CREST syndrome diagnosed by oral lesions: A case report and review of the literature.

BACKGROUND: Calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is an acronym for the clinical features that are seen. Its etiology is unknown, affecting women three times more than men. CREST syndrome is often diagnosed by systemic symptoms. However, oral manifestations could be helpful in the early diagnosis of the disease. Less than 20 cases of CREST syndrome with oral symptoms were described. OBJECTIVE: To report a case of a 26-year-old female, who was diagnosed with CREST syndrome based on findings of the oral mucosa. CASE REPORT: Clinical examination revealed sclerodactyly and nail alterations. Oral findings were associated with hypochromic and paleness mucosa. The tongue was strongly rigid and reddish areas compatible with telangiectasias were found. The mouth opening was particularly compromised. Histological findings were suggestive of systemic sclerosis in the context of CREST syndrome. Considering the available diagnosis criteria, this case was diagnosed as CREST syndrome based on oral manifestations. CONCLUSIONS: Oral manifestations of CREST syndrome could help in early clinical diagnosis, preventing a delay in the onset of an aggressive form of the disease. Accurate referrals of patients to specialists are needed for a multidisciplinary approach.

Differences among oral carcinomas arising de novo from those associated with oral potentially malignant disorders: a systematic review and meta-analysis.

OBJECTIVE: To analyze the frequency of sequential oral squamous cell carcinomas (s-OSCC), preceded by oral potentially malignant disorders, and OSCC de novo (OSCC-dn) and explore differences in their clinicopathologic presentations. STUDY DESIGN: A structured electronic search strategy identified studies that analyzed frequency, clinical, biological, demographic, biomarkers, and prognostic features of s-OSCC and OSCC-dn according to PRISMA guidelines in PubMed, Scopus, Cochrane Library, and Google Scholar, up to January 31, 2023. Inclusion criteria were original English, Spanish, Portuguese, French, Italian, and German cross-sectional, cohort, and case-control studies. The quality of studies was assessed using the Agency for Research and Health Quality tool and the Newcastle-Ottawa Scale tool. RESULTS: The final selection included 40 studies. OSCC-dn and s-OSCC represent, respectively, 71% and 29% of cases of OSCC (P = .00), showing a higher percentage of T1 or of T1+T2 in s-OSCC (P < .0001). The association meta-analysis showed OSCC-dn with a significant association. The meta-analysis showed that s-OSCC was significantly associated with smaller tumor size, absence of distant metastases, relapses, male sex, and tumor sites different from tongue; and OSCC-dn was associated with more advanced tumor size, more regional and distant metastases, more advanced stages, and worse survival. CONCLUSIONS: S-OSCC was less frequent than expected. OSCC-dn seems to have specific clinical, biological, and prognostic features. Future perspectives on oral cancer prevention should address novel approaches and alternatives to screening, such as urgent referral of OSCC-dn.

Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.

OBJECTIVE: This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). METHODS: This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. RESULTS: Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). CONCLUSION: The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study.

OBJECTIVE: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. METHODS: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. RESULTS: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. CONCLUSIONS: In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Unusual clinical presentations of plasma cell mucositis involving oral mucosa: Presentation of 2 cases and review of the literature.

OBJECTIVE: Plasma cell mucositis (PCM) is a non-neoplastic plasma cell disorder of the upper aerodigestive tract with a high impact on life quality. Less than 70 cases were reported in the literature. The objective of this study was to report 2 cases of PCM. A concise review of the literature is also presented. STUDY DESIGN: Two cases of PCM that presented during the COVID-19 quarantine are reported. The inclusion criteria for the literature review were English-indexed case reports of the last 20 years. RESULTS: Cases were treated with meprednisone. As mechanical trauma was proposed as a triggering factor, its control was also considered. Patients were followed with no relapses. There were 29 studies included. The mean age was 57 years, with a male predominance, different clinical phenotypes, and intensely erythematous mucosa as a classical finding. The most frequent site was the lip, followed by the buccal mucosa. The final diagnosis is clinicopathologic. CD138 expression is a hallmark of plasma cells, frequently aiding PCM diagnosis. Plasma cell mucositis treatment is mostly symptomatic, and several therapeutic modalities have been mostly unsuccessful. CONCLUSIONS: Diagnosing plasma cell mucositis becomes challenging as many lesions may mimic other conditions. Consequently, in these cases, the diagnostic process should gather clinical, histopathologic, and immunohistochemical data.

Oral squamous cell carcinoma arising from chronic traumatic ulcers.

BACKGROUND: A proportion of oral squamous cell carcinoma (OSCC) is preceded by oral potentially malignant disorders (OPMD), and the rest might not be associated with any well-established OPMD. Chronic traumatic ulcer (CTU) has been suggested as a lesion with potential for malignant transformation, but the evidence is inconclusive. OBJECTIVE: The aim of this study was to describe clinicopathological features of non-healing CTU (NHCTU) that later developed to OSCC. MATERIALS AND METHODS: A retrospective cohort study was performed of patients attending the Facultad de Odontología Universidad Nacional de Córdoba (2013-2019). The study included patients with a provisional diagnosis of CTU. CTUs without complete healing after removal of traumatic factors-non healing CTU (NHCTU)-were investigated by biopsy. A detailed description of cases where a malignancy was diagnosed is presented. RESULTS: A total of 107 CTU were included. Of these, 32 CTUs were considered NHCTU and two cases showed histological features of OSCC in the background of NHCTU. In both cases, lesions were found on the lateral tongue. Both were non smoking, non alcohol drinking individuals. Absence of any well-known OPMD was also registered. CONCLUSIONS: The possibility of malignant transformation in a subset of tongue NHCTU should not be underestimated. CLINICAL RELEVANCE: In a subgroup of patients, NHCTU could be considered an OPMD. Although the potential malignant transformation rate is low, these conditions should be always followed up.

[Therapeutic alternatives for drug-associated maxillary osteonecrosis (MRONJ): reports of two clinical cases and review of the literature]. / Alternativas terapéuticas de osteonecrosis maxilar asociada a medicamentos (ONMAM): reportes de dos casos clínicos y revisión de la literatura.

Introduction: Drug-associated Maxillary Osteonecrosis is one of the most relevant adverse effects in treatment with antiresorptive drugs such as bisphosphonates and denosumab. Oncological conditions such as multiple myeloma, breast cancer, prostate, and bone-metabolic disorders such as osteoporosis lead the indications for these antiresorptive therapies. Treatment is complex because the disease is often refractory. Pharmacological, conservative and surgical treatments are described. Objective: The aim of this study is to report two clinical cases of MRONJ treated with two different therapeutic protocols and the analysis of the available literature on these aspects based on the clinical classification defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Conclusion: Patients who develop clinical signs of great morbidity associated with MRONJ, may see their quality of life conditioned and suffer a worsening of their underlying pathology. MRONJ treatment is conditioned by the stage of the disease, its success depends on interdisciplinary management and strict medical and dental clinical follow-up, as well as rigorous monitoring to prevent or detect future recurrences early.

Introducción: La Osteonecrosis Maxilar asociada a Medicamentos (ONMAM) constituye uno de los efectos adversos más relevantes en el tratamiento con drogas antirresortivas como bifosfonatos y denosumab. Patologías oncológicas como mieloma múltiple, cáncer de mama, próstata, y alteraciones óseas-metabólicas como la osteoporosis lideran las indicaciones para estas terapias antirresortivas. El tratamiento es complejo debido a que muchas veces, la enfermedad es refractaria a la terapéutica aplicada. Se describen tratamientos farmacológicos, conservadores y quirúrgicos. Objetivo: El objetivo de este trabajo es reportar dos casos clínicos de ONMAM tratados con dos protocolos terapéuticos diferentes y el análisis de la literatura disponible en la actualidad sobre estos aspectos en base a la clasificación clínica definida por la American Association of Oral and Maxillofacial Surgeons (AAOMS). Conclusión: Los pacientes que desarrollan cuadros clínicos bucales de gran morbilidad como lo es ONMAM, pueden ver condicionada su calidad de vida y sufrir un agravamiento de su patología de base. El tratamiento de ONMAM está condicionado al estadio de la enfermedad, el éxito del mismo depende del manejo interdisciplinario y de un estricto seguimiento clínico médico y odontológico, así como también un riguroso monitoreo para evitar o detectar precozmente futuras recurrencias.

Chronic mechanical irritation enhances the effect of tobacco and alcohol on the risk of oral squamous cell carcinoma: a case-control study in Argentina.

OBJECTIVES: Oral squamous cell carcinoma (OSCC) is a multifactorial disease. The individual effect of each risk factor for OSCC may be conditioned by the frequency of other factors. The objective of this study was to identify the association between chronic mechanical irritation (CMI) and OSCC and to analyse the influence of CMI on other important risk factors for OSCC. MATERIALS AND METHODS: A prospective and age/sex-matched case-control study was performed in two institutions from Argentina between 2009 and 2019, with consecutive and newly diagnosed OSCC. The frequencies of tobacco, alcohol, and CMI were analysed using conditional logistic regression. Cumulative tobacco consumption and the presence of CMI were analysed using the Mann-Whitney test. RESULTS: CMI and OSCC were associated with an OR of 7.02 (95% CI 3.57-13.78, p < 0.001). The combination of CMI and alcohol demonstrated the highest risk of OSCC (OR 53.83, CI 95% 8.04-360, p < 0.0001), followed by the combination of CMI, tobacco, and alcohol (OR 48.06, CI 95% 8.47-272, p < 0.0001). The combination of CMI and tobacco was also significant (OR 5.61, CI 95% 1.07-29.54, p = 0.042). Patients with CMI developed OSCC with less cumulative tobacco use compared with those without CMI. CONCLUSION: CMI is an independent risk factor for OSCC, and it could act as a risk modifier among tobacco and alcohol users having an enhancing effect. CLINICAL RELEVANCE: Elimination of CMI could decrease the risk of OSCC.

Oral squamous cell carcinoma in coca chewers from a north region of Argentina: A case series and review of literature.

Chewing coca leaves is a habit still practiced in Bolivia, Peru and Argentina. There is scarce evidence in the relationship between this habit and development of oral squamous cell carcinoma (OSCC), some authors have found oral epithelial changes in coca chewers. This study aimed to present a case series of patients with a coca chewing habit that developed OSCC, in the absence of risk factors for oral cancer. Patients were evaluated in Hospital Señor del Milagro, Salta, Argentina. None of them had a relevant morbid history and presented intraoral tumors, with an ulcerated surface on the gingivobuccal complex. Coca chewing habit was recorded in all cases. Present cases could start discussions and new lines of researches focusing on the habit of coca leaves chewing as a risk factor for OSCC. It would be very useful to know the underlying mechanisms between this habit and a possible role in oral carcinogenesis.

Acquired oral syphilis: A multicenter study of 339 patients from South America.

OBJECTIVE: To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS: Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS: The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION: This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.

False cheilitis (fausse cheilitis) as a clinical manifestation of oral secondary syphilis.

BACKGROUND: Syphilis is the oldest sexually transmitted infectious disease in humanity. In the last decades, it was noted the re-emergence of the disease, and actually it remains an important public health problem. Oral mucosa could be affected by the infection. Oral manifestations are commonly associated with secondary syphilis. It was described that the labial commissure could be involved as a split papule, also known as false cheilitis (FC). However, this clinical manifestation is poorly described in current literature. AIM: This brief report aims to determine the frequency of FC in patients diagnosed with secondary syphilis in our institution during the period 2009-2019. MATERIAL & METHODS: A cross-sectional retrospective study was conducted using the medical records of the Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina. The cases included were patients with provisional diagnosis of secondary syphilis with oral manifestations, confirmed by laboratory tests. Collection of clinical and serological data was performed. Absolute and relative values were obtained. RESULTS: In this study, 58 patients (26 males and 32 females) with an average age of 34.70 years old were included. The frequency of false cheilitis in these patients was 13% (8/58). All these patients with false cheilitis and secondary syphilis were young females with an average age of 25.12 years old. These lesions presented as angular cheilitis with an unilateral pattern with painful fissured papules associated with other oral lesions such as fissures, intraoral papules, tongue depapillation, white or red plaques, and the evidence of submandibular lymphadenopathies when examining the head and neck region. CONCLUSION: Our findings suggest that when angular cheilitis presents in young females as a painful, unilateral lesion, in the clinical context of other lesions and lymphadenopathies in the head and neck region, it could represent a suspicious clinical sign of syphilis. Considering the global re-emergence of sexually transmitted diseases, dentists should be aware of the oral clinical manifestations of syphilis as they play a significant role in the early detection of these conditions.

Clinical management of alveolar osteitis. A systematic review / Manejo clínico de la osteítis alveolar. Una revisión sistemática

Background: Alveolar Osteitis (AO) is one of the most common complications of tooth extraction. Several thera-peutic interventions have been described for the treatment of AO, however, there are no treatment standardizedprotocols. The aim of this study was to conduct a systematic review on the efficacy in pain control of the differenttreatments for AO. The feasibility of the application of these interventions is also discussed.Material and Methods: A structured electronic and hand search strategy was applied to PubMed, Scopus, Co-chrane Library, OpenGrey, and Google Scholar between January 2010 and July 2020 to identify studies accordingto PRISMA guidelines. The inclusion criteria were original English and Spanish clinical trials that analyzed pain-control parameters according to visual analog scale (VAS, 0-10 scale), or pain relief patients’ percentages. Thosetreatments that reach VAS ≤ 4 on day 2 or before; or ≥ 85% of patients with absence of pain symptoms at day 7 orbefore were considered acceptable for their recommendation.Results: The final review included 17 clinical trials. Among them, there were analyzed a total of 39 different AOtreatments. 53,8% of the treatments fulfill the proposed parameters for pain control.Conclusions: Treatment alternatives are multiple, heterogeneous, and difficult to compare. The management ofAO is summarized in basic (intra-alveolar irrigation) and specific procedures (Alveogyl®, Neocones®, SaliCeptPatch®, Low-Level Laser, Platelet-Rich Fibrin) that reach pain control success. They could be selected accordingto their availability and advantages or disadvantages.(AU)

Invasive oral squamous cell carcinoma induced by concurrent smokeless tobacco and creamy snuff use: A case report.

Oral squamous cell carcinomas (OSCC) are caused by chronic tobacco abuse. In this regard, the carcinogenic potential of smoking and smokeless forms of tobacco, including chewing tobacco and moist/dry snuff, has been widely documented. However, the effects of tobacco-containing products such as creamy snuff on oral health have not been widely reported. Here, we report on the clinical presentation of a patient with OSCC induced by concurrent chewing tobacco and creamy snuff use. The development and progression of mucosal carcinogenesis in the context of mixed tobacco use habits is discussed. With the increased availability of newer tobacco-containing products, it is important for clinicians to be aware of these products in the marketplace, including dentifrices and nicotine pouches, and counsel their patients regarding their health risks.

Tinción con azul de toluidina en biopsia dirigida de lesiones displásicas de la mucosa bucal: informe de casos clínicos / Toluidine blue guided biopsy of dysplastic lesions of the oral mucosa: clinical cases report

Objetivo: Los desórdenes de mucosa bucal potencialmente malignos pueden presentar áreas displásicas. En estos casos, la biopsia es un procedimiento imprescindible para un correcto diagnóstico. La inspección visual y la palpación, como método de selección del área de biopsia, ofrecen sensibilidad y especificidad adecuadas pero mejorables. El objetivo de este artículo es presentar una serie de casos clínicos en los que se describen el empleo y la interpretación de la tinción vital con azul de toluidina como método complementario para contribuir a una mejor elección del área de biopsia. Casos clínicos: Se trata de siete casos de lesiones con sospecha de displasia epitelial en mucosa bucal. En cada uno se detalla la correlación de las áreas teñidas con las manifestaciones clínicas y con el diagnóstico de displasia. Además, se muestran patrones de tinción considerados falsos positivos. En la interpretación de la tinción positiva, se tuvieron en cuenta el aspecto superficial y el color de la lesión teñida. El empleo combinado de inspección, palpación y tinción vital podría constituir un procedimiento integral de utilidad para obtener mayor precisión en la determinación del sitio de biopsia en comparación con los mismos procedimientos aplicados de manera individual. En la interpretación de la tinción positiva con azul de toluidina deberían considerarse el aspecto superficial y el color de la lesión teñida (AU)

Aim: Potentially Malignant Disorders in the oral cavity can present dysplastic areas. In these cases, the biopsy is an essential procedure for a correct diagnosis. Visual inspection and palpation, are adequate methods to select the area for the biopsy, however there is margin for improvement. The objective of this article is to present a series of clinical cases in which the use and interpretation of vital staining with Toluidine Blue is described as a complementary method to contribute to a better choice of the biopsy area. Clinical cases: Seven clinical cases that presented lesions with suspected epithelial dysplasia in the oral mucosa were presented. The correlation of the stained areas with the clinical manifestations and with the diagnosis of dysplasia is detailed in each case. Staining patterns considered false positives are also shown. In the interpretation of the positive staining, the superficial appearance and color of the stained lesion were considered. The combined use of inspection, palpation and vital staining could constitute a useful comprehensive procedure to obtain greater precision in determining the biopsy site in relation to the same procedures applied individually. In the interpretation of the positive staining with Toluidine Blue, the superficial appearance and color of the stained lesion should be considered (AU)

Lichenoid proliferative leukoplakia, lichenoid lesions with evolution to proliferative leukoplakia or a continuum of the same precancerous condition? A revised hypothesis.

BACKGROUND: Multiple white plaques of the oral mucosa are usually associated with potentially malignant disorders such as oral lichen planus, oral lichenoid lesions and proliferative verrucous leukoplakia. Previous studies in the current literature describe a potential clinical overlap in these entities. The aim of this study is to review clinicopathological and evolutive features of these Oral Potentially Malignant Disorders highlighting the dynamic changes of diagnoses. DISCUSSION: It was previously hypothesized that a subset of patients with oral lichen planus or oral lichenoid diagnosis, could develop multiple white plaques during the natural history of the disease, fulfilling diagnostic criteria for proliferative verrucous leukoplakia. Consequently, these entities could, under certain conditions, obey a continuum of the same precancerous condition in the context of the field cancerization theory, increasing the risk of malignant transformation. Nevertheless, there is limited scientific evidence concerning this issue. CONCLUSION: Further studies are needed to understand the biological and evolutive features of the link between these oral potentially malignant disorders. Regardless of its diagnosis, these patients with multifocal white lesions must be carefully monitored to detect early malignant transformation.

[Oral leukoplakia associated with Human Papilloma Virus; a bipolar infection in a young patient]. / Leucoplasia Bucal asociada al Virus de Papiloma Humano; infección bipolar en paciente joven.

Introduction: Human Papilloma Virus could infect human epithelia, including cervical and oral keratynocites, leading to the development of dysplastic or malignant changes. Regarding the oral mucosa, leukoplakia is the most potentially malignant disorder associated with Papilloma Virus coinfection. Objective: the aim of this report is to present a case of a young woman with a previous history of a high-risk cervical lesion associated with Human Papillomavirus and an oral leukoplakia associated with the same viral infection using immunohistochemical techniques. Methodology: the case was recorded and treated at the Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba. The patient was monitored and followed-up during three years, with no evidence of disease recurrence. Conclusion: due to the increased rates of Oral Squamous Cell Carcinomas among young patients in recent years and a supposed relationship to Human Papillomavirus infection, this case reflects a challenge not only in the diagnosis, treatment and follow-up, but also the urgent need to approach these patients in a transdisciplinary perspective. Since most of these viral lesions are usually transmitted sexually, it is necessary to promote awareness in the population about prevention and protection measures against sexually transmitted infections.

Introducción: El virus de Papiloma Humano infecta epitelios del organismo como el cervical o el bucal pudiendo generar cambios displásicos o malignos. Clínicamente, en la mucosa bucal la lesión potencialmente maligna más asociada a una coinfección viral es la leucoplasia. Objetivo: el objetivo de este trabajo es presentar un caso de una joven con antecedentes de lesiones cervicales de alto grado asociadas a infección por virus de Papiloma Humano y una lesión de leucoplasia bucal asociada a la misma infección viral mediante técnicas de inmunohistoquímica. Metodología: el caso fue registrado y tratado en la Cátedra de Estomatología "A" de la Facultad de Odontología, Universidad Nacional de Córdoba, con un seguimiento clínico de tres años, sin evidencia de recurrencias de la enfermedad. Conclusión: debido al incremento en los últimos años de carcinomas bucales en pacientes jóvenes y una supuesta relación a factores de riesgo como la infección por Virus de Papiloma Humano, este caso refleja un desafío no solo en el diagnóstico, tratamiento y seguimiento, sino también la imperiosa necesidad de abordar estos pacientes en forma transdisciplinaria. Ya que la mayoría de estas lesiones virales suelen transmitirse por vía sexual, es necesario promover conciencia en la población sobre las medidas de prevención y protección ante infecciones de transmisión sexual.

[Myelodysplastic syndrome, osteoporosis and medication-related osteonecrosis of the jaw: a case report]. / Síndrome mielodisplásico, osteoporosis y osteonecrosis maxilar asociada a medicamentos antirresortivos: reporte de un caso.

Introduction: Medication-related osteonecrosis of the jaw is a frequent collateral effect found in patients under antiresorptive treatments. Malignancies such as multiple myeloma, breast and prostate cancer as well as bone-metabolic disorders such as osteoporosis, lead the indications for these antiresorptive therapies. Even with a low frequency, myelodysplastic syndromes are also entities that have previously been associated with the development of jaw osteonecrosis. Objective: the aim of this study is to present a case of a 78-year-old male patient with myelodysplastic syndrome and secondary osteoporosis, treated with high-dose Zoledronic Acid and who developed a clinical scenario compatible with medication-related osteonecrosis of the jaw during its evolution. Methodology: : the case was recorded and treated in the Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, during a two-years period with a partial resolution, which recurred fourteen months later, where finally therapeutic success was achieved through a conservative management. Conclusion: Due to the increasingly use of antiresorptive drugs, the development of jaw osteonecrosis is possible associated with less frequent pathologies, such as myelodysplastic syndrome. Treatment success in these patients depends on interdisciplinary management and a rigorous clinical, medical and dental follow-up.

Introducción: La osteonecrosis maxilar asociada a medicamentos es una complicación encontrada en pacientes bajo tratamiento con drogas antirresortivas. Patologías oncológicas como mieloma múltiple, cáncer de mama y próstata y alteraciones óseas-metabólicas como la osteoporosis lideran las indicaciones para estas terapias antirresortivas. Aún con una baja frecuencia, los síndromes mielodisplásicos también son entidades que previamente han sido vinculadas al desarrollo de osteonecrosis. Objetivo: el objetivo de este trabajo es presentar un caso de un paciente masculino de 78 años con síndrome mielodisplásico y osteoporosis secundaria, tratado con Ácido Zoledrónico a altas dosis y que en su evolución desarrolló un cuadro clínico compatible con osteonecrosis maxilar asociada a medicamentos. Metodología: el caso fue registrado y tratado en la Cátedra de Estomatología "A" de la Facultad de Odontología, Universidad Nacional de Córdoba, durante un periodo de dos años con una resolución parcial del cuadro, el cual recurrió a los catorce meses, donde finalmente se llegó al éxito terapéutico mediante terapéuticas conservadoras. Conclusión: debido al uso cada vez más extendido de fármacos antirresortivos, es posible el desarrollo de osteonecrosis maxilar asociada a patologías menos frecuentes, como el síndrome mielodisplásico. El éxito del tratamiento en estos pacientes depende del manejo interdisciplinario y de un riguroso seguimiento clínico médico y odontológico.