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JAMA Clinical Challenge

Jaw Lesion and Discomfort

Image of exposed bone tissue in the mandible of the patient

Liran Levin, DMD
Liat Luder, RDH
A 57-year-old woman reports experiencing discomfort and a lesion around her mandibular incisor teeth for the past 3 months. She had received the bisphosphonate zoledronate for treatment of metastatic renal carcinoma for several months before the lesion appeared. The patient reports no trauma or acute process around the area. On examination, the teeth are mobile, and an area of exposed bone tissue in the mandible is detected (Figure). There is no tenderness on palpation or profound gingival bleeding. The teeth are splinted for the patient’s comfort.

See the full article for an explanation and discussion.

Author Affiliations: Dr Levin (liranl@technion.ac.il)is affiliated with the Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts; and the Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Faculty of Medicine, Technion, IIT, Haifa, Israe. Drs Levin and Luder are affiliated with the Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Faculty of Medicine, Technion, IIT, Haifa, Israel.