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Article: Volume 42 Number 8 Page 735 - October 2015

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  Dent Update 2015; 42: 735-743

Oral medicine:  Case Report: Beware the Silver Nitrate Stick − A Risk Factor for Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)

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Abstract: 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.

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.

Author notes: Michelle C de Souza, BDS, MJDF RCS(Eng), Specialty Doctor in Oral and Maxillofacial Surgery and Gabriela Stepavoi, Stat Exam, FDS RCS(Eng), Associate Specialist in Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Department, Princess Alexandra Wing, Kingston Hospital, Surrey, KT2 7QB, UK.

Objective: To highlight the potential adverse sequelae of using topical silver nitrate in the oral cavity, particularly in the presence, or with a history, of bisphosphonate therapy.