Table 1:

Patient data

Patient	Age, years	Sex	Underlying Condition	Presentation	Location	Bisphosphonate	Biopsy	Management
1	65	F	Multiple myeloma	Nonhealing extraction socket/necrotic bone	Left maxilla	Zoledronate	Necrotic bone	Curettage, antibiotics, hyperbaric oxygen therapy
2	67	F	Metastatic breast cancer	Pain; nonhealing extraction socket	Right posterior mandible	Pamidronate changed to zoledronate	Not done	Analgesia; antibiotics
3	60	F	Metastatic breast cancer	Nonhealing extraction site; later complicated by infection and fistula formation	Left posterior mandible, third molar	Pamidronate	Chronic osteomyelitis	Curettage; antibiotic therapy
4	77	F	Multiple myeloma	Multifocal exposed bone	Bilateral body and symphysis of mandible	Pamidronate changed to zoledronate	Osteonecrosis, extensive bacterial and inflammatory cell infiltration (Fig 5C)	Mouth wash, antibiotics, surgical debridement
5	64	M	Multiple myeloma	Chronic nasal infection/sinusitis; pain	Central maxilla	Clodronate and pamidronate in the past	Not done	Long-term antibiotics
6	61	M	Metastatic prostate cancer	Painful bone exposure; subsequent loosening of teeth and spontaneous sequestration of the left mandible	Bilateral mandibular bodies	Zoledronate	Not done	Mouth rinses, antibiotics; filing of sharp bone spicule; removal of sequestra; extraction of tooth
7	75	F	Metastatic breast cancer	Infection, subcutaneous fistula; painful bone exposure	Initially anterior mandible, subsequently bilateral mandibular bodies	Zoledronate	Active osteomyelitis	IV antibiotics, then oral; marginal mandibulectomy
8	52	F	Metastatic breast cancer	Nonhealing extraction socket; painful bone exposure	First left mandibular molar	Zoledronate	Sequestrum and chronically inflamed mucosa	Mouth rinses; antibiotics; analgesia; debridement of extraction site
9	79	M	Metastatic prostate cancer	Infection; pain	Right posterior mandible	Alendronate changed to an injectable bisphosphonate	Not done	Antibiotics; mouth rinses
10	54	F	Metastatic breast cancer	Pain	Anterior mandible	Zoledronate	Not done	None
11	82	F	Osteoporosis	Nonhealing extraction socket	Left maxilla	Alendronate	Necrotic bone coated with bacterial colonies	Antibiotics, debridement
12	70	F	Osteoporosis	Nonhealing extraction socket	Right posterior mandible	Alendronate	Not done	Curettage, antibiotics
13	85	F	Osteoporosis	Nonhealing extraction socket; infection	Left posterior mandible	Alendronate	Necrotic bone coated with bacteria	Curettage, antibiotics
14	74	M	Osteoporosis	Infected exposed bone; pain	Right posterior body of mandible	Alendronate	Not done	Antibiotics, mouth washes, incision and drainage
15	54	F	Metastatic breast cancer	Pain, swelling, exposed bone, loose teeth; palatonasal and palatoantral fistula, sinusitis	Maxilla, bilateral	Zoledronate, alendronate, and pamidronate in the past	Osteonecrosis and acute osteomyelitis, abundant bacteria associated with bone infiltration	Multiple dental extractions, bilateral subtotal maxillectomy; antibiotics

Note:—M indicates male; F, female.