The American Academy of Oral Medicine (AAOM) affirms that medication-related osteonecrosis of the jaw (MRONJ) is defined as a condition of exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for more than 8 weeks in patients who are with current or have had previous exposure to antiresorptive or antiangiogenic agents and have no history of radiation therapy of the jaws. The AAOM also affirms that over the years, important information has emerged and can help providers make treatment decisions and minimize the risk for MRONJ. However, there still is limited clinical trialÀrelated evidence to support recommendations for the care of these patients; however, denying oral comprehensive care to patients who are in pain and have an active area of infection and sending them home with a prescription of analgesics and antibiotics is not the best management strategy. Patients in treatment with antiresorptives can receive dental care with a relatively good safety margin. This clinical practice statement was developed as an educational tool based on expert consensus of the AAOM leadership. Readers are encouraged to consider the recommendations in the context of their specific clinical situation, and consult, when appropriate, other sources of clinical, scientific, or regulatory information prior to making a treatment decision.

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Aim: This case describes multiple phleboliths found incidentally during a routine dental examination. Background: Phleboliths are pathological entities that are often associated with hemangiomas or vascular malformations in the maxillofacial region. Case Report: A 56-year-old female presented for comprehensive dental examination. Extraoral examination showed no facial skin abnormalities, lymphadenopathy, or salivary gland enlargement. Intraoral examination disclosed normal oral tissues, partially edentulous jaws, multiple dental restorations, recurrent caries, and marginal periodontal disease. Dental radiographs were obtained including an orthopantomograph, which revealed multiple well-defined, rounded radiopaque masses with laminated appearance, approximately 6-8 mm in diameter, located on the right side, and mainly superimposed on the coronoid process of the mandible. Magnetic resonance imaging with contrast confirmed the presence of low signal intensity foci suggestive of phleboliths, involving the inferior aspect of the right temporalis muscle, and extending anteriorly to the lateral pterygoid muscle within the retro antral fat of the right face, most compatible with a slow flow vascular malformation. Computed tomography angiography of head and neck with contrast verified the presence of multiple phleboliths involving the muscles of mastication on the right face and with no evidence of hemodynamically significant stenosis of the cervical and head blood vessels.Conclusion: Phleboliths in the maxillofacial area are mostly asymptomatic, and could represent the presence of a serious vascular anomaly. Clinical Significance: Dentists should be aware of these calcified bodies to avoid the risk of hemorrhage during oral and maxillofacial treatments. The clinician must be vigilant when considering, particularly, surgical procedures in the head and neck region.