Primary oral malignant melanoma is a rare condition, accounting for 1.3–1.4% of all melanomas, usually presenting with an aggressive clinical behavior. The present study reports the clinicopathological findings of two cases of oral malignant melanoma and discusses the epidemiology, diagnosis and current therapeutic approaches for this uncommon condition. In the first case the patient presented with a pigmented lesion located on the lower mucosal lip. The patient showed no nodal metastases and therefore, underwent a wedge resection. After seven months, the patient presented with neck lymph nodes and multiple visceral metastases. Molecular analysis of BRAF, using a pyrosequencing approach, revealed the presence of BRAF V600E mutation. The patient developed multiple visceral metastases, but refused treatment and was lost to follow-up. In the second case, no BRAF V600E mutation was found, but the patient exhibited a pigmented patch in the lower gingival mucosa, which was excised by surgical treatment. The patient was followed up by an oncologist, but did not undergo an additional therapy and is currently alive with no evidence of visceral metastases at one year following the diagnosis.

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The importance of oral hygiene to minimise their risk of ONJ has often been emphasized in the literature. Some patients may require a change in behaviour in terms of brushing, interdental cleaning and other oral hygiene techniques, as well as other lifestyle behaviours such as diet and tobacco use. There may also be a benefit in prescribing high fluoride toothpaste for those patients with increased caries risk. Therefore, dental hygienists and dental practitioners should give personalised preventive advice to help the patient optimise their oral health, emphasising the importance of having a healthy diet and reducing sugary snacks and drinks; maintaining excellent oral hygiene; and using fluoride toothpaste and fluoride mouthwash. The aim of the present communication was to review the literature about the protocols, methods and advises about a correct home and professional oral hygiene in patients at risk for development of ONJ and in patients affected by ONJ.

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Oral hygiene seems to be crucial to minimise their risk of ONJ.  Oral hygiene was suggested as effective ONJ prevention in the literature. Attention regarding brushing, interdental cleaning and other oral hygiene techniques has been stressed. Furthermore, the prescription of high fluoride toothpaste for those patients with increased caries risk has been suggested. Oral hygiene habits may also play an important role, thus creating a potential bias in oral health studies. However, there does not seem to be plenty of studies in the literature explaining a precise protocol about a professional oral hygiene program that could be applied to cancer patients that are at risk for developing ONJ.  Therefore, the aim of the present communication was to present and discuss our protocol for the management of oral hygiene in cancer patients that are going to start an antiresorptive therapy or that have already started it, in order to lower the risk for ONJ.