INFLAMMATORY
LESIONS OF THE
JAW
Inflammatory Lesions Of The
Jaw
Periapical Inflammatory Lesions
Pericoronitis
Osteomyelitis
Acute
Chronic
Osteoradionecrosis
Biphosphonate- related Osteonecrosis
I.
Periapical Inflammatory
Lesions
a local response of the bone around the apex of the
tooth that occurs secondary to pulpal necrosis or
extensive periodontal diseases
Clinical features
Asymptomatic
Toothache
Sever pain with or without facial
swelling
Fever
Lymphadenopathy - swelling of
the lymph nodes or glands
Fistula (parulis) - "gum boil"
Radiographic feature
No radiographic sign but may be clinical signs only
Show lytic (radiolucent) or sclerotic (radiopaque)
changes or both
II. Pericoronitis
Inflammation of the tissues surrounding the crown of a
partially erupted tooth
Clinical feature
Pain and swelling
Trismus (lockjaw) may occur
especially in lower third molar
area
Most common site – mandibular
3rd molar
Radioluscenct or sclerotic with
thick trabeculae
III. Osteomyelitis
Inflammatory process of bone that spread to all parts of
bone causing destruction of endosteal surface of
cortical bone
May resolve
intervention
2 Divisions
a. acute
b. chronic
spontaneously
or
with
antibiotic
a. Acute Osteomyelitis
Infection spreads to bone marrow
Inflammatory exudates spread subperiosteally, elevating
periosteum and stimulating new bone formation
Clinical features
Common on the mandible
Rapid onset, swelling of adjacent
soft tissue
Fever, lymphadenopathy
b. Chronic Osteomyelitis
sequelae of acute osteomyelitis
may represent a long-term, low-grade inflammatory reaction
that never went through a significant or clinically noticeable
acute phase
produce sclerotic radiograph appearance
Clinical feature
Location: posterior part of
the mandible
Intermittent pain
Swelling
Fever
Lymphadenopathy
May spread to TMJ cause
septic
arthritis
&
ear
infection
IV. Osteoradionecrosis
Inflammatory condition of bone (osteomyelitis) that
occur after the bone has been exposed to therapeutic
doses of radiation for treatment of malignancy of head
and neck
Clinical feature
Location: posterior part of the
mandible
Similar to chronic osteomyelitis
with stimulation of sclerosis
Clinical features
Patients have exposed bone after invasive dental surgical procedures
(e.g. extraction, periodontal surgery)
More common in posterior mandible (60%) and maxilla (40%) and both
(9%)
Incidence: 3% of patients receiving these drugs will have exposed
bone
V. Biphosphate- Related
osteonecrosis
Synthetic
analogs
of
pyrophosphates that act to
inhibit osteoclasts and reduce
bone metabolism
Clinical feature
Increase in bone sclerosis
Widening of PDL space
Thickening of lamina dura
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