Medication Related Osteonecrosis of Jaw

ABSTRACT

A 41 year old female patient reported with the complaint of pain in the right posterior mandibular region for the past 5 months. History revealed that patient was diagnosed with breast cancer before 4 years following which she underwent mastectomy, radiotherapy and chemotherapy. PET / CT taken post chemotherapy showed bone metastasis to the lumbar spine for which she was prescribed I.V. zoledronic acid to be administered every 3 months. Patient was under I.V. zoledronic acid for a total of 36 months.Patient underwent surgery for extraction of impacted lower third molar before 7 months. The extraction site did not completely heal following which the tooth adjacent to the extraction site became mobile. The mobile tooth was also extracted before 5 months following which she developed pain and swelling in the region. Patient was diagnosed with osteoradionecrosis and underwent curettage and antiseptic dressing for 2 months. However, there was no reduction in pain. Pain was gradual in onset, continuous, gnawing, in the extraction site, aggravated by mastication and relieved by medication.