Journal of The Japanese Stomatological Society

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【Introduction】 The number of patients with antiresorptive agents-related osteonecrosis of the jaw （ARONJ） with osteoporosis is increasing in Japan. Tooth extraction in patients treated with antiresorptive agents （ARA） is a risk factor for ARONJ. However, there are few reports on the rate of development of ARONJ. Therefore, in this study, we aimed to clarify the rate of development rate and factors for ARONJ after tooth extraction in osteoporosis patients treated with ARA.
【Materials and Methods】 Between April 2011 to March 2019, we retrospectively enrolled 424 patients （15 men, 409 women） who were treated with ARA for osteoporosis, and underwent tooth extraction at Tokyo Dental College, Chiba Hospital and Chiba Dental Center, and examined the development and factors for ARONJ.
【Results】 The number of patients who developed ARONJ was 6 （1.4％）. The results of multivariate analysis for ARONJ factors were gender （p＝0.006, odds ratio＝0.028, 95％ confidence intervals＝0.002, 0.351）, risk factors （p＝0.001, odds ratio＝28.262, 95％ confidence intervals＝3.187, 250.607）, and wound condition （p＝0.021, odds ratio＝0.068, 95％ confidence intervals＝0.007, 0.621）.
【Conclusion】 The rate of development of ARONJ after tooth extraction in osteoporosis patients receiving ARA was 1.4％. The risk factor for ARONJ were male, risk factors in general （cancer, diabetes mellitus, rheumatoid arthritis, anemia） and combination drug （corticosteroid, anti-cancer agent）, and open wound.

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Nodular fasciitis is a proliferative lesion that induces the reactive proliferation of fibroblasts and myofibroblasts. It commonly occurs in the upper limbs, trunk, head, and neck. However, although rare, it can also occur in the oral cavity. Here, the case of a 22-year-old man with lower lip nodular fasciitis is described. An intraoral examination revealed a soft elastic thumb-sized nodular tumor on the right lower lip. The overlying mucosa had a normal appearance, and there were no adhesions to the surrounding tissues. The lesion was resected under local anesthesia. Hematoxylin and eosin staining revealed that the resected specimen had no capsule and was in contact with the striated muscle. Periodic acid–Schiff Alcian Blue staining confirmed the presence of a myxoma-like substrate. Immunohistochemical analysis revealed that the cells were positive for α-SMA and negative for desmin, CD34, S-100, β-catenin, and ALK. The presence of the MYH9-USP6 fusion gene was ruled out by reverse transcription-polymerase chain reaction. Altogether, a diagnosis of nodular fasciitis was made. There was no recurrence during follow-up at 3 months and 1 year post-operatively.

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