Painful tongue ulcerations in patients with bisphosphonate-associated osteonecrosis of the jaws

Objectives. Bisphosphonate-associated osteonecrosis of the jaws (BONJ) is a recently recognized and well described complication in cancer patients. While pain and associated morbidity have been reported, this has largely been attributed to localized infection of the nonvital bone and surrounding soft tissue, or in rare cases, pathologic fracture. Study design. Cancer patients who were treated with intravenous bisphosphonate therapy and subsequently developed BONJ with associated traumatic tongue ulcerations were reported. Results. We report a series of 5 patients who presented with unilateral painful tongue ulcerations secondary to the tongue rubbing against adjacent exposed mylohyoid bone on the lingual surface of the mandible. Smoothing, recontouring, or removal of the bone, and in some cases intralesional steroid therapy, resulted in complete resolution of symptoms. Conclusions. Oral health care specialists and physicians must be alert to this potential complication of BONJ because it is easily managed with conservative measures and results in rapid and significant improvement in symptoms and overall quality of life.