Table 1.

AAOMS 2014 criteria for diagnosing MRONJ and MRONJ stages [14]

Criteria for diagnosis of MRONJ

1. Current or previous treatment with BMAs or antiangiogenic agents 2. Exposed bone or bone that can be probed through a fistula, situated within or outside the mouth, in the maxillofacial region that has persisted for longer than 8 weeks 3. No history of radiation therapy to the jaws or obvious metastatic disease to the jaws

MRONJ stages

• “At risk” includes patients who have been treated with BMAs but who have no apparent necrotic bone

• Stage 0 includes patients with no clinical evidence of necrotic bone but who have non-specific symptoms or clinical/radiographic findings

• Stage 1 includes patients with exposed and necrotic bone, or fistulae that probe to bone, who are asymptomatic with no evidence of significant adjacent or regional soft tissue inflammation or infection

• Stage 2 includes patients with exposed and necrotic bone, or fistulae that probe to bone, associated with infection, as shown by pain and adjacent or regional soft tissue inflammatory swelling, with or without purulent drainage

• Stage 3 includes patients with exposed and necrotic bone, or fistulae that probe to bone, associated with pain and infection, and at least one of the following: (1) pathologic fracture, (2) an extra-oral fistula, (3) an oral-antral fistula, or (4) radiographic evidence of osteolysis extending to the inferior border of the mandible or the floor of the maxillary sinus

AAOMS, American Association of Oral and Maxillofacial Surgeons; BMA, bone-modifying agent; MRONJ, medication-related osteonecrosis of the jaw