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Table 2 Staging and treatment strategies for MRONJ

From: Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

Staging Clinical symptoms
Stage 0 systemic management, including use of pain medications and antibiotics improvement of oral hygiene (rinsing and cleaning of fistulas and periodontal pockets)
Stage 1 antibacterial mouth rinse clinical follow-up on a quarterly basis improvement of oral hygiene (rinsing and cleaning of fistulas and periodontal pockets) patient education and review of indications for continued bisphosphonate therapy
Stage 2 combination or monotherapy of symptomatic treatment with oral antibiotics and/or oral antibacterial mouth rinse pain control debridement to relieve soft tissue irritation and infection control
Stage 3 antibacterial mouth rinse antibiotic therapy and pain control surgical debridement or resection for longer-term palliation of infection and pain extraction of tooth in exposed bone/necrotic bone as source of infection maintenance of nutrition with supplements and infusions