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
