Bisphosphonate-associated osteonecrosis of jaw reoccurrence after methotrexate therapy: a case report.
INTRODUCTION
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known complication caused by amino-bisphosphonate therapy. We document one case of BRONJ associated with oral administration of methotrexate, a known immunosuppressive drug used to treat rheumatoid arthritis.


METHODS
A 66-year-old woman was referred for evaluation and endodontic surgery of recently re-treated tooth 13. Tooth 14 was extracted 3 months prior, and the extraction site had not completely healed. Her medical history revealed rheumatoid arthritis and osteoporosis. She had been taking Fosamax (alendronate) 70 mg daily. Because of adequate root canal therapy of tooth 13, endodontic surgery was performed. Five months after apicoectomy, her symptoms had not changed. Tooth 13 was extracted, and the socket healed without complications. The socket of extracted tooth 14 was also healing. At the 3-month recall visit, bone exposure and purulent discharge at the site of extracted tooth 14 were noted. The patient had recently received methotrexate. The methotrexate was discontinued, and she was given course of amoxicillin.


RESULTS
At the 18-month follow-up, the healing progressed, and the wound was closed.


CONCLUSIONS
A medication that suppresses the immune system such as methotrexate may complicate the management of BRONJ. Once a diagnosis of BRONJ is made, a closely monitored conservative approach is recommended.
['Alsalleeh|Fahd|F|', 'Keippel|Jeffery|J|', 'Adams|Lyde|L|', 'Bavitz|Bruce|B|']
D000368:Aged D019386:Alendronate D000658:Amoxicillin D000900:Anti-Bacterial Agents D001047:Apicoectomy D001172:Arthritis, Rheumatoid D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw D050071:Bone Density Conservation Agents D004347:Drug Interactions D005260:Female D005500:Follow-Up Studies D006801:Humans D007166:Immunosuppressive Agents D008727:Methotrexate D010024:Osteoporosis D014081:Tooth Extraction D014945:Wound Healing
methotrexate rheumatoid arthritis Bone necrosis induced by bisphosphonate