Golimumab （GLM）, a tumor necrosis factor （TNF） inhibitor, is approved as a rheumatoid arthritis （RA） drug and shows excellent effects. On the other hand, patients treated with GLM are susceptible to infection due to immunosuppression. We report a case of mandibular osteomyelitis developed in a patient with RA during the administration of GLM.
A 75-year-old woman with RA who had been treated with GLM for nearly four years consulted our department in March of 2017 with chief complaints of swelling and pain in the left mandible. She had undergone surgical extraction of the left lower 7th due to periodontal disease at a private dental office in November 2016. We made a diagnosis of mandibular osteomyelitis from clinical findings and CT scan results. Her condition was thought to be caused by a dental infection which rose from immunosuppression. In addition to the administration of antibiotics, the GLM treatment was suspended temporarily by the orthopedic doctor, and acute symptoms disappeared. Out of necessity, the GLM treatment was restarted to control RA one month later, and we decided to continue to observe her condition. Although chronic symptoms such as fistulas are still present, she is rejecting the surgery because of the absence of pain or swelling, and it is impossible to interrupt the GLM treatment for an extended period. Therefore, we are hesitant to start the surgery considering her quality of life, and we are continuing to observe her condition with the administration of antibiotics.
When administering biological disease-modifying antirheumatic drugs such as TNF inhibitors, both oral management and medical-dental collaborations are very important.

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Accidental ingestion and aspiration of desiccants is often seen in children and the elderly. Accidental ingestion of calcium oxide, a frequently used desiccating agent for food products, leads to corrosion of the mucosa due to heat and alkalinity, and the symptoms are easily aggravated compared to the ingestion of silica gel. This is a case report of a patient who received an extensive oral mucosal chemical injury due to the accidental ingestion of a desiccant. A 74-year-old woman visited our hospital after accidentally ingesting calcium oxide. Extensive ulceration of the oral mucosa, swelling of the tongue and dryness of the mouth were observed. During hospitalization, the symptoms improved with oral health care and nutritional management and the patient was discharged on hospital day 15. It is crucial that appropriate measures are taken based on the type of desiccant and the amount ingested.

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Surgery, chemotherapy, and/or radiotherapy are treatment options for oral cancer, but they have certain side effects, such as mucositis and decreased oral function. A case of a patient with tongue cancer who underwent oral function management by multidisciplinary care teams is reported. The patient was a 68-year-old man who had undergone surgery and chemoradiotherapy for squamous cell carcinoma of the tongue. Oral functional management was started from the early stage of hospitalization, with repeated discussion with multidisciplinary care teams to support the patient’s deglutition function and nutrition. By the sharing of information between teams and continued specialized support, the patient was able to maintain oral function until his discharge.

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Actinomycosis is caused by Actinomyces israelli, an oral flora （oral indigenous bacteria）. Actinomycosis leads to nonspecific inflammation caused by suppurative bacteria and becomes chronic. Its typical symptoms include multiple abscesses, board-like induration, and severe trismus, which can become chronic. Moreover, pus, including drusen, discharges from an abscess. Here, we report two cases of atypical actinomycosis with a mass localized at the oral mucosa but without the typical clinical signs of actinomycosis. The first case was an 80-year-old male having an elastic hard mass on his lip. Excisional biopsy revealed sialadenitis with sulfur granules. The second case was a 59-year-old male having an elastic hard mass under the buccal mucosa. Puncture of the lesion revealed sulfur granules in pus. Thus, Actinomycosis with a localized nodule should be considered in the differential diagnosis of a neoplasm lesion and be accurately diagnosed before treatment.

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