title: Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports.
abstract: BACKGROUND
  Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.
  
  
  METHODS
  Two case reports of BRONJ involving RA patients were discussed
  
  
  RESULTS
  Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.
  
  
  CONCLUSIONS
  This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.
authors.affiliation: UNESP-Univ, Estadual Paulista, School of Dentistry, Department of Diagnosis and Surgery, Division of Periodontology, Rua Humaitá 1680, 14801-903 Araraquara, SP/Brazil. ncn1@ibest.com.br
authors.forename: Nicolau
authors.initials: N
authors.lastname: Conte-Neto
authors.forename: Alliny S
authors.initials: AS
authors.lastname: Bastos
authors.forename: Luis C
authors.initials: LC
authors.lastname: Spolidorio
authors.forename: Rosemary Ac
authors.initials: RA
authors.lastname: Marcantonio
authors.forename: Elcio
authors.initials: E
authors.lastname: Marcantonio
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019386:Alendronate