Malden N, Beltes C, Lopes V. Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm. Br Dent J. 2009; 206:93-98
Rustemeyer J, Bremerich A. Bisphosphonate-associated osteonecrosis of the jaw: what do we currently know? A survey of knowledge given in the recent literature. Clin Oral Invest. 2010; 14:59-64
Bagan JV. Letter to the Editor. Jaw osteonecrosis associated with bisphosphonates: multiple exposed areas and its relationship to tooth extractions. Study of 20 cases. Oral Oncol. 2006; 42:327-329
Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005; 63:1567-1575
Tortorici S, Burruano F, Difalco P. Maxillary bone necrosis following the use of formaldehyde containing paste: management and case series. Br Dent J. 2007; 203:(9)511-512
Bataineh AB, al-Omari MA, Owais AI. Arsenical necrosis of the jaws. Int Endod J. 1997; 30:(4)283-287
Loo Yi Kwan Nicotine-induced osteonecrosis. A case report. Dent Update. 2009; 36:289-291
McLeod NMH, Patel P, Kusanale A, Rogers SN, Brennann PA. Bisphosphonate osteonecrosis of the jaw – a literature review of UK policies versus international policies on the management of bisphosphonate osteonecrosis of the jaw. Br J Oral Maxillofacial Surg. 2011; 49:335-342
Filleul O, Crompot E, Saussez S. Bisphosphonate-induced osteonecrosis of the jaw: a review of 2400 patient cases. J Cancer Res Clin Oncol. 2010; 136:1117-1124
Seymour RA, Walton G. Effect of malignant disease and treatments on oral structures. Dent Update. 2009; 36:594-603
Markiewicz M, Maragone JE, Campbell JH, Aguirre A. Bisphosphonate-associated osteonecrosis of the jaws. A review of current knowledge. J Am Dent Assoc. 2005; 12:1669-1674
Ruggiero SL, Drew SJ. Osteonecrosis of the jaws and bisphosphonate therapy. J Dent Res. 2007; 86:(11)1013-1021
Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontol 2000. 2007; 44:178-194
Barker K, Rogers S. Bisphosphonate-associated osteonecrosis of the jaws: a guide for the general dental practitioner. Dent Update. 2006; 33:(5)270-275
Montefusco V, Gay F, Spina F, Miceli R, Maniezzo M, Teresa Ambrosini M Antibiotic prophylaxis before dental procedures may reduce the incidence of osteonecrosis of the jaw in patients with multiple myeloma treated with bisphosphonates. Leukemia Lymphoma. 2008; 49:(11)2156-2162
Moule I, Parsons PA, Irvine GH. Avoiding artefacts in oral biopsies: the punch biopsy versus the incisional biopsy. Br J Oral Maxillofac Surg. 1995; 33:244-247
Lynch DP, Morris LF. The mucosal punch biopsy: indications and technique. J Am Dent Assoc. 1990; 121:145-149
Reid IR, Bolland MJ, Grey AB. Is bisphosphonate associated osteonecrosis of the jaw caused by soft tissue toxicity?. Bone. 2007; 41:318-320
Patel V, McLeod MH, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw – a literature review of UK policies versus international policies on bisphosphonates and prevention. Br J Oral Maxillofac Surg. 2011; 49:251-257
Amin M, Glynn F, Phelan S, Sheahan P, Crotty P, McShane D. Silver nitrate cauterisation, does concentration matter?. Clin Otolaryngol. 2007; 32:(3)197-199
Alidaee MR, Taheri A, Mansoori P, Ghodsi SZ. Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial. Br J Dermatol. 2005; 153:521-525
Frost DE, Barkmeier WW, Abrams H. Apthous ulcer – a treatment complication. Oral Surg Oral Med Oral Pathol. 1978; 45:(6)863-869
Sudhindra TV, Joseph A, Hacking CJ, Haray PN. Are surgeons aware of the dangers of diathermy?. Ann R Coll Surg Engl. 2000; 82:(1)31-32
Bashetty K, Nadig G, Kapoor S. Electrosurgery in aesthetic and restorative dentistry: a literature review and case reports. J Conserv Dent. 2009; 12:(4)139-144
Oliver RJ, Sloan P, Pemberton MN. Oral biopsies: methods and applications. Br Dent J. 2004; 196:329-333
Case report: beware the silver nitrate stick – a risk factor for bisphosphonate-related osteonecrosis of the jaw (BRONJ) Michelle C de Souza Gabriela Stepavoi Dental Update 2024 42:8, 707-709.
Specialty Doctor in Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, Princess Alexandra Wing, Kingston Hospital, Surrey, KT2 7QB, UK
Associate Specialist in Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, Princess Alexandra Wing, Kingston Hospital, Surrey, KT2 7QB, UK
Topical silver nitrate may be used in oral and maxillofacial clinical settings owing to its astringent, caustic and disinfectant properties. Uses of the toughened silver nitrate pencil stick include haemostasis at bleeding points and for the management of aphthous ulcers, hypergranulation tissue, warts and verrucas. We present an interesting case of apparent silver nitrate-induced, bisphosphonate-related osteonecrosis of the hard palate following mucosal lesion biopsy in a multiple myeloma patient receiving zoledronic acid intravenous infusions. Our review of the literature indicates that this is the first report of such a scenario.
CPD/Clinical Relevance: Clinicians must consider all potential sources of chemical and mechanical trauma to the bone and overlying mucosa when managing patients at risk of developing bisphosphonate-related osteonecrosis of the jaw.
Article
Topical silver nitrate, in its toughened pencil stick form (Figure 1), has a wide variety of medical uses in the head and neck region (Table 1). Its caustic nature dictates its cautious use. Overzealous use may result in painful chemical burns of the oral mucous membranes/skin. For the patient on bisphosphonate therapy, this may result in osteonecrosis of the underlying bone.
Bisphosphonate-related osteonecrosis of the jaw (or BRONJ/BONJ) is defined as a minimum eight-week history of exposed non-vital (necrotic) maxillary/mandibular bone in the absence of a history of radiotherapy to the jaw but in the presence of current or past bisphosphonate therapy (BST).1 It can develop spontaneously or following oral mucosal and/or bony trauma and can be a highly unpleasant and protracted problem for the affected patient. It is now a widely recognized and increasingly documented, though still considered rare, adverse consequence of BST.
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