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Infective bone disease
Dr.Mohamed Rahil
(( Maxillofacial surgeon ))
Tikrit dentistry college
2015 – 2016
definition
• Osteomyelitis is an infection in a bone. Infections
can reach a bone by traveling through the
bloodstream or ...
Predisposing factors
• Decrease blood supply
• Decrease in host defence mechanism
osteomylitis
• More in mandible
Decreased dramatically due to ;
• AB
• Improve nutrition
• Better medical and dental care
...
pathogenesis
In maxillofacial region main causes of osteomlyitis;
• Spreading of odontogenic infection
• Trauma
• Hematoge...
Microbiology
• Staphylococcal species consider the most
pathogen in osteomylitis of the jaw
• Other organisms as streptoco...
classification
• 1. Acute osteomylitis
a. Contiguous focus
b. Progressive
c. Hematogenous
2. chronic osteomylitis
a. Recur...
Clinical presentation
Pain (deep )
Swelling
Lymphadenopathey
Fever
malaise
Paresthesia of inferior alveolar nerve
Trismus
...
Radiograph
• Acut osteomylitis usually show normal OPG
• Chronic osteomylitis classicaaly show moth eaten
appearance , and...
Treatment
• Correct diagnosis is so important
• History , clinical examination ,radiographical
evaluation
• Biopsy ,cultur...
Surgical treatment
• Sequestrectomy
• Saucerization
• Decortication
• Hyperbaric oxygen
Osteoradionecrosis
• Bone necrosis as complication of radiotherapy
• Occur due to trauma to the jaw (dental
extraction) or...
Treatment
• Debridment of exposed bone with hyperbaric
oxygen
• HBO protocol ; 2,4 atm 90 min for each
session
• 20 – 30 d...
osteochemonecrosis
• Biphosphanate therapy (zoledronate ,pamidronate
)act as osteoclast inhibitor
• Used in treatment of ;...
Role of dentist in BRONJ treatment
• Medical consultation about the drugs that used by the
patient
• Routine dental care
•...
Actinomycosis
• Is a long-term (chronic) bacterial infection
that commonly affects the face and neck.
• caused by bacteriu...
Treatment
• Drainage of abscess
• Removal of causative factors
• Long term use of antibiotic ,mainly pencillin
mucormycosis
• Mucormycosis refers to several different diseases caused by
infection with fungi
• occur mainly in immunoco...
Thank you for listening
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
Infective bone diseases
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Infective bone diseases

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A lecture for 4th stage dentistry students

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Infective bone diseases

  1. 1. Infective bone disease Dr.Mohamed Rahil (( Maxillofacial surgeon )) Tikrit dentistry college 2015 – 2016
  2. 2. definition • Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs.
  3. 3. Predisposing factors • Decrease blood supply • Decrease in host defence mechanism
  4. 4. osteomylitis • More in mandible Decreased dramatically due to ; • AB • Improve nutrition • Better medical and dental care • Improvement of diagnostic modality
  5. 5. pathogenesis In maxillofacial region main causes of osteomlyitis; • Spreading of odontogenic infection • Trauma • Hematogenous spread (very rare) Mechanism : o bacteria introduce to the bone o Induce inflamatory respons o Edema and hyperemia occure o Increase in the intrameduulary pressure lead to compromise blood supply to the bone which aggrivate the condition o End point occurs when the pus exits the soft tissues and form sinusis
  6. 6. Microbiology • Staphylococcal species consider the most pathogen in osteomylitis of the jaw • Other organisms as streptococcus , anaerobic MO as bacteroid ,peptostreptococcus
  7. 7. classification • 1. Acute osteomylitis a. Contiguous focus b. Progressive c. Hematogenous 2. chronic osteomylitis a. Recurrent multifocal b. Garre’s osteomylitis c. Suppurative or nonsuppurative d. sclerosing
  8. 8. Clinical presentation Pain (deep ) Swelling Lymphadenopathey Fever malaise Paresthesia of inferior alveolar nerve Trismus fistulas
  9. 9. Radiograph • Acut osteomylitis usually show normal OPG • Chronic osteomylitis classicaaly show moth eaten appearance , and bone sequestration • Ct scan is the standard imaging in evalaution of osteomylitis • MRI usfel in early detection of osteomylitis • PET scan can be used in detection of osteomylitis
  10. 10. Treatment • Correct diagnosis is so important • History , clinical examination ,radiographical evaluation • Biopsy ,culture and sensetivity • Medical evaluation and treating any immunocompromised cases
  11. 11. Surgical treatment • Sequestrectomy • Saucerization • Decortication • Hyperbaric oxygen
  12. 12. Osteoradionecrosis • Bone necrosis as complication of radiotherapy • Occur due to trauma to the jaw (dental extraction) or may occur spontanousely • Radiation dose above 5000 – 6000 rads • Clinically manifestated as pain and exposed bone • Radiographically appear as osteomylitis
  13. 13. Treatment • Debridment of exposed bone with hyperbaric oxygen • HBO protocol ; 2,4 atm 90 min for each session • 20 – 30 dives preoperatively before any surgical intervention followed by 10 additional div. • If no response then resection of necrotic tissue and replased by free flap
  14. 14. osteochemonecrosis • Biphosphanate therapy (zoledronate ,pamidronate )act as osteoclast inhibitor • Used in treatment of ; osteoporosis,paget’s disease,multiple myeloma ,metastaic cancer • Biphosphanate bone necrosis seen today as side effect to use these drugs • Mechanism of bone necrosis differ from that occur due to radiotherapy • In biphosphanate necrosis bone failed to regenerate after trauma as tooth extraction
  15. 15. Role of dentist in BRONJ treatment • Medical consultation about the drugs that used by the patient • Routine dental care • All dental procedures should be performed as atraumatically as possible with little tissue trauma, bleeding ,and risk of postoperative infection • If BRONJ occur, only sharp edges of exposed bone should be removed ,there is no definitive treatment till now • In case of any infection aggressive use of systemic antibiotic is indicated
  16. 16. Actinomycosis • Is a long-term (chronic) bacterial infection that commonly affects the face and neck. • caused by bacterium called Actinomyces israelii • Charactraised by Multiple sinuses discharge • Other symptoms ; Fever , Minimal or no pain , Swelling or a hard, red to reddish-purple lump on the face or upper neck ,Weight loss
  17. 17. Treatment • Drainage of abscess • Removal of causative factors • Long term use of antibiotic ,mainly pencillin
  18. 18. mucormycosis • Mucormycosis refers to several different diseases caused by infection with fungi • occur mainly in immunocompromised patient . • Most mucormycosis infections are life-threatening • Severe infection of the facial sinuses, which may extend into the brain, is the most common presentation. • Treatment requires correction of the underlying risk factor(s), antifungal therapy with amphotericin B, and aggressive surgery .
  19. 19. Thank you for listening

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