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oral medicine seminar

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PRATHUSHA.U
III YR
 The word “osteomyelitis” originates from the ancient
Greek words osteon(bone) and muelinos(marrow).
 Osteomyelitis is defined as inflammation of the bone
and its marrow contents.
 Changes in the calcified tissue is secondary to
inflammation of the soft tissue component of the
bone.
 LOCAL
 SYSTEMIC
FACTORS(decreased
vascularity/vitality of
bone)
 Fractures
 Gunshot wounds
 Radiation
 Pagets disease
 Osteopetrosis
FACTORS(impaired
host defense)
 Malnutrition
 Acute Leukemia
 Sickle Cell Anemia
 Diabetes Mellitus
 Alcoholism
 BASED ON SEVERITY
 Acute osteomyelitis
 Chronic osteomyelitis
 BASED ON ETIOLOGY
* Specific osteomyelitis
 Physical causes
 Chemical causes
 Specific infection
 Radiation
* Non specific osteomyelitis
 BASED ON PATHOLOGICAL PROCESS
 Suppurative osteomyelitis
 Acute suppurative osteomyelitis
 Chronic suppurative
osteomyelitis
o Sclerosing osteomyelitis
 Focal/condensing osteitis
 Diffuse osteomyelitis
 Sclerosing osteomyelitis with
proliferating periostitis/ Garre’s osteomyelitis
 It is a sequelae of periapical infection the often results in
diffuse spread of infection throughout the medullary
space , with subsequent necrosis of variable amount of
bone .
 Most common cause: Dental infection
 Other causes: Infection due to fracture of jaw , gun shot
or hematogenous spread.
 CLINICAL FEATURES
 Involves maxilla or mandible
 Severe pain, trismus , paresthesia of lip in case of mandibular
involvement.
 WBC count is frequently elevated
 Pus may exude from gingival margin
 Teeth in involved area are loose and sore
RADIOGRAPHIC FEATURES
 Appears normal in early stages of disease.
 Rapid progress in 1-2 weeks
Radiograph shows ill defined radiolucency
 Indistinct trabeculae – moth eaten
appearence.
HISTOPATHOLOGY:
ACUTE INFLAMMATORY CELLS
TREATMENT & PROGNOSIS:
 Debridement
 Drainage
 Antibiotic therapy
CENTRAL
RADIOPACITY
- SEQUESTRUM
NECROTIC BONE
TRABACULAE WITH EMPTY
OSTEOCYTIC LACUNAE
 ETIOLOGY:inadequately treated acute suppurative
osteomyelitis,dental infections,irradiation
 C/F:milder signs and symtoms,acute exacerbations
may occur with fistulous tract formation.
 TREATMENT :Surgery, antibiotic regimen,
hyperbaric oxygen therapy, hard and soft tissue
reconstruction.
 Reaction of bone to bacterial infection
 Occurs in case of high degree of host tissue resistance




and tissue reactivity
CLINICAL FEATURES:
Age:commonly affects young adults and children
Site:mandibular molar is affected commonly.
Mild pain due to infected pulp
 RADIOGRAPHIC FEATURES
 Well circumscribed radiopaque mass of sclerotic bone
associated with tooth apex.
 Widening of PDL space.
DEEP RESTORATION
PERIODONTAL LIGAMENT SPACE
PERIAPICAL RADIODENSE MASS
 HISTOPATHOLOGICAL FEATURES
 Dense bony trabeculae wth little interstitial marrow
 Empty osteocytic lacunae
 Reversal and resting lines –Pagetoid appearance
 TREATMENT
 Endodontic treatment or extraction of associated tooth.
 Bone scar- residual chronic focal sclerosing osteomyelitis
 If surgical mass is symptomatic, surgical removal is
indicated
 ETIOLOGY : diffuse periodontal infection
 CLINICAL FEATURES:occur at any age group mainly in
edentulous mandible,
 Insidious in nature, acute exacerbation, vague pain , if
suppurative fistula formation
 RADIOGRAPHIC FEATURES:
 Diffuse patchy sclerosis of
the bone–cottonwool appearance.
 Indistinct borders
DIFFUSE SCLEROSIS IN THE
EDENTULOUS MANDIBLE
HISTOPATHOLOGICAL FEATURES
•
•
•
•
•
•
•
Dense trabaculae with osteoblastic rimming
Osteoclastic activity in focal area
Resorption alternate repair - mosaic pattern
Interstitial tissue – fibrosed, fibroblastic,
Focal collection of lymphocytes, plasma cells
Acute phase – pmn cells
Burn – out interstitial tissue
 TREATMENT:
 Resolution of adjacent focus of infection
 Acute episodes treated with antibiotics
 Extraction of tooth attached to the sclerotic mass
Synonyms:
CHRONIC OSTEOMYELITIS WITH PROLIFERATING PERIOSTITIS
GARRE’S CHRONIC NON-SUPPURATIVE SCELEROSING OSTEITIS
PERIOSTITIS OSSIFICANS
gross thickening of periosteum
AL FEATURES
below 25 years
pid,molar region of mandible
hache or pain of jaws
develop only due to dental infection but also from
issue infection or cellulitis
RADIOGRAPHIC FEATURES:
Occlusal radiograph – focal growth of outer surface of cortexonion peel appearence
HISTOLOGY
Reactive new bone with osteoid tissue
Trabeculae perpendicular to coretx
Intervening fibrous connective tissue
TREATMENT :Endodontic treatment or extraction of
associated tooth
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