osteomyelitis's types and it's treatment

1.  Refers to acute / chronic
inflammatory process in medullary
spaces or cortical surfaces of
bones.
 Various patterns recognized like
focal and diffuse sclerosing,
proliferative periostitis etc.
OSTEOMYELITIS

2. Predisposing factors of osteomyelitis
 Local Factors
• Anatomical site of the disease: The mandibular bone has poor blood
supply in comparison to that of the maxilla, besides this it has more
compact bony pattern due to which, osteomyelitis occurs far more
commonly in mandible than maxilla.
• Pre-existing bone disease: Long standing bony disease like Paget’s
disease of bone, fibrous dysplasia, cystic lesions, etc.
 SYSTEMIC FACTOR
 Immune deficiency states.
 Immunosuppression
 Diabetes mellitus.
 Malnutrition.
 Extremes of age.
Certain predisposing factors play an important role in the onset and severity of
the osteomyelitis, in addition to the virulence of microorganism.

3. PATHOGENESIS OF
OSTEOMYELITIS

5. involucrum
sequestrum.

6. Classification of osteomylitis
Oteomyelitis can be classified into :
 Suppurative :
A. Acute osteomyelitis
B. Chronic osteomyelitis .
 Non suppurative
A. Chronic Focal sclerosing ostitis
B. Chronic Diffuse sclerosing ostitis
C. Chronic osteomyelitis with proliferative periostitis ( Garr’s
disease)
D. Alveolar ostitis (dry socket).
 Osteonecrosis
a Osteoradionecrosis .
b. Bisphosphonate-associated osteonecrosis

7. ACUTE SUPPURATIVE
OSTEOMYELITIS
 Acute osteomyelitis occurs when acute
inflammation spreads through medullary
spaces of bone.
CLINICAL FEATURES: -
Age incidence: Any age
Sex incidence: Strong male predilection

10. Signs & symptoms:
 Fever, leukocytosis,
lymphadenopathy and soft
tissue swelling of affected
area.
 X-rays can show large areas
of radiolucencies in the jaw
bone, with ill-defined, moth-
eaten margins .
 Occasionally, fragments of
necrotic bone can be seen
separating from surrounding
normal bone – Sequestrum.
 If sequestrum is surrounded
by vital bone – Involucrum.

11. Treatment ..
 If obvious abscess formation is noted. the treatment of
acute osteomyelitis consists of antibiotics and
drainage.
 The antibiotics most frequently selected include
penicillin. cephalexin. cefotaxime, and gentamicin.

12. CHRONIC OSTEOMYELITIS
 It can arise either de novo from the onset
or as a continuation of acute
osteomyelitis, if it is not resolved quickly.
CLINICAL FEATURES: -
Age incidence: Any age
Sex incidence: Strong male predilection
Site predilection: Mostly in mandible.

13. Signs & symptoms:
 Pain, swelling, purulent
discharge, sinus formation,
sequestrum formation, tooth
loss.
 Frequent acute
exacerbations may occur if
infection continues for a
long time.
 X-rays reveal ill defined,
moth eaten radiolucency
often showing a central
radiopacity (sequestrum).

14. Treatment …
Administration of antibiotics after bacterial
culture and sensitivity testing.
Surgical intervention in order to remove the
sequestrum

15. DIFFUSE SCLEROSING
OSTEOMYELITIS
 is a proliferative reaction in response to a low grade
inflammation or infection in the jaw bone.
The infections in such cases are usually wide spread or
diffuse in nature and are derived either from the
periodontal tissue or from the periapical tissue.
CLINICAL FEATURES
• Diffuse sclerosing osteomyelitis is usually seen
among elderly people.
• Mandible is mostly affected in diffuse sclerosing
osteomyelitis especially in edentulous areas. The disease
can affect the maxilla as well

16. RADIOGRAPHIC FEATURES: -
 Radiograph shows areas of diffuse
or nodular
sclerosis of the bone. The
appearance may be similar to the
“cottonwool” radiopacities seen
in Paget’s disease of bone. The
border between the sclerotic bone
and the normal bone is not well-
demarcated.

17. Treatment…
 No treatment is required as the disease is
often asymptomatic and is too extensive for
surgical removal. In case of acute
exacerbations, surgical debribement and
removal of the sequestrum is done along with
antibiotic therapy.

18. FOCAL SCLEROSING
OSTEOMYELITIS
(Condensing osteitis)
 is non-suppurative inflammatory
condition of bone characterized by
sclerotic bone formation around the
root apex of a nonvital tooth.

19. CLINICAL FEATURES: -
 may be found at any age but is typically
discovered in young adults.
 Patients are usually asymptomatic, and 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.

20. Radiographically…
 Well-circumscribed radiopaque mass with
uniform radiodensity; seen around the root
apex of a nonvital tooth.

21. Treatment…
 The affected tooth should be treated
endodontically or it should be removed.
• No treatment required for the bony lesion.
• Biopsy may be necessary to rule out the
malignancy.

22. OSTEOMYELITIS WITH
PROLIFERATIVE PERIOSTITIS
 Also called Periostitis ossificans or
Garrѐ’s Osteomyelitis.
 It is a type of osteomyelitis it is
characterized by focal gross thickening
of the involved bone due to
subperiosteal new bone deposition
(duplication of the cortex).

23. CLINICAL FEATURES: -
Affected patients are primarily children & young adults.
Incidence is mean age of 13 years.
No sex predominance is noted.
Most cases arise in the premolar & molar area of mandible.
Hyperplasia is located most commonly along lower border of
mandible.
Most cases are uni-focal, multiple quadrants may be affected.

25. Signs & symptoms:
 Swelling may be noted on lower border of
mandible.
 Pain may / may not be present.
 Radiographs demonstrate radiopaque
laminations roughly parallel to each other and
the underlying cortical surface (onion skin
appearance).

26. Radiographically…
 The standard occlusal radiograph reveals a smooth, convex, bony
overgrowth on the outer cortex of the jaw. This is often called
‘duplication’ of the cortex.
• Few newly formed bony trabeculae are often oriented
perpendicular to the “onion skin” layers.

27. Treatment…
 • Elimination of the causative agent.
• Extraction of the offending tooth and
antibiotic
therapy.
• The cortical swelling undergoes
spontaneous
physiologic remodelling and does not required
any additional surgical intervention

28. ALVEOLAR OSTEITIS
(Dry socket / Fibrinolytic alveolitis)
 After extraction of a tooth, a blood clot is formed at the site. with
eventual organization of the clot by granulation tissue, gradual
replacement by coarse fibrillar bone, and, finally, replacement by
mature bone.
 Destruction of the initial clot prevents appropriate healing and
causes clinical syndrome known as alveolar osteitis . Extensive
investigations have shown that the clot is lost secondary to
transformation of plasminogen to plasmin, with subsequent lysis of
fibrin and formation of kinins (fibrinolytic alveolitis)

29. PREDISPOSING FACTORS: -
1. Local trauma
2. Estrogens
3. Bacterial toxins
4. Inadequate irrigation of
surgery site
5. Tobacco abuse.

30. CLINICAL FEATURES: -
 The frequency of alveolar osteitis is
higher in the mandible and the
posterior areas
 Typically, severe pain, foul odor, and
(less frequently) swelling and
lymphadenopathy develop 3 to 4 days
after extraction of the tooth. The signs
and symptoms may last from 10 to 40
days

32. Treatment …
 On evaluation of the patient complaining of post extraction pain, a
radiograph should be taken of the affected area to rule out the
possibility of a retained root tip or a foreign body. The socket is
irrigated with warm saline, followed by thorough clinical inspection
of the socket for any unexpected pathosis. Curettage of the socket
is not recommended, because this typically increases the
associated pain. Finally, the socket is packed with an obtundent
and antiseptic dressing, such as iodoform gauze containing
eugenol

33.  Typically, the dressing is changed every 24 hours for the
first 3 days, then every 2 to 3 days until granulation
tissue covers the exposed bone. Because it acts as a
foreign material. The dressing should be discontinued as
soon as the patient is out of pain. After that time the
patient should be given a plastic syringe with instructions
for home irrigation. The irrigation should be continued
until the socket no longer collects any debris (usually 3
to 4 weeks).

34. THANKS