inflammatory bone disease

1. Inflammatory diseases
of the bone

2. Inflammatory diseases of bone can be divided into three
broad but overlapping categories depending largely on
the extent on involvement of the bone
1-Osteitis: - this term is used to describe a localized
inflammation of bone with no progression through the
marrow spaces.
2-Osteomyelitis: - extensive inflammation of the interior
of the bone involving, and typically spreading through the
marrow spaces.
3-Periostitis: - inflammation of the periosteal spaces of
the bone and may not be associated with osteomyelitis

3. Osteomyelitis
osteomyelitis (osteo- = bone; -myel-
= marrow, -itis = inflammation of).
bone & bone marrow
Osteomyelitis is a very serious
condition that can cause destruction
of large sections of the jaw and be
difficult to cure.

4. Osteomyelitis of the jaw was a common
complication of dental sepsis before the
advent of antibiotics, now it is a rare
disease.
The main reason for treating apical
abscesses with vigor is to prevent spread
along the bone marrow spaces.

5. Osteomyelitis is caused by virulent
organisms and/or decreased
immunologic responses.
this reflecting the balance between
the nature and severity of the irritant,
the host defense, local and systemic
predisposing factors
Osteomyelitis more commonly affects
the mandible rather than the maxilla.

6. Predisposing factors:
1-chronic systemic diseases, immunocompromised
status, and disorders associated with decreased
vascularity of bone.
2-tobacco use, alcohol abuse and intravenous drug
abuse.
3-diabetus mellitus
4-exanthematous fever and malaria
5-sickle cell anemia
6-malnutrition
7-malignancy
8-collagen vascular disease
9-aids
10-radiation
11-osteopetrosis, pagets disease, end-stage
cemento-osseous dysplasia, may result in

7. suppurative osteomyelitis
Acute suppurative osteomyelitis:
results when an acute inflammatory process
spreads through the medullary spaces of the
bone and insufficient time has passed for the
body to react to the presence of the
inflammatory infiltrate
Chronic suppurative osteomyelitis:
results when the defensive response leads to
the production of granulation tissue, which
subsequently forms dense scar tissue in an
attempt to wall of the infected area.

8. Acute osteomyelitis.
signs and symptoms of an acute
inflammatory process less than 1 month in
duration,
Fever.
leukocytosis.
lymphadenopathy,
soft tissue swelling of the affected area may be
present.
There may be swelling of the mandible and
suppurative drainage

9. Acute suppurative osteomyelitis

10. The radiographs may be unremarkable or
may demonstrate an ill-defined
radiolucency.

12. A fragment of necrotic bone that has
separated from the adjacent vital bone is
termed a sequestrum.
Sequestra often exhibit spontaneous
exfoliation into the oral cavity.
On occasion. Fragments of necrotic bone
may become surrounded by vital bone.
and the mass of encased nonvital bone is
called an involucrum.
Sequestrum

13. Acute osteomyelitis with sequestrum. Radiolucency
of the right body of the mandible with central radiopaque
mass of necrotic bone.

14. Histopathologic Features
material from patients with acute osteomyelitis
is not common because of the predominantly
liquid content and lack of a soft-tissue
component.
the material consists predominantly of necrotic
bone.

The bone shows a loss of the osteocytes from
their lacunae. Peripheral resorption and
bacterial colonization.

17. Chronic Osteomyelitis
-If acute Osteomyelitis is not resolved,
chronic osteomyelitis occur or the process
may arise primarily without a previous
acute episode.
-Swelling, pain, sinus formation, purulent
discharge, sequestrum formation, tooth
loss or pathological fracture
- Patient may show acute exacerbation or
periods of decreased pain associated with
chronic remodelling process

18. Chronic osteomyelitis in the region of third-molar
extraction. moth-eaten radiolucent

19. A- ill-defined area of radiolucency of the right body of the
mandible adjacent to a recent extraction site.
B- After the initial intervention. the patient failed to return for
follow-up because of lack of significant pain. An enlarged, ill-
defined radiolucency of the right body of the mandible was
discovered 2 years after the initial surgery.

20. Chronic osteomyelitis of the mandible associated with
periodontal disease. Note moth-eaten radiolucent
appearance.

21. Chronic osteomyelitis.
significant soft issue component that
consists of chronically inflamed fibrous
connective tissue filling the lntertrabecular
areas of the bone.
Scattered sequestra and pockets of
abscess formation are common.

23. Chronic osteomyelitis showing fibrous
marrow and osteoclastic resorption of resident
bone.

24. Treatment and Prognosis
Acute osteomyelitis.
obvious abscess formation _______antibiotics and
drainage.
The antibiotics most frequently selected include
penicillin. clindamycin. cephalexin. cefotaxime,
tobramycin, and gentamicin.

Chronic osteomyelitis
Surgical intervention is mandatory.
The antibiotics are similar to those used in the
acute form

25. Chronic sclerosing osteomyelitis
Chronic Focal sclerosing osteomyelitis
(CONDENCING OSTITIS)
1. young adult ,
2. both sexes ,
3. low grade inflammatory stimulus.
4. located in the Isth lower sixes
5. induce a reactive osteosclerotic response
at the apex in person who has a high
degree of tissue resistance and tissue
reactivity
6. the tissue react to the infection by
proliferation rather than destruction .

26. This lesion may occasionally be
adjacent to a sound, unrestored
tooth, suggesting that other
etiologic factors such as
malocclusion may be operative.

27. Focal sclerosing osteitis.

29. Clinical Features
asymptomatic, most lesions are
discovered on routine radiographic
examination.
A majority are found at the apices
of mandibular first molars, with a
minority associated with
mandibular second molars and
premolars. When teeth are
extracted, these lesions remain
behind indefinitely.

30. Histopathology
Microscopically, these lesions are
masses of dense sclerotic bone.
Connective tissue is scant, as are
inflammatory cells.

31. CHRONIC defuse sclerosing osteomyelitis:-
similar to the focal sclerosing osteomyelitis
represent a proliferative reaction of the bone to a low
grade infection
the source of infection through the periodontal ligament
rather than a carious tooth.
middle age ,
female more than male
no clinical sign and symptom unless there is an acute
exacerbation of the chronic infection

32. Radiographically :-
one or all four jaw quadrant can be
affected and mostly edentulous area
which show patchy diffuse or nodular
sclerosis resemble cotton-wool radio-
opacities.

33. Diffuse sclerosing osteomyelitis.

35. Chronic osteomyelitis with proliferative
periostitis ( Garre’s osteomyelitis)
reactive periosteal proliferative inflammatory response
to infection or trauma
A new bone is formed, expansion become evident
usually affect children and young adult with no sex
predilection and patient suffer from tooth ach and a
bony hard swelling in the jaw for several weeks.

36. Clinical Features
This variety of osteomyelitis is uncommonly
It has been described in the tibia, and in the
head and neck area, it is seen in the
mandible. It typically involves the posterior
mandible and is usually unilateral.
Patients characteristically present with an
asymptomatic bony, hard swelling with
normal appearing overlying skin and
mucosa.

37. Chronic Osteomyelitis with Proliferative
Periostitis (Garré's Osteomyelitis)

38. Radiographically:-
it is pathognomic,
best seen in occlusal film
which show focal over growth of the
bone on the outer surface of the
cortex which is described as
duplication of the cortical layer of
bone.

40. Osteoradionecrosis
one of the most serious complications of
radiation to the head and neck
seen less frequently today because of better
treatment modalities and prevention.
it increases dramatically if a local surgical
procedure is performed within 21 days of
therapy initiation
or between 4 and 12 months after therapy.


41. Radiation of bone results in permanent
damage:' to the osteocytes and
microvasculature system.
The altered bone becomes hypoxic,
hypovascular, and hypocellular.
Osteoradionecrosis is the result of
nonhealing, dead bone; infection is not
necessarily present.

42. Osteoradionecrosis. Note fistula formation of the left
submandibular area resulting from osteoradionecrosis of
the mandibular body.

43. Osteoradionecrosis. Ulceration overlying left
body of the mandible with exposure and sequestration of
superficial alveolar bone.

44. Osteoradionecrosis. Multiple ill-defined areas of
radiolucency and radiopacity of the mandibular
body.

45. Osteoradionecrosis of the lingual
mandible precipitated by trauma.

46. Osteoradionecrosis of the mandible.

47. Alveolar osteitis :- ( dry socket)
the most painful complication of dental
extraction
inflammation of bone following the loss of
protection of the socket by blood clot either
due to
failure of a blood clot to form or the premature
loss or may be due to break down of the clot.

48. The frequency of alveolar osteitis is higher
in the mandible and the posterior areas.
oral contraceptive use
no significant sex predilection.
The prevalence is between 1% and 3% of all
extractions, but it increases to 25% to 30%
for impacted mandibular third molars.

49. The overall prevalence is highest
between 20 and 40 years
The affected extraction site is filled
initially with a dirty gray clot that is
lost and leaves a bare bony socket
(dry socket).

50. The diagnosis is confirmed by
probing of the socket, which reveals
exposed and extremely sensitive
bone.
Typically, severe pain, foul odor, and
(less frequently) swelling and
lymphadenopathy develop 3 to 4 days
after extreaction of the tooth.

51. Treatment:-
removal of the dead bone .
pain relived by irrigation with mild
warm
antiseptic and dressing of socket to
prevent accumulation of food debris .
healing of the socket from its base by

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