Sir, we wish to present an interesting case of osteonecrosis of the jaw caused by a biopsy of the oral mucosa.

A 40-year-old female with an unremarkable medical history was examined at our department because of an asymptomatic mucosal alteration on the posterior, right side of the hard palate. The alteration was red/brown and located near the maxillary tuberosity (Fig. 1). A seemingly uncomplicated punch biopsy was performed, with oral melanin hyperpigmentation as the histological diagnosis.

Figure 1
figure 1

Mucosal alteration on the posterior part of the hard palate

However, at the follow-up 18 days after the biopsy, the patient complained of mild pain at the location of the biopsy. Examination revealed dehiscence of the mucosa and exposure of the osseous structures at the location of the biopsy. The circular bone exposure covered the entire area of the pigmentation and was not sensible to probing (Fig. 2).

Figure 2: Bone exposure at the site of mucosal alteration and biopsy.
figure 2

Note the prominent bony ridge medial to the dental arch

Treatment consisted of use of chlorhexidine gel twice daily and paracetamol per os. Healing was confirmed one month later. It was noted that the patient had a bilateral prominent bony ridge, medial to the dental arch, extending posteriorly to the maxillary tuberosity. The mucosa at the site of the biopsy was very thin. In retrospect, we would have preferred a scalpel for a thinner and longer biopsy, instead of a circular biopsy punch with a diameter of 5 mm. Conservative treatment strategy as presented here should be regarded as the primary option. However, in cases with increasing pain or increasing bone exposure, surgery is required to reduce the amount of bone exposure and to facilitate faster mucosal coverage.