[Diffuse sclerosing osteomyelitis of the jaw: research advances and treatment strategies]

Diffuse sclerosing osteomyelitis of the jaw (DSO) is a rare non-suppurative inflammatory bone disease of unknown etiology, characterized by a chronic course, recurrent pain, and diffuse jawbone sclerosis. Diagnosis is challenging, and conventional surgical and anti-infective therapies have limited efficacy with high recurrence. Recent studies reveal that DSO is closely associated with synovitis-acne-pustulosis-hyperostosis-osteitis syndrome. The core mechanisms involves autoinflammatory bone-immune imbalance, particularly dysregulation of the receptor activator of nuclear factor-κB (NF-κB) ligand/receptor activator of NF-κB/osteoprotegerin (RANKL/RANK/OPG) signaling pathway. Consequently, the treatment strategy for DSO has fundamentally shifted from surgery and anti-infective drugs to a precision medicine approach with bisphosphonates, as the cornerstone,and expanded to include denosumab, tumor necrosis factor-α inhibitors, and JAK inhibitors. This article systematically reviews the etiology, diagnosis, key differential diagnoses, and recent advances in pharmacotherapy, and proposes a stepped treatment algorithm.