Patients who have advanced breast cancer, squamous cell carcinoma of the lung, head and neck carcinoma, renal cell carcinoma, multiple myeloma, or some forms of lymphoma may develop systemic hypercalcemia. Pamidronate (Aredia) and zoledronic acid (Zometa) are bone resorption-inhibiting bisphosphonates that reduce hypercalcemia by restraining osteoclastic activity. Marx 12 associates these 2 medications with painful bone exposures in the mandible, maxilla, or both that were unresponsive to surgical or medical treatments. Thirty-six cases were observed, of which 28 were initiated by tooth removal, resulting in bone exposures mostly on the lingual surface of the posterior mandible. Marx further notes that other bisphosphonates such as risedronate (Actonel), etidronate (Didronel), and tiludronate (Skelid) have not been associated with osseous necrosis of the jaws. The manufacturers of pamidronate and zoledronic acid initially did not recognize a causal relationship between these bisphosphonates and jaw necrosis. 13 However, extreme caution is recommended when considering dental extractions, periodontal surgery, or dental implants in patients who are receiving pamidronate or zoledronic acid since the reported cases of necrosis have proven refractory to commonly employed treatments for osteonecrosis.
Subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. It is also used to lessen the appearance of severe glabella lines, though its effectiveness in this application is debatable. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as laser resurfacing , microdermabrasion or chemical peels can be used to smooth out the scarred tissue. [ citation needed ]