Bisphosphonates are primarily applied in patients with skeletal complications associated with osteoporosis as well as malignancy [
1,
2]. Bisphosphonate–associated osteonecrosis of the jaw (BRONJ), first described in 2003, poses a serious complication in patients currently or previously treated with Bisphosphonates and is associated with exposed bone in the maxillofacial region for at least 8 weeks without any radiotherapy of the jaw in the past [
3,
4]. The occurrence of BRONJ not only depends on the duration of the BP therapy but also varies between oral and intravenous application with far more cases reported after intravenous infusions with a cumulative incidence of 0,8%- 12% [
5,
6]. Although the pathomechanism is not yet completely understood, there are local risk factors like extraction of teeth, placement of dental implants, periapical surgery or dental abscesses going along with an increased incidence of osteonecrosis [
7]. Beyond this, genetic and drug- related factors influence the appearance of BRONJ [
8]. Clinically BRONJ presents as non-vital, exposed bone that might go along with inflammatory reactions due to secondary infection and therefore the gingival or mucosal tissue is usually sensitive to palpation. This process can aggravate to bone sequestration going along with acute osteomyelitis resulting in spreading and increased mobility of additional teeth [
9]. Presumably, BRONJ is associated with infection and therefore immune-modulating drugs, as applied in patients with Crohn’s disease or rheumatoid arthritis, might be an important risk factor in the development of necrotic lesions in the jaw [
10,
11]. We already know that not only Bisphosphonates but also Denosumab or other biologicals are under suspicion to promote or even cause necrotic lesions in the jaw [
12,
13]. To our knowledge there is currently no published case of BRONJ in a patient with Crohn’s disease also affecting the oral cavity and treated with Adalimumab.