Table 2.

Diagnosis and staging of osteochemonecrosis

Stage 0	Patients with no clinical evidence of necrotic bone, but present with non-specific symptoms or clinical and radiographic findings
Note: In Stage 0 patient must have:
1. Current or previous treatment with antiresorptive or antiangiogenic agents;
2. No history of radiation therapy to the jaws
3. No obvious metastatic disease to the jaws; and
4. Signs or symptoms of greater than 8 weeks duration with confirmation that signs and/or symptoms that are not of standard odontogenic origin
Stage 1	Exposed and necrotic bone, or;
	Fistula(e) that probes to bone, in patients who are asymptomatic and if purulence is evident, it is only pustular and not extensive enough to warrant Stage 3 classification (see Fig. 3)
Stage 2	Exposed and necrotic bone, or;
	Fistula(e) that probes to bone, with evidence of infection. Infection is defined as purulence that is more than merely pustular
	These patients are typically symptomatic
Stage 3	Exposed and necrotic bone, or fistulae that probe to bone, with evidence of infection, and one or more of the following:
	Exposed necrotic bone extending beyond the region of alveolar bone, e.g. inferior border and ramus in the mandible, maxillary sinus and zygoma in the maxilla
	Pathologic fracture
	Extra-oral fistula
	Oral antral/oral nasal communication
	Osteolysis extending to the inferior border of the mandible or sinus floor
Note: In Stages 1–3 patient must have:
1. Current or previous treatment with antiresorptive or antiangiogenic agents;
2. Intraoral exposed bone or bone that can be probed through a significant intraoral or extraoral fistula(e) in the maxillofacial region that has/have persisted for more than 8 weeks; and
3. No history of radiation therapy to the jaws; and/or
4. No obvious metastatic disease to the jaws
Minor editorial changes and notes have been modified by the author. For full explanations and context see original AAOMS article (Ruggiero et al. [11] #1319)