Osteonecrosis of the jaw (ONJ) is a well-known pathological condition in oncology derived from the use of bisphosphonates (BPs) and denosumab. Many molecular and immunological targets have been introduced for daily use in cancer treatment in recent years; consequently, new cases of ONJ have been reported in association with these drugs, especially if administered with BPs and denosumab. When the drugs are administered alone, ONJ is rarely seen. The objective of our study was to analyze the recent literature relative to the association of ONJ with these new drugs highlighting the pathogenic, clinical and therapeutic aspects. The close collaboration between maxillofacial surgeon, oncologist, dentist, and dental hygienist remains the most important aspect for the prevention, prompt recognition, and treatment of this pathology.

Mouth metastatic cancers are very rare and they usually represent the evidence of a widespread disease. Common primary tumors are lung carcinoma in men and breast carcinoma in women, followed by kidney cancer. In the oral soft tissues, the gingiva is the most common site, suggesting a possible role of inflammation in the attraction of circulating tumor cells. Oral metastasis has a serious prognosis. In this work, we describe the case of a 58-year-old man affected by renal cancer, who was brought to our attention for the appearance of a gingival swelling. Initially, the lesion was excised through a provisional clinical diagnosis of epulis. Subsequently, anatomopathological analysis showed a metastasis compatible with clear-cell carcinoma and specifically its renal origin was confirmed by immunohistochemical techniques.

Multifocal brown tumors are a rare complication of primary hyperparathyroidism (PHPT). The reported prevalence of PHPT-related brown tumor is 3-4%. The tumor may histologically resemble any giant cell tumor of the jaws; hence, diagnostic errors or a delayed diagnosis of PHPT, when the lesion is the first clinical manifestation of this disease.We present a 27-year-old patient at 17-week gestation, who was diagnosed with an expansile mass in the left maxilla. Diagnostic tests also revealed two osteolytic lesions in the mandible.The patient underwent left maxillary segmental resection; the tumor was resected en bloc with teeth 25, 26. Histology confirmed the primary diagnosis of giant cell tumor. The observation was continued on an outpatient basis. Following delivery, progression of mandibular osteolytic lesions and maxillary tumor recurrence were found. Blood chemistry panel was ordered and the results raised a suspicion of primary hyperparathyroidism. Subsequent diagnostic tests revealed lower right parathyroid adenoma. Parathyroidectomy resulted in an almost complete regression of the mandibular lesions and a slight regression of the maxillary tumor.The paper presents diagnostic challenges associated with brown tumors as well as clinical, radiological, biochemical and histological manifestations thereof. The effect of pregnancy on the course of primary hyperparathyroidism is discussed and a diagnostic/therapeutic scheme is proposed when giant cells are present in a biopsy specimen.Key words: primary hyperparathyroidism, brown tumor of the maxilla/mandible, giant cell tumor of the maxilla/mandible, pregnancy epulides Słowa kluczowe: pierwotna nadczynność przytarczyc, guz brunatny szczęki i żuchwy, guz olbrzymiokomórkowy szczęki i żuchwy, guzy ciążowe

Medication-related osteonecrosis of the jaw (MRONJ) has recently associated to the increase in antiresorptive and anti-angiogenic drugs prescriptions in the treatment of oncologic and osteoporotic patients. The physiopathogenesis of MRONJ remains unclear and available treatments are unsatisfactory. Newer pharmacological treatments have shown good results, but are not curative and could have major side effects. At the same time as pharmacological treatments, mesenchymal stem cells (MSCs) have emerged as a promising therapeutic modality for tissue regeneration and repair. MSCs are multipotential non-hematopoietic progenitor cells capable to differentiating into multiple lineages of the mesenchyme. Bone marrow MSCs can differentiate into osteogenic cells and display immunological properties and secrete paracrine anti-inflammatory factors in damaged tissues. The immunomodulatory, reparative, and anti-inflammatory properties of bone marrow MSCs have been tested in a variety of animal models of MRONJ and applied in specific clinical settings. The aim of this review is to discuss critically the immunogenicity and immunomodulatory properties of MSCs, both in vitro and in vivo, the possible underlying mechanisms of their effects, and their potential clinical use as modulators of immune responses in MRONJ, and to identify clinical safety and recommendations for future research.

The epidemiology of the dental disease in sickle cell anemia is not adequately described. The aim of this work is either the evaluation of literature on the topic, or to describe if the disease itself predisposes to a dental pathology, and eventually also if the latter can influence its course. We selected many cases and reviews in order to identify the dental diseases related to sickle cell anemia. Caries and periodontitis are not directly caused by disease. However, an inflammatory state caused by a dental infection can trigger or precipitate a sickle crisis. Malocclusion angle class II is particularly frequent, as a result of bone facial changes and/or related to muscle imbalance. Temporomandibular joint disorder is possible. Asymptomatic pulp necrosis is due to the sickling that causes vasocclusion within microcirculation of the dental pulp. Large population-based studies are needed in order to clarify the dental involvement in this disease. A strict collaboration between the dentist and the hematologist is essential.