Table I -.
Clinical Staging of BRONJ and treatment guidelinesa.
| Stages | Treatments guidelines |
|---|---|
| At risk category: no apparent exposed/necrotic bone in patients treated with either oral or iv bisphosphonates | No treatment indicated Patients education |
| Stage 1: exposed/necrotic bone in patients who are asymptomatic and have no evidence of infection | Antibacterial mouth rinse Clinical follow-up every 4 months |
| Stage 2: exposed/necrotic bone associated with infection. Presence of pain and erythema in the lesional area with or without purulent drainage irritation |
Treatment with broad-spectrum oral antibioticsb Antibacterial mouth rinse Pain control Superficial debridement to relieve soft tissue |
| Stage 3: exposed/necrotic bone in patients with infection and pain. Presence of one or more of the following: pathologic fractures, extraoral fistula, or osteolysis extending to the inferior border |
Antibacterial mouth rinse Antibiotic therapy and pain control Surgical debridement/resection for longer term palliation of infection and pain |
a
Modified from reference 35.
b
Penicillin, amoxicillin/clavulanate potassium, metronidazole, cephalexin, clindamycin, fluoroquinolone.