A rare case of osteomyelitis of the jaw due to Citrobacter freundii following odontogenic abscesses in a patient with breast cancer receiving bisphosphonates

Osteonecrosis of the jaw is a rare but very serious complication of the therapy with bisphosphonates. In this case report, we describe the case of a 47-year-old women affected by a metastatic adenocarcinoma of the breast on chemotherapy and bisphosphonate treatment, who developed a dental abscess that was surgically treated with avulsion of dental elements. One year after surgery, the patient developed an osteonecrosis and secondary osteomyelitis in the same point of the previous abscess. A new surgical treatment was performed with the prompt resolution infection. In this case, several factors contributed to the development of osteonecrosis of the jaw: the patient's primary disease, dental history and ongoing treatment with bisphosphonates. The latter is certainly the most important factor, although the dental abscess and the subsequent dental surgery are other important factors that contributed, in this case, to the development of this sequelae. For these reasons, a correct oral hygiene is of utmost importance in patients undergoing therapy with BPs, as well as the collaboration between dentist, radiologists and otolaryngology specialists to correctly prevent and appropriately treat this rare condition.