Purpose Bisphosphonate (BP) therapy in the treatment of bone diseases and malignancy may induce a major side effect known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). A particular view of this condition is reported in this case series investigating eight patients. The aim of the study was to evaluate the BRONJ lesions concerning their aspects and progression. Also, identify if it is possible to predict the degree of severity in these cases. Methods Patients were evaluated by their condition and systemic health. The lesions were evaluated in clinical and radiographic aspects. The patients were followed-up for 2 years. Results The patients presented with specific peculiarities, and the BRONJ lesions varied in several characteristics. The BRONJ lesions ranged from simple to severe conditions, and the complicated cases presented with major pain, swelling, secondary infection and an extensive necrotic area, classified with high grade of severity. Conclusions The patients presented here confirm the existence of a relation between multiple features and BRONJ and to understand the whole process of aggravation, all systemic and local information have to be taken into account, together with all data related to the BP utilized. Regardless of the low incidence of this side effect in relation to osteoporosis treatment, in some cases, the BRONJ may become a severe condition and compromise the patient's quality of life.

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Aim The aim of this article is to present a case of idiopathic thrombocytopenic purpura (ITP) in order to emphasize the importance of the clinical exam since the anamnesis leads to a diagnostic hypothesis of ITP. Background Acute ITP is considered an autoimmune disease characterized by the production of antibodies against platelets, antigens produced by a viral infection, or a platelet sparing drug combination. These antibodies adhere to platelets and are recognized and destroyed by the reticulo-endothelial system. Consequently, the platelet count gradually diminishes and is insufficient for the maintenance of primary hemostasis. Report A 77-year-old woman presented with post-extraction intermittent bleeding. The physical examination revealed discoloration of the skin, multiple petechiae, hematomas, ecchymosis of the upper lip, bruises all over the body, gingiva that bled spontaneously, and a malformed blood clot at the extraction site of tooth #44. The hematological exams confirmed the hypothesis of ITP. The patient was immediately hospitalized in the Hematology Department of a local hospital and received platelet replacement, hydration, medication, and general care. After the spontaneous bleeding stopped, the malformed clot was removed using alveolar curettage along with a thorough cleaning of the extraction site with a 0.9% saline solution before suturing the wound and prescribing medication. After the sixth day of hospitalization, the patient presented with the following results: Hb: 12.3 mg/dL, Ht: 36.1%, and PC: 87,000 mm3. The patient was then discharged and was placed under outpatient follow-up care. Summary The importance of the clinical exam must be emphasized since the anamnesis leads to a diagnostic hypothesis of ITP and provides the dental surgeon with an opportunity to make important systemic alterations to improve the prognosis of a patient with ITP. Citation Martini MZ, Lopez JS Jr., Gendler JLPL, da Fonseca EV, Soares HA, Franzi SA. Idiopathic Thrombocytopenic Purpura Presenting as Post-extraction Hemorrhage. J Contemp Dent Pract 2007 September; (8)6:043-049.

Tuberculosis (TB) is a chronic granulomatous disease caused by Mycobacterium tuberculosis, which is transmitted by saliva droplets from patients with active pulmonary disease to persons in close contact with those infected. TB remains a leading cause of morbidity and mortality in developing countries, including Brazil. This disease primarily occurs in the lungs; however, other organs can be affected. Cervical tuberculous lymphadenitis or scrofula is the commonest form of extrapulmonary TB, particularly in immunocompromised patients. In the stomatognathic system, the tongue is the site most often affected by TB, whereas bone is rarely affected. The diagnosis of the active form of TB is made based mainly on clinical and radiographic findings, histopathologic features and sputum culture for M. tuberculosis, while the latent form of TB can be detected by tuberculin skin test or an interferon-γ release assay. The present article aimed to report a case of TB occurring concurrently in the oral cavity, bone and lungs.

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