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OSTEOMYELITIS

THE WORD OSTEOMYELITIS ORIGINATES FROM


ANCIENT GREEK WORD ‘’OSTEON’’(BONE) AND
‘’MUELINOS’’(MARROW)
CONTENTS
 DEFINATION
 CLASSIFICATION
 CAUSATIVE MICROORGANISMS
 PREDISPOSING FACTORS
 AETIOLOGY
 CLINICAL FEATURES
 RADIOGRAPHIC FEATURES
 HISTOLOGICAL FEATURES
 TREATMENT AND MANAGEMENT
DEFINATION
 It is defined as the inflammation of bone and
its marrow contents
 Predisposing factors are trauma, road traffic

accidents, gun shot wounds, radiation


damage, pagets disease and osteopetrosis
ACUTE OSTEOMYELITIS
 DEFINATION: It is a serious sequalae of
periapical infection that often results in
diffuse spread of infection throughout the
medullary spaces which subsequent necrosis
of various amount of bone
Staphlococcus
aureus Pseudomonas

CAUSATIVE
MICROORGANISMS

Beta hemolytic streptococci Hemophilus influenza


PREDISPOSING FACTORS
 DIABETES
 ANAEMIA
 LEUKAEMIA
 ANTIVITAMINOSIS
 MALNUTRITION
 SYPHILIS
 TYPHOID
AETIOLOGY
SPREAD OF INFECTION FROM DENTAL PULP INTO THE
MANDIBLE

SPREAD OF INFECTION FROM MANDIBLE PRESENTING SUPPURATIVE


ODONTOGENIC INFECTIONS

SPREAD OF INFECTION FOLLOWING REMOVAL OF TOOTH WITHOUT


PROPER ASEPSIS AND ANTIBIOTIC COVERAGE

COMPOUND FRACTURE OF MANDIBLE WITH EXPOSURE OF BONE


OUTSIDE THE MUCOSA

POST RADIATION, SEONDARY


INFECTION
SYMPTOMS INCLUDE…
•FEVER, MALAISE, ANOREXIA, VOMITING

•MULTIPLE INTRAORAL AND EXTRAORAL PUS


DISCHARGE SINUSES

•DISCHARGE OF PUS IS SEEN IN GINGIVAL CREVICE OF


AFFECTED TEETH
CLINICAL FEATURES
•OCCURS AT THE AGE OF 50 YEARS

•MALES COMMONLY AFFECTED

•REGIONAL LYMPHADENOPATHY

•TRISMUS AND PARESTHESIA OF LIPS

•LOOSENING AND SORENESS OF TEETH WITH DIFFICULTY


IN MASTICATION

•HALITOSIS

•PATIENT IS SLIGHTLY FEBRILE


HISTOLOGIC FEATURES..
BONE MARROW UNDERGOES
LIQUEFACTION AND PURULENT
EXUDATES OCCUY MARROW
SPACE

PMNS WITH OCCASIONAL


LYMPHOCYTES AND PLASMA
CELLS ARE PRESENT

AFFECTED BONE UNDERGOES


NECROSIS WITH DEGENERATION
OF OSTEOBLASTS AND
OSTEOCLASTS RESULTING IN
DEVELOPMENT OF SEQUESTRUM
DIFFERENTIAL DIAGNOSIS..
TREATMENT
CHRONIC SUPPURATIVE
OSTEOMYELITIS
IT MAY DEVELOP IN INADEQUATELY TREATED
ACUTE OSTEOMYELITIS OR MAY ARISE FROM A
DENTAL INFECTION WITHOUT PRECEEDING
ACUTE STAGE.

TYPES:
1.CHRONIC FOCAL SCLEROSING
OSTEOMYELITIS
2.CHRONIC DIFFUSE SCLEROTIC
OSTEOMYELITIS
GARRE’S OSTEOMYELITIS
CHRONIC FOCAL SCLEROSING CHRONIC DIFFUSE SCLEROTIC
OSTEOMYELITIS OSTEOMYELITIS

NON SUPPURATIVE INFLAMMATORY CONDITION ANALOGUES TO THE


CONDITION OFTEN SEEN IN FOCAL FORM OF DISEASE AND
DENTULOUS JAWS ALSO APPARENTLY REPRESENTS A
PROLIFERATIVE REACTION OF
BONE TO A LOW GRADE OF
INFECTION
SEEN IN LESS THAN 20 YRS OF AGE MORE COMMON IN OLDER PERSONS
MANDIBULAR 1ST MOLAR MORE COMMON IN EDENTULOUS
COMMONLY AFFECTED MANDIBULAR JAW
RADIOGRAPHIC FEATURES
RADIOPACITY AT THE APEX OF PATCHY SCLEROSIS OF BONE
ROOT WITH INTACT LAMINA DESCRIBED AS ‘COTTON WOOL
DURA. APPEARANCE’.

BECAUSE OF DIFFUSE NATURE


LESION HAS DENSE BONY OF THE DISEASE THE BORDER
TRABECULAE WITH LITTLE BETWEEN THE SCLEROSIS AND
STROMA NORMAL BONE IS OFTEN
DISTINCT.

PATTERN MAY ACTUALLY


MIMIC PAGET’S DISEASE OF
BONE OR CEMENTO OSSEOUS
DYSPLASIA
HISTOLOGICAL FEATURES
DECREASE MASS OF LESIONS SHOWS
BONY TRABECULAE DENSE, IRREGULAR
WITH LITTLE TRABECULAE OF BONE
INTERSTITIAL MARROW SOME OF WHICH ARE
TISSUE BORDERD BY AN ACTIVE
LAYER OF
OSTEOLYTIC OSTEOBLASTS
LACUNAE APPEAR
EMPTY PMN LEUCOCYTES
MAY BE PRESENT
BONY TRABECULAE
EXHIBIT MANY BONE IN SOME
REVERSAL AND RESTING LESIONS SHOW A
LINES GIVING PAGETOID PRONOUNCED ‘MOSAIC
APPEARANCE PTTERN’ APPEARANCE
TREATMENT
CHRONIC FOCAL SCLEROSING OSTEOMYELITIS

ENDODONTIC THERAPY OF AFFECTED TOOTH


EXTRACTION OF AFFECTED TOOTH

CHRONIC DIFFUSE SCLEROTIC OSTEOMYELITIS

 ACUTE EPISODES ARE TREATED WITH


ANTIBIOTICS
EXTRACTION OF TOOTH PRESENT IN ANY OTHER
SCLEROSED AREAS WITH REMOVAL OF LIBERAL
AMOUNTS OF BONE TO FACILITATE INCREASED
BLEEDING
GARRE’S OSTEOMYELITIS
OTHER NAMES: CHRONIC OSTEOMYELITIS WITH
PROLIFERATIVE PERIOSTITIS/ PERIOSTITIS
OSSIFICANS/ GARRE’S CHRONIC NON SUPPURATIVE
SCLEROSING OSTEITIS.
CLINICAL FEATURES
COMMON IN YOUNG CHILDREN
AND ADULTS

POSTERIOR REGION OF MANDIBLE


MORE COMMONLY INVOLVED

INVOLVED JAW BONE HAS


CARIOUS NON VITAL TOOTH

TENDER ON PERCUSSION

HARD, NON TENDER SWELLING


WITH MEDIAL AND LATERAL
EXPANSION OF JAW

LYMPHADENOPATHY, SLIGHT
PYREXIA MAY BE PRESENT BUT ESR
IS NORMAL
RADIOGRAPHIC FEATURES
PRESENT AS A CENTRAL JAW LESION WIH
PREDOMINANTLY RADIOLUCENT APPAERANCE
HAVING FEW RADIOOPAQUE FOCI.

 CHARACTERISTIC FEATURE: ONION SKIN


APPEARANCE
ELIMINATION OF
CAUSATIVE HYPERBARIC OXYGEN
AGENT THERAPY

TREATMENT
EXTRACTION OF
CARIOUS INFECTED ANTIBIOTIC
TOOTH THERAPY
HYPERBARIC OXYGEN
THERAPY
IT IS AN ADJUNCTIVE
THERAPY AND SHOULD
BE USED ALONG WITH
ANTIBIOTICS AND
SURGICAL
DEBRIDEMENT

HELPS IN
STRENGTHENING OF
BONE CELLS—
REABSORB DEAD BONE—
REMOVE BONY DEBRIS
ENHANCES FUNCTION
OF IMMUNE SYSTEM

HELPS BODY TO
CREATE NEW BLODD
CELLS CALLED
CAPILLARIES
PROCEDURE OF HBOT
Oxygen is important in wound healing.
When the environment of the fibroblast cell has an oxygen
tension of less than 10mmHg, the cell can divide, but it can
no longer make collagen.
 It also cannot migrate to where it is needed for healing.
When the oxygen tension is increased, the fibroblast can
again carry out these wound healing functions.
The collagen produced by these cells forms a fibrous
matrix, and new capillaries grow into this.
 Wound healing is a dynamic process and an adequate
oxygen tension is mandatory for this process to proceed to
healing.
 HBOT provides oxygen to promote collagen production,
angiogenesis (new vessel growth) and wound healing in the
ischemic or infected wound
 Adequate supply of oxygen is key in the treatment of
osteomyelitis
AYESHA MUSHTAQ
FINAL B.D.S