Phossy jaws

Sir, a five-year-old girl visited our clinic with an extraoral swelling located on the lower left side of her face that had been there for two days. On clinical examination, severe dental caries extending up to the pulp (many of the teeth with only root stumps left) was seen in all of the deciduous teeth except the lower anteriors. The patient had a history of chronic matchstick consumption for the past two-and-a-half years until it was noticed and stopped by her parents. The child had also drunk milk from a bottle for the last three years. Seeing the child's condition, 'nursing bottle caries' was the instant diagnosis. However, the matchstick consumption reminded me of an occupational hazard associated with matchstick (phosphorus) consumption which has long been eradicated: 'phossy jaws'.

'Phossy jaws' was osteonecrosis of the jaw caused by exposure to white phosphorus during the manufacture of matches. They were made by dipping the match ends into a mixture containing white phosphorus.1,2 Factory workers were exposed to fumes from the white phosphorus during mixing and spreading of the dipping material, and the drying and boxing of the matches.2,3

About 11% of those exposed to phosphorus developed the disease. The average period from first exposure to diagnosis was five years. The mandible and maxilla could be affected. Phossy jaws were seen mostly in children, adolescents and women who worked in match factories up to 16 hours every day. Phosphoric vapour is generated by heating up phosphoric compounds, and is also absorbed through the gastro-intestinal tract. Dental decay was considered a prerequisite, leading to more serious problems like periostitis and osteomyelitis. Phossy jaw was fatal in about 20% of cases, usually because of septicaemia or meningitis.1,3

The discovery of red phosphorus led to successive prohibition of white phosphorus throughout the industry and after prohibition of the use of red matchsticks and matchstick making industries, this occupational disease was eradicated.4

In our case, no other finding was recorded apart from caries and facial swelling. Thus, the aim of this letter is to make readers aware of the 'matchstick menace' of the past.

References

  1. 1

    Donoghue M A . Bisphosphonates and osteonecrosis: analogy to phossy jaw. Med J Aust 2005; 183: 163–164.

  2. 2

    Carter G, Goss A N, Doecke C . Bisphosphonates and avascular necrosis of the jaw: a possible association. Med J Aust 2005; 182: 413–415.

  3. 3

    Purcell P M, Boyd I W . Bisphosphonates and osteonecrosis of the jaw. Med J Aust 2005; 182: 417–418.

  4. 4

    Myers M L, McGlothlin J D . Matchmakers' 'phossy jaw' eradicated. Am Ind Hyg Assoc J 1996; 57: 330–332.

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Kamboj, M. Phossy jaws. Br Dent J 203, 559 (2007). https://doi.org/10.1038/bdj.2007.1057

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