Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice—A Narrative Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategies
2.2. Eligibility Criteria and Study Selection
2.3. Data Extraction and Analysis
2.4. Quality Assessment
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Clinical Characteristics
3.4. Quality Assessment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
OUBS | Oral ulceration with bone sequestration |
MRONJ | Medication-Related Osteonecrosis of the Jaw |
References
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Database | Search Strategy (Search Date: 27 January 2024) | Results |
---|---|---|
PUBMED | (“Oral ulceration with bone sequestration” OR “Lingual mucosal ulceration with mandibular sequestration” OR “lingual mucosal ulceration with bone necrosis” OR “lingual mandibular bone sequestration” OR “lingual mandibular sequestration and ulceration” OR “lingual mandibular sequestration with ulceration” OR “lingual mandibular osteonecrosis” OR “oral ulceration with mandibular necrosis” OR “mandibular bone exposure and osteonecrosis” OR “bony necrosis and sequestration in the mandible” OR “idiopathic exposure and sequestration of alveolar bone”) | 211 |
SCOPUS | TITLE-ABS-KEY((“Oral ulceration with bone sequestration”) OR (“Lingual mucosal ulceration with mandibular sequestration”) OR (“lingual mucosal ulceration with bone necrosis”) OR (“lingual mandibular bone sequestration”) OR (“lingual mandibular sequestration and ulceration”) OR (“lingual mandibular sequestration with ulceration”) OR (“lingual mandibular osteonecrosis”) OR (“oral ulceration with mandibular necrosis”) OR (“mandibular bone exposure and osteonecrosis”) OR (“bony necrosis and sequestration in the mandible”) OR (“idiopathic exposure and sequestration of alveolar bone”)) | 1655 |
WEB OF SCIENCE | “Oral ulceration with bone sequestration” OR “Lingual mucosal ulceration with mandibular sequestration” OR “lingual mucosal ulceration with bone necrosis” OR “lingual mandibular bone sequestration” OR “lingual mandibular sequestration and ulceration” OR “lingual mandibular sequestration with ulceration” OR “lingual mandibular osteonecrosis” OR “oral ulceration with mandibular necrosis” OR “mandibular bone exposure and osteonecrosis” OR “bony necrosis and sequestration in the mandible” OR “idiopathic exposure and sequestration of alveolar bone” | 87 |
Variables | Literature Review (n = 57) | |
---|---|---|
n | % | |
Sex | ||
Male | 41 | 71.9 |
Female | 16 | 28.1 |
M:F ratio | 2.5:1 | - |
Age group | ||
0 to 9 | - | - |
10 to 19 | - | - |
20 to 29 | 1 | 1.8 |
30 to 39 | 8 | 14.0 |
40 to 49 | 19 | 33.3 |
50 to 59 | 18 | 31.6 |
60 to 69 | 9 | 15.8 |
70 to 79 | 1 | 1.8 |
80 to 89 | 1 | 1.8 |
Mean age ± SD | 50.2 ± 11.4 | - |
Range | 27–86 | - |
Location | ||
Maxilla | 3 | 5.3 |
Mandible | 54 | 94.7 |
Ulcer size (cm) | ||
<1.0 | 30 | 78.9 |
≥1.0 | 8 | 21.1 |
Mean ± SD | 0.75 ± 0.85 | - |
Range | 0.1–1.5 | - |
NI | 19 | - |
Symptomatology | ||
Pain | 48 | 88.9 |
Discomfort | 6 | 11.1 |
Burning sensation | 2 | 3.7 |
Sensation of sharp bony surface | 2 | 3.7 |
Soreness | 2 | 3.7 |
Difficulty in mastication | 1 | 1.9 |
Symptomatic NS | 1 | 1.9 |
Asymptomatic | 2 | 3.7 |
NI | 3 | - |
Duration | ||
≤2 weeks | 18 | 42.9 |
>2 ≤ 4 weeks | 12 | 28.6 |
>4 ≤ 8 weeks | 5 | 11.9 |
>2 months | 4 | 9.5 |
Unspecified duration | 3 | 7.1 |
Range | 2 days–1 year | - |
NI | 15 | - |
Imaging findings (n = 40; 70.17%) | ||
Two-dimensional radiographs (n = 36; 90%) | ||
No alterations | 24 | 60.0 |
Alteration | 12 | 30.0 |
No alterations | 0 | 0 |
Alteration | 4 | 10.0 |
Not performed | 17 | - |
Previous traumatic event | ||
Yes | 9 | 33.3 |
Does not recall any traumatic event | 13 | 48.1 |
The authors suggest possible trauma | 3 | 11.1 |
No | 2 | 7.4 |
NI | 30 | - |
Treatment | ||
Surgical (n = 23; 40.3%) | ||
Surgery/Surgical removal | 14 | 24.6 |
Sequestrectomy | 3 | 5.3 |
Osteotomy | 4 | 7.0 |
Surgical debridement | 1 | 1.8 |
Bone removed by curettage | 1 | 1.8 |
Non-surgical (n = 12; 21.1%) | ||
Spontaneous exfoliation | 6 | 10.5 |
Non-surgical removal/debridement | 5 | 8.8 |
Patient removed | 1 | 1.8 |
Others (n = 22; 38.6%) | ||
Bone sequestration removal NS | 10 | 17.5 |
Supportive medications only a | 12 | 21.1 |
Supportive therapy (n = 48; 84.21%) b | ||
Systemic antibiotic therapy | 13 | 27.1 |
NSAID/Analgesic | 8 | 16.7 |
Corticosteroid | 2 | 4.2 |
Antiseptic mouthwash c | 20 | 41.7 |
Chlorhexidine gluconate 0.2% gel or sodium hyaluronate and sucralfate gel | 9 | 18.8 |
Lidocaine Ointment 5% | 1 | 2.1 |
Tissucol d | 1 | 2.1 |
Time required for complete healing (n = 31; 54.4%) | ||
≤2 weeks | 14 | 45.2 |
>2 ≤ 4 weeks | 7 | 22.6 |
>1 month | 7 | 22.6 |
NS * | 3 | 9.7 |
Range | 2 to 60 days | - |
NI | 26 | - |
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Monteiro, M.A.; Andrade Rios da Silva, L.; Sousa-Neto, S.S.; Albuquerque-Júnior, R.L.C.d.; Nonaka, C.F.W.; Alves, P.M.; Cunha, J.L.S. Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice—A Narrative Systematic Review. Healthcare 2025, 13, 1350. https://doi.org/10.3390/healthcare13111350
Monteiro MA, Andrade Rios da Silva L, Sousa-Neto SS, Albuquerque-Júnior RLCd, Nonaka CFW, Alves PM, Cunha JLS. Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice—A Narrative Systematic Review. Healthcare. 2025; 13(11):1350. https://doi.org/10.3390/healthcare13111350
Chicago/Turabian StyleMonteiro, Mariana Agra, Lázaro Andrade Rios da Silva, Sebastião Silvério Sousa-Neto, Ricardo Luiz Cavalcanti de Albuquerque-Júnior, Cassiano Francisco Weege Nonaka, Pollianna Muniz Alves, and John Lennon Silva Cunha. 2025. "Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice—A Narrative Systematic Review" Healthcare 13, no. 11: 1350. https://doi.org/10.3390/healthcare13111350
APA StyleMonteiro, M. A., Andrade Rios da Silva, L., Sousa-Neto, S. S., Albuquerque-Júnior, R. L. C. d., Nonaka, C. F. W., Alves, P. M., & Cunha, J. L. S. (2025). Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice—A Narrative Systematic Review. Healthcare, 13(11), 1350. https://doi.org/10.3390/healthcare13111350