BRONJ* Stage | Description | Treatment Strategies†‡§ |
---|---|---|
At risk category | No apparent necrotic bone in patients who have been treated with either oral or IV bisphosphonates | No treatment indicated Patient education |
Stage 0 | No clinical evidence of necrotic bone, but nonspecific clinical findings and symptoms | Systemic management, including use of pain medication and antibiotics |
Stage 1 | Exposed and necrotic bone in asymptomatic patients without evidence of infection | Antibacterial mouth rinse Clinical follow-up on quarterly basis Patient education and review of indications for continued bisphosphonate therapy |
Stage 2 | Exposed and necrotic bone associated with infection as evidenced by pain and erythema in region of exposed bone with or without purulent drainage | Symptomatic treatment with oral antibiotics Oral antibacterial mouth rinse Pain control Superficial debridement to relieve soft tissue irritation |
Stage 3 | Exposed and necrotic bone in patients with pain, infection, and one or more of the following: exposed and necrotic bone extending beyond the region of alveolar bone, (ie, inferior border and ramus in the mandible, maxillary sinus and zygoma in the maxilla) resulting in pathologic fracture, extraoral fistula, oral antral/oral nasal communication, or osteolysis extending to the inferior border of the mandible or the sinus floor | Antibacterial mouth rinse Antibiotic therapy and pain control Surgical debridement/resection for longer term palliation of infection and pain |