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• Management is determined by the stage, severity of symptoms,
functional impact and overall prognosis and should be on an 8
week follow-up schedule
• At risk: no apparent necrotic bone in patients who have been
treated with oral or intravenous BMAs
• Stage 1: conservative therapy – improve oral hygiene. Treat
active dental and periodontal disease, topical antibiotic mouth
rinses
• Stage 2: as in stage 1 also treat symptoms, systemic antibiotics
if infection is suspected, consider surgical debridement
• Stage 3: as in stage 2 also surgical debridement, resection
including jaw reconstruction if necessary
Dental
Specialist
Dental
Specialist
Oncologist
• Based on the stage of MRONJ, the dental specialist
designs a treatment plan for the management of
MRONJ and reports the treatment plan to the
oncologist. Patient should be on an 8 week follow-
up schedule with the oral specialist
• Follows patient's lesion status and reports it to the
oncologist
• Lesion Status:
▶ Resolved: Complete healing
▶ Improving: Significant improvement (>50% of
mucosal coverage)
▶ Stable: Mild improvement (<50% of mucosal
coverage)
▶ Progressive: No improvement
• Continue to reinforce modifiable risk factors:
invasive dental procedure, diabetes, periodontal
disease, denture use, smoking
MRONJ Management Flow Diagram (cont'd)
