Table 1.

Summary of differential diagnosis of bisphosphonates induced osteonecrosis of the jaws (BRONJ)

Disease	Aetiology	Clinical presentations
BRONJ	Multifactorial such as BPs therapy, high bone turnover, concomitant drugs, infection, dentoalveolar surgery, compromised immune response and others	Poor wound healing, spontaneous or postsurgical soft-tissue breakdown leading to intraoral bone exposure, bone necrosis and osteomyelitis. But in advance stages some additional orofacial finding like intense pain, extensive sequestration of bone and cutaneous draining sinus tracts
Osteoradionecrosis	Radiation therapy	Oral mucolytics, xerostomia, loss of taste, trismus, periodontitis, soft tissue necrosis
Alveolar osteitis	Partial or total loss of blood clot in extraction site	Exposed extraction site, pain that may radiate to adjacent structures
Gingivitis	Soft tissue inflammation in response to plaque, bacteria, biofilm	Gingival inflammation (red, swollen, rounded margin, bleeding on manipulation)
Periodontitis	Loss of attachment as a host modulated immune response to plaque, bacteria, biofilm	Gingival inflammation, foul odour, evidence of alveolar bone loss
Periapical pathology	Pulpal necrosis (caries, trauma)	Possible gingival inflammation, gingival sinus tract as well as evidence of periapical lesion

BPs bisphosphonates