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On June 2014 the patient received a restoration of the alveolar bone disease and infection in the pathogenesis of
2nd right mandibular premolar because of pain. Pain and ONJ. [17,18]
purulence persisted in spite of endodontic therapy. Dental
extraction was recommended and completed in December The major treatment objectives for patients with ONJ
2014. The post-extraction follow up revealed a non- are pain and infection control and minimization of ONJ
healing socket. This area was managed with antibiotics progression. Antibiotics and topical antiseptics combined
(amoxicillin alone or combined with metronidazole) and with ozone oil applications and LLLT are used as best
surgical debridements (January to July 2015). A biopsy available clinical practice for early ONJ stages. [1,5,17,22]
taken from the soft tissue of the socket showed granulation Ozone oil has antimicrobial and healing properties, while
tissue. On July 2015 pain, swelling and purulence at the site LLLT biostimulation can improve healing. [23,24] The
of previous extraction [Figure 1], with necrotic bone being patient was managed with antibiotics, amoxicillin and/or
probed through a fistula and radiolucency, was observed on metronidazole, ozone oil applications and LLLT. The long
the periapical X-ray [Figure 2], leading to the diagnosis of delay (12 months) for the diagnosis of ONJ and the multiple
osteonecrosis. unsuccessful dental and surgical interventions, combined
with the continued azacitidine therapy, may be related to
Management with antibiotics, ozone oil applications and the persistent ONJ lesion.
low level laser therapy (LLLT) treatments [Ripamonti-11,
Nicolatou-13], twice weekly, resulted in remission of In conclusion, this case increased the list of medications
symptoms [Figure 3], while the radiolucency and fistula that can lead to ONJ and highlighted the importance of the
persisted [Figure 4].This is a retrospective case presentation presence of localized alveolar bone infection prior to the
from existing de-identified medical record data. Patient appearance of ONJ. The occurrence, though rare, of this
gave consent for the medical record review. potentially serious complication may increase with the
long-term survival of cancer patients.
DISCUSSION
Financial support and sponsorship
Azacitidine is a chemical analogue of the cytosine Nil.
nucleoside and functions as a DNA demethylating
agent and as an antimetabolite. Reduced cell division Conflicts of interest
[21]
and growth may result from demethylation of DNA. There are no conflicts of interest.
Azacytidine, as a metabolite, can exert a direct myelotoxic
and cytotoxic effect. Azacytidine, by both its demethylating REFERENCES
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Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ June 15, 2016 ¦