Methotrexate-related osteonecrosis of the jaw: Report of two cases

Although methotrexate (MTX) is widely used to treat malignancies and autoimmune diseases, it is associated with a range of adverse effects. We report the cases of two men aged 88 and 73 years who were treated with MTX for rheumatoid arthritis and who both presented with exposed bone in the jaw, characteristic of osteonecrosis. We saw no change in symptoms in the first patient while MTX was being administered, while expansion of the jaw and bone exposure stopped immediately after cessation of MTX in the second case. We therefore suspected that both cases were MTX-related osteonecrosis of the jaw. Osteonecrosis has been reported with drugs that are not among those recognized as causing medication-related osteonecrosis of the jaw. Dentists and oral surgeons must carefully examine the oral cavity of patients on MTX therapy as part of regular practice.