OSTEOMYELITIS&

ALVEOLAR OSTEITIS

Presented by:Fasahat Ahmed Butt (36)

Group: C1

OBJECTIVES• What is osteomyelitis?• Predisposing factors of osteomyelitis?• ClassificationClinical featuresRadiographic features• Management of osteomyelitis

• What is Alveolar osteitis?• PathogenesisClinical features• Treatment

OSTEOMYELITIS

• Osteon: Bone• Myelitis: Inflammation of the bone marrow

• Acute or chronic inflammatory process in the medullary spaces or cortical surfaces of the bone that extends away from the initial site of involvement

PREDISPOSING FACTORS

Decreased vascularity or Vitality of bone• Trauma• Radiation injury• Paget’s disease• Osteoporosis• Major vessel disease

Impaired host defence• Immune deficiency state• Immunosuppression• Diabetes Mellitus• Malnutrition• Extremes of age

Local factors Systemic factors

CLASSIFICATION

• SUPPURATIVE OSTEOMYELITIS• FOCAL SCLEROSING OSTEOMYELITIS• DIFFUSE SCLEROSING OSTEOMYELITIS• PROLIFERATIVE PERIOSTITIS

SUPPURATIVE OSTEOMYELITIS

ACUTE CHRONIC

ANAEROBIC

• Bacteroids• Porphyromonas• Prevotella

Staphylococcus (open fractures)

PATHOGENESISOrganism enters the jaw (mandible) blood

supply

Medullary infection spreads through marrow spaces

Thrombosis, bone necrosis

Lacunae empty of osteoid filled with neutrophil & bacteria proliferate in dead tissue

Proliferation of periosteum & sinus formation

Sequestrum separated once removed, new bone is formed (INVOLUCRUM)

C/F

• Location: Mandible• Male: Adult males• Pain• Soft tissue swelling• Fever• Lymphadenopathy

R/F

• It may be normal in the early stages of the disease, but after 10-14 days sufficient bone resorption may have occurred to produce irregular, MOTH-EATEN areas of radiolucency.

CHRONIC SUPPURATIVE OSTEOMYLITIS

C/F

• Swelling• Pain• Sinus formation• Tooth loss• Sequestrum formation

R/F

• ILL-defined radiolucency that often contains central radiopaque sequestra.

FOCAL SCLEROSING OSTEOMYELITIS

C/F

• Age: Children and young adults

• Location: Mandibular premolar and molar

• Bone sclerozing associated with non vital pulpitic tooth

R/F

• Increased areas of radiodensity surround the apices of non-vital mandibular 1st molar

DIFFUSE SCLEROSING OSTEOMYELITIS

C/F

• Age: Adults• No sex predilection• Location: Mandible• Sclerosing around the site of periapical/PD

inflammation• Persistent pain• No swelling

R/F

• Radiodencities• Sclerotic bone seen in tooth bearing area

PROLIFERATIVE PERIOSTITIS C/F

• Age: Children and young adults.• Location: Lower border of the mandible.• No sex predominance.

R/F• New periosteal bone formation along the inferior

border of the mandible

• CT image: new periosteal bone growth with onionskin lamination

MANAGEMENT

Essential measures:

Bacterial sampling and culture

Vigorous (empirical) antibiotic treatment

DrainageAnalgesicSpecific antibioticsDebridement

Adjunctive treatment:

SequestrectomyDecorticationResection and

reconstruction for extensive bone destruction

Hyperbaric oxygen

For acute osteomyelitis antibiotic treatment for 4-6 wksFor chronic osteomyelitis treatment is carried for 12 wks

Hyperbaric Oxygen Chamber

ALVEOLAR OSTEITIS

• Localized inflammation of the bone following:

Failure of blood clot to form in the socketPremature loss of the clotDisintegration of the clot

• Common complication following tooth extraction

Food debris Bacteria Saliva

Empty socket

Bone becomes infected & necrotic

Inflammatory reactions in the

adjacent marrow

Localizes it to the socket

wall

Osteomyelitis

Necrotic bone is separated by

osteoclast

Tiny sequestra

Proliferation of granulation tissue from surrounding

vital bone

HEALING

C/F

• Location: Mandible in posterior areas.

• No sex predilection• Severe pain• Radiates to ear and neck• Foul odor• Lymphadenopathy• Trismus

TREATMENT

• Administration of regional local anesthesia• Debridement of socket wall• Irrigate with normal saline• Antiseptic/analgesic

AlvogelZinc oxide/eugenol packChlorhexidine gelTetracycline pack

NO drainage.

PRECAUTIONS• Chlorhexidine mouth rinses should be done gently.• Patient should not smoke minimum for 48 hours

after extraction.• Patient should avoid sucking, spitting or drinking

through the straw.• Patient should try to maintain good oral hygiene

REFERENCES

• CAWSON• J.V. SOAMES & J.C. SOUTHAM• NEVILLE & DAMM• GOOGLE for images