A diagnosis of bisphosphonate-associated osteonecrosis of the<unk>  relies on three criteria: # the patient possesses an area of exposed bone in the<unk>  persisting for more than 8 weeks, # the patient must present with no history of radiation therapy to the head and neck # the patient must be taking or have taken bisphosphonate<unk> . According to the updated 2009 BRONJ Position Paper published by the American Association of Oral and Maxillofacial Surgeons, both the potency of and the length of exposure to bisphosphonates are linked to the risk of developing bisphosphonate-associated osteonecrosis of the<unk> . In the 2014 AAOMS update on MRONJ, a staging and treatment strategies table was created: Staging and Treatment Strategies *Exposed or probable bone in the maxillofacial region without resolution for greater than 8 weeks in patients treated with an antiresorptive and/or an antiangiogenic agent who have not received radiation therapy to the<unk> s.**Regardless of the disease stage, mobile segments of bony sequestrum should be removed without exposing uninvolved bone. The extraction of symptomatic teeth within exposed, necrotic bone should be considered since it is unlikely that the extraction will exacerbate the established necrotic process. MRONJ Staging Criteria* (>8 weeks) Treatment Strategies** Picture At risk No apparent necrotic bone in patients who have been treated with either oral or IV bisphosphonates No treatment indicated, Patient education N/A Stage 0 No clinical evidence of necrotic bone, but non-specific clinical findings, radiographic changes and symptoms Systemic management, including the use of pain<unk>  and antibiotics N/A Stage 1 Exposed and necrotic bone, or fistulae that probes to bone, in patients who are asymptomatic and have no evidence of infection Antibacterial mouth rinse, Clinical follow-up on a quarterly basis, Patient education and review of indications for continued bisphosphonate therapy 100px Stage 2 Exposed and necrotic bone, or fistulae that probes to bone, associated with infection as evidenced by pain and erythema in the region of the exposed bone with or without purulent drainage Symptomatic treatment with oral antibiotics, Oral antibacterial mouth rinse, Pain control, Debridement to relieve soft tissue irritation and infection control 100px Stage 3 Exposed and necrotic bone or a fistula that probes to bone in patients with pain, infection, and one or more of the following: exposed and necrotic bone extending beyond the region of alveolar bone,(i.e., inferior border and ramus in the mandible, maxillary sinus and zygoma in the maxilla) resulting in pathologic fracture, extra-oral fistula, oral antral/oral nasal communication, or osteolysis extending to the inferior border of the mandible of sinus floor Antibacterial mouth rinse, Antibiotic therapy and pain control, Surgical debridement/resection for longer term palliation of infection and pain 100px100px
Medication-related osteonecrosis of the jaw
Osteomyelitis
Metastatic tumor of jaws
Osteoradionecrosis
Osteonecrosis of the jaw
Dysbaric osteonecrosis
Alveolar osteitis
Osteochondritis dissecans