Osteonecrosis of the jaw classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Stage 0: Patients who present with unspecific symptoms or radiographic findings but without clinical evidence of necrosis.

• Symptoms:

• Dull pain in the mandible body which can radiate to the temporomandibular joint
• Unexplained odontalgia
• Maxillary sinus pain
• Altered mental status

• Clinical findings

• Not caries associated periapical or periodontal fistula
• Unexplained loosening of the teeth

• Radiographic findings

• Trabecular pattern changes

• Thickening of the periodontal ligament

• Osteosclerosis regions which involves alveolar bone and the basilar bone
• Alveolar bone loss or resorption

• Stage 1: Asymptomatic patients, without infection evidence who present an exposed necrotic bone or fistula. Radiographic findings mentioned above can be found in patients with stage 1
• Stage 2: Patients with exposed necrotic bone or fistula and signs of infection, usually symptomatic. Radiographic findings mentioned above can be found in patients with stage 2
• Stage 3: Patients with the characteristics of stage 2 plus one or more of the following conditions:

• Pathologic fracture
• Osteolisis which reaches the sinus floor or the external border of the mandible
• Orocutaneos fistula
• Comunication with the maxillary sinus (oroantral) or the nose (oronasal)