title: Arsenic Trioxide-Induced Mandibular Osteomyelitis.
abstract: Previously, arsenic was a popular devitalizing agent used to necrotize inflamed dental pulp to lower the pulp sensitivity owing to the unavailability of appropriate anesthesia. However, leakage from the apical foramen, lateral or accessory canals, or cracks in the tooth is common. This can be dangerous because of the reportedly high toxic effects of arsenic in both hard and soft tissues, leading to gingival and osseous necrosis and, consequently, osteomyelitis. Therefore, arsenic can prove fatal for both bones and teeth and is no longer used. We encountered a case involving a 50-year-old man who had developed mandibular osteomyelitis with lower lip paresthesia caused by arsenic trioxide used during endodontic treatment. The patient was treated with appropriate antibiotics, adjunctive hyperbaric oxygen therapy, and adequate surgical debridement. Hyperbaric oxygen therapy can induce neovascularization in necrosed tissues and improve bone and soft tissue healing. At a 4-year follow-up visit, bone healing was observed, with restoration of periodontal health, although the paresthesia had persisted. We describe this case, present a review of the relevant published data, and discuss the possible causes, diagnosis, treatment, and follow-up protocol of mandibular osteomyelitis caused by arsenic trioxide.
authors.affiliation: Visiting Staff, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; and PhD Program, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Lu
authors.affiliation: Assistant Professor, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; PhD Program, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Assistant Professor, Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ju-Hui
authors.initials: JH
authors.lastname: Wu
authors.affiliation: Professor, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; PhD Program, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Assistant Professor, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; PhD Program, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Assistant Professor, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: dujekang@gmail.com.tw.
authors.forename: Je-Kang
authors.initials: JK
authors.lastname: Du
mesh_terms: D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D008875:Middle Aged; D010019:Osteomyelitis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D010087:Oxides / Q000009:adverse effects*; D011862:Radiography, Panoramic
chemical_list: D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide