title: Painful tongue ulcerations in patients with bisphosphonate-associated osteonecrosis of the jaws.
abstract: OBJECTIVE
  Bisphosphonate-associated osteonecrosis of the jaws (BONJ) is a recently recognized and well described complication in cancer patients. While pain and associated morbidity have been reported, this has largely been attributed to localized infection of the nonvital bone and surrounding soft tissue, or in rare cases, pathologic fracture.
  
  
  METHODS
  Cancer patients who were treated with intravenous bisphosphonate therapy and subsequently developed BONJ with associated traumatic tongue ulcerations were reported.
  
  
  RESULTS
  We report a series of 5 patients who presented with unilateral painful tongue ulcerations secondary to the tongue rubbing against adjacent exposed mylohyoid bone on the lingual surface of the mandible. Smoothing, recontouring, or removal of the bone, and in some cases intralesional steroid therapy, resulted in complete resolution of symptoms.
  
  
  CONCLUSIONS
  Oral health care specialists and physicians must be alert to this potential complication of BONJ because it is easily managed with conservative measures and results in rapid and significant improvement in symptoms and overall quality of life.
authors.affiliation: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA 02115, USA. ntreister@partners.org
authors.forename: Nathaniel S
authors.initials: NS
authors.lastname: Treister
authors.forename: Paul
authors.initials: P
authors.lastname: Richardson
authors.forename: Robert
authors.initials: R
authors.lastname: Schlossman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Miller
authors.forename: Sook-Bin
authors.initials: SB
authors.lastname: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced / Q000150:complications* / Q000601:surgery; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D019226:Oral Ulcer / Q000209:etiology* / Q000628:therapy; D010020:Osteonecrosis / Q000139:chemically induced / Q000150:complications* / Q000601:surgery; D011788:Quality of Life; D014060:Tongue Diseases / Q000209:etiology* / Q000628:therapy; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide