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Case report: beware the silver nitrate stick – a risk factor for bisphosphonate-related osteonecrosis of the jaw (BRONJ) Michelle C de Souza Gabriela Stepavoi Dental Update 2024 42:8, 707-709.
Authors
Michelle Cde Souza
BDS, MJDF RCS(Eng)
Specialty Doctor in Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, Princess Alexandra Wing, Kingston Hospital, Surrey, KT2 7QB, UK
Associate Specialist in Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, Princess Alexandra Wing, Kingston Hospital, Surrey, KT2 7QB, UK
Topical silver nitrate may be used in oral and maxillofacial clinical settings owing to its astringent, caustic and disinfectant properties. Uses of the toughened silver nitrate pencil stick include haemostasis at bleeding points and for the management of aphthous ulcers, hypergranulation tissue, warts and verrucas. We present an interesting case of apparent silver nitrate-induced, bisphosphonate-related osteonecrosis of the hard palate following mucosal lesion biopsy in a multiple myeloma patient receiving zoledronic acid intravenous infusions. Our review of the literature indicates that this is the first report of such a scenario.
CPD/Clinical Relevance: Clinicians must consider all potential sources of chemical and mechanical trauma to the bone and overlying mucosa when managing patients at risk of developing bisphosphonate-related osteonecrosis of the jaw.
Article
Topical silver nitrate, in its toughened pencil stick form (Figure 1), has a wide variety of medical uses in the head and neck region (Table 1). Its caustic nature dictates its cautious use. Overzealous use may result in painful chemical burns of the oral mucous membranes/skin. For the patient on bisphosphonate therapy, this may result in osteonecrosis of the underlying bone.
Bisphosphonate-related osteonecrosis of the jaw (or BRONJ/BONJ) is defined as a minimum eight-week history of exposed non-vital (necrotic) maxillary/mandibular bone in the absence of a history of radiotherapy to the jaw but in the presence of current or past bisphosphonate therapy (BST).1 It can develop spontaneously or following oral mucosal and/or bony trauma and can be a highly unpleasant and protracted problem for the affected patient. It is now a widely recognized and increasingly documented, though still considered rare, adverse consequence of BST.
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