Medication-Related Osteonecrosis of the Jaw: A Case Report of an Unusual Side Effect of Adalimumab

Table 2

Staging of medication-related osteonecrosis of the jaw according to the American Association of Oral and Maxillofacial Surgeons. Reproduced from Ruggiero et al. [28].

At risk	No apparent necrotic bone in patients who have been treated with oral or intravenous bisphosphonates
Stage 0	No clinical evidence of necrotic bone but nonspecific clinical findings, radiographic changes, and symptoms
Stage 1	Exposed and necrotic bone or fistula that probes to bone in patients who are asymptomatic and have no evidence of infection
Stage 2	Exposed and necrotic bone or fistula that probes to bone associated with infection as evidenced by pain and erythema in the region of exposed bone with or without purulent drainage
Stage 3	Exposed and necrotic bone or a fistula that probes to bone in patients with pain, infection, and ≥1 of the following: exposed and necrotic bone extending beyond the region of alveolar bone (i.e., inferior border and ramus in mandible, maxillary sinus, and zygoma in maxilla) resulting in pathologic fracture, extraoral fistula, oral antral or oral nasal communication, or osteolysis extending to inferior border of the mandible or sinus floor