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Post-COVID-19 Jaw Osteonecrosis: A Narrative Review
George Cătălin Alexandru1,2, Loredana-Neli Gligor1,3, Doina Chioran4,5
1Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania.
Medicina (Kaunas, Lithuania)
|May 4, 2026
Summary
Post-COVID-19 osteonecrosis of the jaw (PC-ONJ) is a new complication linked to SARS-CoV-2 infection. Management depends on the cause, with fungal infections requiring antifungals and surgery, while non-fungal types need conservative treatment.
Area of Science:
- Oral and Maxillofacial Surgery
- Infectious Diseases
- Pathology
Background:
- Osteonecrosis of the jaw (ONJ) is an emerging complication following SARS-CoV-2 infection, termed post-COVID-19 osteonecrosis of the jaw (PC-ONJ).
- PC-ONJ presents in both COVID-19-associated mucormycosis (CAM) and non-fungal forms, posing diagnostic and management challenges.
Purpose of the Study:
- To review and analyze current evidence on PC-ONJ, focusing on terminology, epidemiology, pathophysiology, clinical presentation, diagnosis, and management.
- To provide guidance for oral and maxillofacial surgeons managing this post-viral condition.
Main Methods:
- A comprehensive literature search was performed across major scientific databases (PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, Google Scholar).
- Publications from 2020 to 2025 were included, encompassing original studies, reviews, case series, guidelines, and case reports.
Main Results:
- Data indicate a predilection for maxillary involvement, frequently associated with diabetes mellitus and corticosteroid use.
- Potential mechanisms include endothelial dysfunction, microthrombosis, immune dysregulation, and treatment effects.
- Clinical signs include pain, tooth mobility, exposed bone, and sinonasal extension; diagnosis is complicated by overlap with MRONJ, ORN, and osteomyelitis.
Conclusions:
- Management strategies must be etiology-specific: CAM requires urgent antifungal therapy and debridement, while non-fungal PC-ONJ warrants conservative surgical approaches and antimicrobial stewardship.
- Standardized diagnostic criteria and prospective multicenter studies are crucial for clarifying PC-ONJ and optimizing patient care.
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