MRONJ* staging | Treatment strategies¶ |
At risk: No apparent necrotic bone in patients who have been treated with either oral or intravenous bone-modifying agents | - No treatment indicated
- Patient education and reduction of modifiable risk factors
|
Increased risk: No clinical evidence of necrotic bone, but nonspecific clinical findings, radiographic changes, and symptoms | - Systemic management, including the use of pain medication, and close scrutiny and follow-up
- Refer to dental specialist and follow up every 8 weeks with communication of lesion status to the oncologist
- Patient education and reduction of modifiable risk factors
|
Stage 1: Exposed and necrotic bone, or fistulas that probe to bone in patients who are asymptomatic and have no evidence of infection | - Antibacterial mouth rinse
- Clinical follow-up on an every-8-week basis by a dental specialist with communication of lesion status to the oncologist
- Patient education and reduction of modifiable risk factors
|
Stage 2: Exposed and necrotic bone or fistulas that probe 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 and topical antibacterial rinse
- Pain control
- Debridement to relieve soft tissue irritation and infection control
- Clinical follow-up on an every-8-week basis by a dental specialist with communication of lesion status to the oncologist
- Patient education and reduction of modifiable risk factors
|
Stage 3: Exposed and necrotic bone or a fistula that probes to bone in a patient with pain, infection, and one or more of the following: exposed and necrotic bone extending beyond the region of alveolar bone (ie, inferior border and ramus in mandible maxillary sinus, and zygoma in the maxilla), resulting in pathologic fracture, extraoral fistula, oral antral or oral nasal communication, or osteolysis extending to the inferior border of the mandible or sinus floor | - Symptomatic treatment with oral antibiotics and topical antibacterial rinse
- Pain control
- Surgical debridement or resection for long-term palliation of infection and pain
- Clinical follow-up on an every-8-week basis by a dental specialist with communication of lesion status to the oncologist
- Patient education and reduction of modifiable risk factors
|