OSTEOMYELITIS l Oral pathology MCQs

 

INFLAMMATORY BONE DISEASE (OSTEITIS , OSTEOMYELITIS AND PERIOSTITIS l Oral pathology MCQs (multiple choice question) for dental students

 

INFLAMMATORY BONE CONDITIONS

• DIVIDED BROADLY INTO : OSTEITIS , OSTEOMYELITIS AND PERIOSTITIS

ALVEOLAR OSTEITIS ( DRY SOCKET)

• Postoperative pain in and around extraction site, which increases in severity 1-3 days after extraction
• Caused by either failure of a blood clot to form in the socket, or premature loss or disintegration of the clot

Failure of a clot to form may be due to:

1. Excessive extraction trauma
2. Limited local blood supply
3. Excessive use of Local anesthesia and excessive irrigation of the alveolus  after extraction
4. Radiotherapy
5. Smoking
6. Oral Contraceptives

Risk factors of DRY SOCKET:

1. Previous experience of Alveolar Osteitis
2. Deeply impacted mandibular third molar
3. Poor oral hygiene
4. Active or recent history of acute ulcerative gingivitis or pericoronitis associated with tooth to be extracted.
5. Immuno-compromised individuals

 

In cases where an adequate blood clot forms it might :

1. Get washed away by excessive mouth rinsing
2. disintegrate prematurely due to fibrinolysis of the clot most likely as a result of infection

• highest incidence of dry socket follows the extraction of impacted lower third molars.

 

Dry socket content:

• Food debris, saliva, and bacteria collect in the empty socket, the bone of which becomes infected and necrotic.
• Healing is extremely slow

 

Clinical Features of Dry socket:

• Severe pain developing a few days after the extraction.
• foul tasting and smelling decomposing food debris which can be washed away to reveal the denuded bone lining the cavity.

 

Prevention Dry socket:

1. Avoid excessive trauma + Confirm the presence of blood clot after extraction
2. Encourage patient to stop or limit smoking in the immediate post op period.
3. Advice patient to avoid vigorous mouth rinsing for the first 24 hrs post extraction
4. Preoperative administration of antibacterial mouthwash

 

Management Dry socket

• A dry socket will heal with time - Local therapy therefore aims at keeping the area clean allowing connective tissue to fill in defect.
• wound irrigation and intra alveolar dressing (antibacterial, topical anesthetic or combination)

FOCAL SCLEROSING (CONDENSING) OSTEITIS

Asymptomatic
Results from long term low grade irritation
Increased radio opacity at the apex of the tooth

Treatment of condensing osteitis :

1. Affected tooth should be treated or extracted
2. Biopsy to rule out metastatic malignancy.

ACUTE SUPPURATIVE OSTEOMYELITIS

• Caused by nearby infection [ extraction , PA infection etc] → infection spreading through the jaw
• Mandible is more commonly affected than maxilla [ because of it’s poor blood supply]
• Necrotic bone (a sequestrum) which is bathed in pus becomes separated from the surrounding vital bone
• After 10-14 days sufficient bone resorption may have occurred to produce irregular, moth-eaten areas of radiolucency.

 

Treatment ACUTE SUPPURATIVE OSTEOMYELITIS :

1. Bacterial sampling & culture → Vigorous antibiotic treatment.
2. Drainage + Debridement
3. Remove source of infection if possible.
4. Sequestrectomy
5. Hyperbaric oxygen

 

CHRONIC SUPPURATIVE OSTEOMYELITIS

• Inadequately treated acute osteomyelitis
• Chronic suppuration and discharge of pus through one or more intraoral or extraoral sinuses.
• Radiolucency with focal areas of opacity [Moth eaten appearance]

Treatment CHRONIC SUPPURATIVE OSTEOMYELITIS :

1. Sequestrectomy
2. Decortications if necessary

CHRONIC FOCAL SCLEROSING OSTEOMYELITIS

• diffuse sclerosing lesions of the mandible due to spread from low-grade infection/inflammation such as a periapical granuloma or periodontal diseases .

Treatment CHRONIC FOCAL SCLEROSING OSTEOMYELITIS :

• Elimination of the source of inflammation (exo or endo).

DIFFUSE SCLEROSING OSTEOMYELITIS

• Asymptomatic , sometimes vague pain & foul smell could be experienced
• Cotton wool appearance

Treatment DIFFUSE SCLEROSING OSTEOMYELITIS:

• Eliminate source of infection but sclerotic areas remain radiographically
• Cotton wool appearance Differential diagnosis:
•  Paget’s disease
• Osteopetrosis
• Cementoma

 

CHRONIC OSTEOMYELITIS WITH PROLIFERATIVE PERIOSTITIS (GARRE'S OSTEOMYELITIS, PERIOSTITIS OSSIFICANS)

mandible in children and young adults

1. Bony hard swelling on the outer surface of the mandible.
2. Overlying mucosa and skin normal

• Radiographically : Concentric layers (Onion skin appearance)
• Treatment: eliminate source of infection

OSTEORADIONECROSIS

• Infection may spread rapidly through the irradiated bone, resulting in extensive osteomyelitis / necrosis of the bone + sloughing of the overlying oral and facial soft tissues

Treatment Osteoradionecrosis :

1. Removal of necrotic bone
2. Hyperbaric treatment

OSTEOCHEMONECROSIS

• Associated with bisphosphonate administration for the treatment of osteoporosis  and osteopenia, Paget’s disease and Multiple myeloma
• Painless exposed bone

Treatment Osteochemonecrosis

1. Prevention of infection is paramount
2. Surgery Increases risk of further necrosis
3. Hyperbaric treatment- Not effective

• Palliative treatment

1. Identification of patients at risk
2. Avoid extractions