Leukemia is the most common neoplastic disease of the white blood cells which is important as a pediatric malignancy. Oral manifestations occur frequently in leukemic patients and may present as initial evidence of the disease or its relapse. The symptoms include gingival enlargement and bleeding, oral ulceration, petechia, mucosal pallor, noma, trismus and oral infections. Oral lesions arise in both acute and chronic forms of all types of leukemia. These oral manifestations either may be the result of direct infiltration of leukemic cells (primary) or secondary to underlying thrombocytopenia, neutropenia, or impaired granulocyte function. Despite the fact that leukemia has long been known to be associated with oral lesions, the available literature on this topic consists mostly of case reports, without data summarizing the main oral changes for each type of leukemia. Therefore, the present review aimed at describing oral manifestations of all leukemia types and their dental management. This might be useful in early diagnosis, improving patient outcomes.

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The aim of this study was to evaluate the strontium incorporation into specific bones and teeth of rats treated with strontium ranelate. The relative strontium levels [Sr/(Ca + Sr) ratio] were obtained by synchrotron radiation micro X-ray fluorescence. The incisor teeth were further examined by energy dispersive X-ray spectroscopy (EDS) in a scanning electron microscope. The isolated mineral phase was investigated by EDS in a transmission electron microscope and X-ray diffraction. The strontium content was markedly increased in animals treated with strontium ranelate, with different incorporation levels found among specific bones, regions within the same bone and teeth. The highest strontium levels were observed in the iliac crest, mandible and calvaria, while the lowest were observed in the femoral diaphysis, lumbar vertebrae, rib and alveolar bone. The strontium content was higher in the femoral neck than in the diaphysis. The strontium levels also varied within the alveolar bone. High levels of strontium were found in the incisor tooth, with values similar to those in the iliac crest. Strontium was observed in both enamel and dentin. The strontium content of the molar tooth was negligible. Strontium was incorporated into the mineral substance, with up to one strontium replacing one out of 10 calcium ions within the apatite crystal lattice. The mineral from treated animals presented increased lattice parameters, which might be associated to their bone strontium contents. In conclusion, the incorporation of strontium occurred in different levels into distinct bones, regions within the same bone and teeth of rats treated with strontium ranelate.

Osteonecrosis of the jaw. Medication-related osteonecrosis of the jaw. Neoplasm metastasis therapy. Diagnosis and management of osteonecrosis of the jaw. Drug-induced osteonecrosis of the jaw.

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A osteonecrose dos maxilares induzida por bisfosfonatos é a primeira complicação tardia da terapia com bisfosfonatos descrita na literatura científica. Essa é definida como o desenvolvimento de osso necrótico na cavidade oral de um paciente que esteja recebendo tratamento com bisfosfonatos e não tenha recebido radioterapia em região de cabeça e pescoço. Clinicamente, as lesões se caracterizam como ulcerações da mucosa oral, frequentemente muito dolorosas, que expõem o osso subjacente. O objetivo deste trabalho é relatar um caso clínico de osteonecrose induzida por bisfosfonatos de surgimento espontâneo, com difícil resposta a tratamento conservador, alcançando a cura com cirurgia.

Background Medication-related osteonecrosis of the jaw (MRONJ) is characterized by the development of bone necrosis in the jaws of patients receiving antiresorptive and/or antiangiogenic medications. No scientific reports have been published yet on bevacizumab-related osteonecrosis of the jaw (BeRONJ) when associated with dental implant placement and adjuvant ozone therapy. Case presentation A 54-year-old female patient with a history of metastatic breast cancer and bevacizumab use presented with a dental infection. Dental extraction followed immediately by dental implant placement was planned after suspension of the bevacizumab treatment. The patient presented with pain, drainage of purulent secretion, and bone exposure 5 weeks post-surgery. Complete healing was achieved at postoperative 7 months. Conclusions The combination of adjuvant ozone therapy and surgical debridement was effective for the treatment of MRONJ; however, the risk of MRONJ may persist after the suspension of bevacizumab for 28 days.