch faces contracted serious conditions, but white phosphorus puzzles me. It’s not radioactive, and phosphorus is used in the body. For that matter, red phosphorus doesn’t have the same effect.

Do any of the medical folk here know the mechanism of developing phossy jaw?

[am77494]

White phosphorus forms vapor and those working in the match industry and exposed to these vapors developed phossy jaw. Red phosphorus does not form vapors.

[Malthus]

Here’s an answer:

Uncovering the cause of "phossy jaw" Circa 1858 to 1906: oral and...

The infamous “phossy jaw” that created an epidemic of exposed bone osteonecrosis exclusively in the jaws began around 1858 and continued until 1906, with only a few cases appearing since that time. This epidemic of osteonecrosis produced pain, swelling, debilitation, and a reported mortality of 20% and was linked to “yellow phosphorous,” the key ingredient in “strike-anywhere” matches. In match-making factories, workers called “mixers,” “dippers,” and “boxers” were exposed to heated fumes containing this compound. Related to the duration of exposure, many of these workers developed painful exposed bone in the mouth, whereas their office-based counterparts did not. The exposed bone and clinical course were eerily similar to what modern day oral and maxillofacial surgeons see due to bisphosphonates used to treat metastatic cancer deposits in bone or osteoporosis. Although yellow phosphorus has a simple chemistry of P(4)O(10), when combined with H(2)O and CO(2) from respiration and with common amino acids, such as lysine, bisphosphonates almost identical to alendronate (Fosamax; Novartis Pharmaceuticals, East Hanover, NJ) and pamidronate (Aredia; Novartis Pharmaceuticals) result. Forensic evidence directly points to conversion of the yellow phosphorus in patients with “phossy jaw” to potent amino bisphosphonates by natural chemical reactions in the human body. Thus, the cause of phossy jaw in the late 1800s was actually bisphosphonate-induced osteonecrosis of the jaws, long before clever modern pharmaceutical chemists synthesized bisphosphonates. Today’s bisphosphonate-induced osteonecrosis represents the second epidemic of “phossy jaw.” Case closed.

… no idea if it is correct or not.

[Canadjun]

@Malthus

Here’s an answer:

Uncovering the cause of "phossy jaw" Circa 1858 to 1906: oral and maxillofacial surgery closed case files-case closed - PubMed

… no idea if it is correct or not.

Interesting! Still puzzled since the body uses phosphorus in day to day life, but a little less puzzled than I was.

[Mangetout]

@Canadjun

Interesting! Still puzzled since the body uses phosphorus in day to day life, but a little less puzzled than I was.

Many elements that are dangerous in pure form (or in specific compounds) are benign or beneficial in others. Breathing chlorine gas will harm you, but eating chlorine compounded with sodium is necessary (and tasty).

[Senegoid]

As mentioned above, the modern-day version of this disease (phossy jaw 2.0) is a sometimes-adverse-effect of bisphosphonates like Fosamax, prescribed to treat osteoporosis. My doctor prescribed this for me a few years ago, without ever discussing the possible side-effects with me. I knew about this, however, and declined to take this drug.

What I have been wondering, though, is why osteonecrosis is so specific to the jaw bone. What is that bone in particular susceptible to osteonecrosis? Why not other bones throughout the body?