Bisphosphonate-associated osteonecrosis of jaw reoccurrence after methotrexate therapy: a case report

Fahd Alsalleeh, Jeffery Keippel, Lyde Adams, J Bruce Bavitz

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

INTRODUCTION: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known complication caused by amino-bisphosphonate therapy. We document one case of BRONJ associated with oral administration of methotrexate, a known immunosuppressive drug used to treat rheumatoid arthritis.

METHODS: A 66-year-old woman was referred for evaluation and endodontic surgery of recently re-treated tooth 13. Tooth 14 was extracted 3 months prior, and the extraction site had not completely healed. Her medical history revealed rheumatoid arthritis and osteoporosis. She had been taking Fosamax (alendronate) 70 mg daily. Because of adequate root canal therapy of tooth 13, endodontic surgery was performed. Five months after apicoectomy, her symptoms had not changed. Tooth 13 was extracted, and the socket healed without complications. The socket of extracted tooth 14 was also healing. At the 3-month recall visit, bone exposure and purulent discharge at the site of extracted tooth 14 were noted. The patient had recently received methotrexate. The methotrexate was discontinued, and she was given course of amoxicillin.

RESULTS: At the 18-month follow-up, the healing progressed, and the wound was closed.

CONCLUSIONS: A medication that suppresses the immune system such as methotrexate may complicate the management of BRONJ. Once a diagnosis of BRONJ is made, a closely monitored conservative approach is recommended.

Original languageEnglish (US)
Pages (from-to)1505-1507
Number of pages3
JournalJournal of Endodontics
Volume40
Issue number9
DOIs
StatePublished - Sep 1 2014

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Bisphosphonate-Associated Osteonecrosis of the Jaw
Methotrexate
Tooth
Alendronate
Endodontics
Rheumatoid Arthritis
Tooth Socket
Apicoectomy
Root Canal Therapy
Therapeutics
Amoxicillin
Diphosphonates
Immunosuppressive Agents
Wound Healing
Osteoporosis
Oral Administration
Immune System
Bone and Bones
Pharmaceutical Preparations

Keywords

  • Bone necrosis induced by bisphosphonate
  • methotrexate
  • rheumatoid arthritis

ASJC Scopus subject areas

  • Dentistry(all)

Cite this

Bisphosphonate-associated osteonecrosis of jaw reoccurrence after methotrexate therapy : a case report. / Alsalleeh, Fahd; Keippel, Jeffery; Adams, Lyde; Bavitz, J Bruce.

In: Journal of Endodontics, Vol. 40, No. 9, 01.09.2014, p. 1505-1507.

Research output: Contribution to journalArticle

Alsalleeh, Fahd ; Keippel, Jeffery ; Adams, Lyde ; Bavitz, J Bruce. / Bisphosphonate-associated osteonecrosis of jaw reoccurrence after methotrexate therapy : a case report. In: Journal of Endodontics. 2014 ; Vol. 40, No. 9. pp. 1505-1507.
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AB - INTRODUCTION: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known complication caused by amino-bisphosphonate therapy. We document one case of BRONJ associated with oral administration of methotrexate, a known immunosuppressive drug used to treat rheumatoid arthritis.METHODS: A 66-year-old woman was referred for evaluation and endodontic surgery of recently re-treated tooth 13. Tooth 14 was extracted 3 months prior, and the extraction site had not completely healed. Her medical history revealed rheumatoid arthritis and osteoporosis. She had been taking Fosamax (alendronate) 70 mg daily. Because of adequate root canal therapy of tooth 13, endodontic surgery was performed. Five months after apicoectomy, her symptoms had not changed. Tooth 13 was extracted, and the socket healed without complications. The socket of extracted tooth 14 was also healing. At the 3-month recall visit, bone exposure and purulent discharge at the site of extracted tooth 14 were noted. The patient had recently received methotrexate. The methotrexate was discontinued, and she was given course of amoxicillin.RESULTS: At the 18-month follow-up, the healing progressed, and the wound was closed.CONCLUSIONS: A medication that suppresses the immune system such as methotrexate may complicate the management of BRONJ. Once a diagnosis of BRONJ is made, a closely monitored conservative approach is recommended.

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