ODONTOGENIC OSTEOMYELITIS

Milad maddah mc_351

 WHAT IS ODONTOGENIC
OSTEOMYELITIS?

Osteomyelitis is a rare complication of tooth-related infections (incidence of 25 in

100,000). In most cases, it is the result of spread of infection from a dento-
alveolar (tooth) or periodontal (pyorrhoea / gum disease) abscess or from the
para-nasal sinuses, by way of continuity through tissue spaces and planes. It
occasionally occurs as a complication of jaw fractures or
as a result of manipulations during surgical procedures.
Most patients are adult males with infection of the mandible (lower jaw).
• Osteomyelitis of the maxilla (upper jaw) is a rare disease of neonates (newly
born) or infants after either birth injuries or uncontrolled middle ear infection.
 CLASSIFICATION

Acute osteomyelitis is loosely defined as OM

which has been present for less than one
month and chronic osteomyelitis is the term
used for when the condition lasts for more than
one month. Suppurative osteomyelitis of the
jaws is
 ACUTE AND SUBACUTE

In the acute form (which rarely, may also be of

hæmatogenous origin , the infection begins in the
medullary cavity (bone marrow) of the bone. The
resulting increase of intra-bony pressure leads to a
decreased blood supply and spread of the infection,
by way of the Haversian canals of the bone, to the
cortical bone and periosteum . This aggravates the
ischæmia (, resulting in necrosis. Causes of necrosis
include inadequate blood supply , bacterial infection,
traumatic injury and hyperthermia) of the bone.
If the establi
 In summary, acute odontogenic osteomyelitis is
a rapidly progressing, severe bone infection
that requires immediate treatment, while
chronic odontogenic osteomyelitis is a long-
standing, low-grade infection that may require
CHRONIC . long-term management and surgical
intervention.

Chronic OM is characterized by a degree of

healing which takes place as a lesser degree of
inflammation is present. Granulation tissue and
new blood vessels form, and fragments of
necrotic bone (sequestra) are separated from vital
bone. Small sections of necrotic bone may be
resorbed completely, and larger segments may
become surrounded by granulation tissue and new
bone (an involucrum). Sequestra may also be
revascularized by new blood vessels, cause no
symptoms or become chronically infected.
Sometimes the involucrum is penetrated by
channels (cloacae) .

SIGNS
Unlike acute OM in the long bones, acute OM
in the jaws gives only a moderate systemic
reaction and systemic inflammatory markers,
such as blood tests, usually remain normal.
Acute OM of the jaws may give a similar
appearance to a typical odontogenic infection
or dry socket, but cellulitis does not tend to
spread from the periosteal envelope of the
involved bone
• Other signs may include:
• Pain, which is severe, throbbing and deep-seated and often radiates along
the nerve pathways.
• Headache or facial pain, as in the descriptive former term “neuralgia-
inducing”
• Fibromyalgia.
• Chronic fatigue syndrome.
• Swelling. External swelling is initially due to inflammatory edema with
accompanying erythema (redness), heat and tenderness, and then later may
be due to sub-periosteal pus accumulation.
• Trismus and dysphagia (difficulty opening the mouth And swallowing),
which may be present in some cases and is caused by edema in the muscles.
• Cervical lymphadenitis (swelling of the lymph nodes in the neck).
• Fever which may be present in the acute phase and is high and intermittent
• Malaise (general feeling of being unwell) which may be present in the acute
phase
• Anorexia (loss of appetite).
• Teeth that are tender to percussion, which may develop as the condition
progresses.
• Loosening of teeth, which may develop as the condition progresses .
 CAUSE

• OM is usually a polymicrobial, opportunistic infection, caused primarily by a

mixture of alpha hemolytic streptococci and anaerobic bacteria from the oral
cavity such as Peptostreptococcus, Fusobacterium and Prevotella, (in contrast
to OM of the long bones, usually caused by isolated Staphylococcus aureus
infection). These are the same as the common causative organisms in
odotonogenic infections. However, when OM in the jaws follows trauma, is the
likely cause is still staphylococcal (usually Staphylococcus epidermi.
 DIAGNOSIS
Radiographic findings may include:
1. Periapical radiolucency (dark area) around
the apex of the affected tooth on dental X-rays
2. Bone destruction or resorption in the
affected area
• 3. Presence of a periapical abscess
Laboratory tests may be conducted to
confirm the presence of infection, such as:
1. Blood tests to check for elevated white
blood cell count or inflammatory markers
2. Microbiological culture of pus or tissue
samples to identify the causative bacteria
In some cases, a biopsy of the affected bone may be
performed to confirm the diagnosis and rule out other
conditions.
 TREATMENT

n. Treatment typically involves a combination of antibiotics and dental procedures to remove the source of the infection.

1. Antibiotics: The first line of treatment for periapical odontogenic osteomyelitis is usually a course of antibiotics to help control the
infection. The specific antibiotic prescribed will depend on the severity of the infection and any underlying health conditions that may
affect treatment.

2. Dental procedures: In addition to antibiotics, dental procedures may be necessary to remove the source of the infection. This may
involve root canal therapy to clean out and disinfect the infected tooth, or in more severe cases, extraction of the tooth.

3. Surgical intervention: In some cases, surgical intervention may be necessary to remove infected tissue or bone that is not responding to
antibiotics or other treatments. This may involve debridement (removal of dead or infected tissue) or more extensive surgery to repair
damaged bone.

4. Pain management: Pain management is an important aspect of treatment for periapical odontogenic osteomyelitis, as it can be quite
painful. Over-the-counter pain medications may be sufficient for mild pain, but stronger prescription medications may be needed for
more severe pain.

5. Follow-up care: After initial treatment, it is important to follow up with your dentist or oral surgeon regularly to monitor your progress
and ensure that the infection has been fully eradicated. Additional treatments or procedures may be necessary if the infection persists or
recurs.

.
PERIAPICAL ODONTOGENIC
OSTEOMYELITIS
Periapical odontogenic osteomyelitis is a type of osteomyelitis that arises from a dental
infection, particularly from a periapical abscess. It occurs when bacteria from an
infected tooth spread to the surrounding bone, leading to inflammation and infection of
the bone marrow.

The infection typically starts in the pulp of the tooth and then progresses to the
surrounding periapical tissues, including the bone. Symptoms of periapical odontogenic
osteomyelitis may include severe toothache, swelling, redness, and pus drainage near
the affected tooth. In severe cases, the infection can spread to other parts of the head
and neck, causing additional complications.

Diagnosis of periapical odontogenic osteomyelitis is usually based on clinical

symptoms, dental X-rays, and sometimes, computed tomography (CT) scans or
magnetic resonance imaging (MRI) to assess the extent of the infection. Treatment
involves antibiotics to eliminate the bacterial infection, along with possible dental
procedures such as root canal therapy or tooth extraction to remove the source of
infection.

In more severe cases, surgical debridement of the infected bone may be necessary to
promote healing. It is essential to address periapical odontogenic osteomyelitis
promptly to prevent further complications such as the spread of infection to other parts
of the body. Good oral hygiene practices and regular dental check-ups can help prevent
dental infections that could lead to this condition.
Tooth 1.6 on CT, sagittal plane
view.
Tooth 1.6 on CT, coronal plane view,
where a complete destruction of
vestibular alveolar cortical lamina
and a sequestrated bone fragment are
observed.
THANKS FOR YOUR ATTENTION