Cancrum oris in developed countries.

Cancrum oris (or noma) is a rapidly progressive disease characterized by destructive necrosis of oral tissues and underlying bone. It is part of a multistage condition and may represent the outcome of untreated necrotizing stomatitis. Necrotising stomatitis and cancrum oris predominantly affect children in developing countries, especially in Africa. Only few cases have been reported in developed countries, and were associated with debilitating diseases and disorders of the immune system. We report a case of noma in an elderly immunosuppressed Italian patient in whom necrosis caused an external buccal communication. This case stresses the importance of an early identification and prompt management of the necrotic condition, in order to avoid diffusion of the destructive process within the oro-facial tissues.

Clinical aspects and management of bisphosphonates-associated osteonecrosis of the jaws.

OBJECTIVE: An increasing incidence of osteonecrosis of the jaws (ONJ) in patients treated with intravenous bisphosphonates has been reported in the literature. The aim of this study was to evaluate the clinical aspects, diagnostic investigations, and management of ONJ associated with bisphosphonates in a series of 12 patients. METHOD: Our patients included 1 asymptomatic and 11 symptomatic subjects. For the symptomatic patients, the osteonecrosis was diagnosed through histological investigations of exposed bone that showed avascular and necrotic tissue with inflammatory infiltrate. The patients were complaining of swelling, fever, and bone exposure involving the jaws. The asymptomatic patient presented as an occasional finding during a routine dental examination and the necrosis was confirmed on the basis of imaging investigations. Radiographic, scintigraphic, and microbiological examinations were carried out for all patients. Treatment included antibiotics, minor surgical interventions, and hyperbaric oxygen therapy. RESULTS: The radiological investigations revealed osteolytic areas and the scintigraphy demonstrated increased bone metabolism. The microbiological analysis showed pathogenic micro-organisms in the majority of patients. Therapy was useful in obtaining short-term symptomatic relief. CONCLUSIONS: Histological, radiological, nuclear medicine, and microbiological investigations are important diagnostic tools for patients with bisphosphonates-associated osteonecrosis of the jaws. However, a long-term follow-up is necessary if we are to better understand the treatment outcome.