Patient aged 67 years, smoker of 6 cigarettes/day. Previously diagnosed with breast cancer (T2 N0 M0) treated by surgery associated with chemotherapy and radiotherapy. Due to metastatic progression of the breast carcinoma, treatment was started with bisphosphonates (pamidronate at a dose of 90 mg e.v. 20 cycles). After the first 9 cycles of pamidronate, the patient was referred to our Oral and Maxillofacial Surgery Department by her oncologist due to a burning sensation and diffuse gingival pain with habitual gingivorrhoea, presenting an ulcerous lesion 5 mm in diameter on the lateral edge of the right hemilengua, which was very painful.
Exodontia of the molar associated with the lingual decubitus lesion and four other non-viable teeth were indicated, with a bone exposure lesion appearing approximately one month after each exodontia at the site of the extractions. Limited debridement of the bone necrosis was performed, supplemented with antibiotherapy (amoxicillin-clavulanic acid, clarithromycin) and chlorhexidine gel. The evolution was favourable in all areas except for the mandibular molar, where the exposure of the bone perpetuated the lingual decubitus, requiring a second, more aggressive ostectomy. Although this exposure did not completely disappear, the patient's pain was well controlled as the lingual lesion disappeared.