Chemical burn of the tongue resulting from improper use of oral bisphosphonate

Bisphosphonate (BP) is used widely for the treatment of osteoporosis and other diseases. BP-related osteonecrosis of the jaw (BRONJ) has been recognized recently as a result of the increased use of BP to prevent bone fracture and osteoporosis in elderly people. Much attention has also been given to patients with dental diseases who are administered BP, and ulcers with osteonecrosis are also noted in conjunction with BRONJ [1], [2]. However, oral mucosal ulcers on the tongue or cheek without BRONJ are not common. To our knowledge, only 7 cases of mucosal ulceration have been identified in previous reports published in English and Japanese [3], [4], [5], [6], [7], [8], [9]. Therefore the clinical behavior, treatment and outcome of ulcers are not well documented. In this report, we describe a case of ulcers occurring on the tongue without BRONJ, and discuss the clinical aspects of BP-induced ulcers, including their treatment and potential cause.