A case of tooth fracture occurred upon medicating bisphosphonate for an elderly person: Preservation therapy and responses for Stage 0 of bisphosphonate-related osteonecrosis of jaw.

This case report aimed to report the progress of preservation therapy and response of symptoms and signs for Stage 0 of bisphosphonate-related osteonecrosis of jaw (BRONJ). A 68-year-old female was recognized having a tooth at the left upper first molar fracture upon medicating bisphosphonate (BP) in 2007. At that time, the extraction of the tooth was an absolute contraindication. Therefore, we performed preservation therapy. We observed the symptoms and signs every month. After 5 months, swelling and redness in the entire first molar tooth were seen and fistula formed partly. Bone exposure was not seen. We administrated antibiotics immediately. As a result, symptoms disappeared. On April 10, 2009, the patient visited us as she felt a sense of incongruity in the lower left first and second molar teeth. Clinically, there were no symptoms of pain. However, we observed the radiolucent finding in about 5 mm diameter at apical position by X-ray photography; we considered a possibility of Stage 0 for BRONJ. We immediately administered medicine for 5 days and the symptoms disappeared. At present, no inflammation with signs and symptoms at the upper left first molar and lower left first, second molar parts is shown. We performed preservation therapy for tooth fracture case medicating of BP. Immediate responses for inflammation and symptoms of the Stage 0 of BRONJ have led to success. Hence, dentists should perform regular clinical observation, and enough education to the patient for BRONJ is necessary.

Occlusal Dysesthesia: A Clinical Report on the Psychosomatic Management of a Japanese Patient Cohort.

PURPOSE: A cohort of Japanese patients diagnosed with occlusal dysesthesia (OD) was clinically analyzed for psychosomatic background, management, and treatment outcome. MATERIALS AND METHODS: The study group comprised 61 patients (17 men and 44 women) who met the OD criteria. Treatment outcomes were categorized as improvement, interruption, and transfer to another department. RESULTS: The diagnosed OD was resolved in 25 patients (41%), 20 patients (33%) discontinued treatment, 13 (21%) were referred or transferred to other specialties such as psychiatry, and 3 (5%) continued to receive treatment following an engagement period of 3 months, 2 years, and 5 years, respectively. Among the 20 patients who discontinued treatment, complaints persisted for 10 and they did not comply with treatment, 1 had immodithymia characterized by adherence to symptoms, 3 had depressive states, 2 were suspected to have schizophrenia, and 2 were suspected to have so-called phantom bite syndrome. CONCLUSION: This study suggests that OD treatment should take into account the underlying psychiatric disorder manifesting as physical complaints.