DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY

OSTEOMYELITIS

presented by:-Yogesh kishan

BDS 3rd year
74
 TODAY'S DISCUSSION
1. INTRODUCTION
11.treatment
2. CLASSIFICATION
12.conclussion
3. PRE DISPOSING FACTORS
13.reffrences
4. ETIOLOGY
5. PATHOGENESIS
6. ACUTE SUPPURATIVE OML
7. CHRONIC SUPPURATIVE OML
8. CHRONIC FOCAL SCLEROSING
OML
9. CHRONIC DIFFUSE
SCLEROSING OML
10. GARRE' s OML
 INTRODUCTION
The word "osteomyelitis" originates from the ancient Greek words osteon
(bone) and muelinos (marrow)
Osteomyelitis is an inflammation of bone & bone marrow.

Definition:-
Osteomyelitis is an inflammatory condition of bone begins as an infection
of the medullary cavity and haversian systems and extends to involve the
periosteum of the affected area.
 CLASSIFICATION
1.Based on clinical course:- 3.Based on intensity

Acute Acute
Sub acute
chronic
Chronic

2.Based on presence of suppuration:- 4.Based on specificity

a.Suppurative b.Non suppurative Non Specific Specific

Acute suppurative Chronic focal Acute OML Tuberculous
OML sclerosing OML Chronic OML OML
Chronic supparative Chronic diffuse shyphilitic OML
OML sclerosing OML Actinomycotic
Infantile OML Garre' OML OML
Actinomyotic OML
Osteoradionecrosis
PRE DISPOSING FACTORS

LOCAL FACTOR SYSTEMIC FACTORS

• Malnutrition and chronic alcoholism

Anatomical site of disease
• Drug addiction
Pre Existing bone lesion
• Anemia, especially sickle cell anemia
Radiation injury
• Diabetes (poorly controlled)
• Acute leukemia
• Agranulocytosis
• Syphilis
 etiology
– Periapical abscess.
– Periodontal pocket involved in a fractured
jaw bone.
– Infected periapical granuloma
– Infected periapical cyst.
– Acute necrotizing ulcerative gingivitis
– Periodontal abscess.
– Pericoronitis
– Infected and fractured tooth/retained root tip.
PATHOGENESIS
Trauma/Infection
ischemia &infiltration of microorganism
Acute Inflamation
liberation of protieolytic enzymes& destruction
Tissue Necrosis

Vascular Thrombosis
necrotic tissue+dead microbes with WBCs
Pus Accumulation
increaed intramedullary pressure
Vascular collapse
venous stasis & ischemia&pus spreads through
Subperiosteal abscess the haverssian and nutrient canal
 further decrease in vscular supply leads to
compression of neurovascular bunddle
OML Mediated Mandibular ansthesia

Mucosal & Cutaneous Abscess & sinus formation

Formation of Squestra

Involucrum

Clocae

through wich pus escapes to the

epithelial surface
ACUTE SUPPURTIVE OML

It exists 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.
 Clinical Features
severe pain, trismus, and paresthesia of the
lips in case of mandibular involvement and
manifests an elevation of temperature with
regional lymphadenopathy.

The white blood cell count is frequently

elevated

The teeth in the area of involvement are

loose and sore so that eating is difficult.

Pus may exude from the gingival margin.

 Radiographic Features
Radiographs may demonstrate an ill-defined radiolucency occasionally combined with widening of the
periodontal ligament, loss of lamina dura. Periosteal new bone formation also may be seen in response to
subperiosteal spread of the infection.
Individual trabeculae become fuzzy and indistinct, and radiolucent areas begin to appear
 Histological Features

Medullary spaces are filled

with inflamatory exudates
Inflamatory cells chiefy
PMNL,Ocassional lymphocyte
and plasma cells
Osteoblast bodering the bony
trabacule are generally
distroyed
 CHRONIC SUPPURATIVE OML

If acute osteomyelitis is not resolved , the entrenchment of chronic

osteomyelitis occurs, or the process may arise primarily without a
previous acute episode.

Clinical features:-
are similar to those of acute osteomyelitis except that all signs and symptoms
are milder.

The pain is less severe; the temperature is still elevated, but only mildly; and th
leukocytosis is only slightly greater than normal.
Teeth may not be loose or sore.
 Radiographic Features
Radiographs reveal a patchy,
ragged, and ill-defined
radiolucency that may contain
central radiopaque sequestra
and be intermixed with zones
of radiodensity.
 Histological Features

A significant soft tissue component

that consists of chronically or
subacutely inflamed fibrous
connective tissue filling the
intertrabecular areas of the bone .

Scattered sequestra and pockets

of abscess formation
are common
 CHRONIC focal sclerosing OML
(c0ndensing osteitis)
It is a rare non-suppurative inflammatory condition of bone characterized by
sclerotic bone formation around the root apex of a nonvital tooth

Clinical features:-
seen most frequently in children and young adults but also can occur in
older adults.
Tooth most commonly involved md.1st molar which contains large carious
lession.
mild pain associated with an infected pulp
 Radiographic Features
Well-circumscribed radiopaque mass with
uniform radiodensity; seen around the root
apex of a nonvital tooth.
There is no radiolucent border around the
lesion

widening of periodontal ligament space

The border of the lesion is usually

welldefined or sometimes the border may
be ragged.
 Histological Features

• There is usually presence of a dense mass of

sclerotic bone in the lesion with little or no
interstitial marrow tissue.

• Wherever the bone marrow is present it is

usually fibrotic and is often infiltrated by
chronic inflammatory cells.
 CHRONIC diffuse sclerosing OML

Diffuse sclerosing osteomyelitis is a different entity form the small, isolated lesions of
focal sclerosing osteomyelitis. It is mainly confined to the mandible and it typically
involves a large section of the bone.

Clinical features:-
Diffuse sclerosing osteomyelitis is usually seen
among elderly people.
• It is mostly seen among blacks and racial
groups.
• More common among females.
• Mandible is mostly affected in diffuse sclerosing osteomyelitis especially in
edentulous areas.
 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.
 Histological Features
• Diffuse sclerosing osteomyelitis shows
formation of dense irregular bone within a
hypocellular fibrous stroma

• Bony trabeculae often reveal multiple reversal

and resting lines.

• Patchy distribution of chronic inflammatory

cells is often found in the marrow tissue.
 chronic oml with proliferative
periostitis(garre's oml)

This is a distinctive type of chronic osteomyelitis in which there is focal gross thickening of the
periosteum, with peripheral reactive bone formation resulting from mild irritation or infection.

Clinical features:-
occurs almost entirely in young persons before the age of 25 year and most frequently involves the
anterior surface of the tibia.
The patient usually complains of a toothache or pain in the jaw and a bony hard swelling on the oute
surface of the jaw.

It develops as a result of an overlying soft-tissue infection or cellulitis that subsequently involves the
deeper periosteum
 Radiographic Features

Garre’s osteomyelitis radiographically

presents a central jaw lesion with a
mottled,predominantly radiolucent
appearance, the lesion often has few
radiopaque foci.

• The affected periosteum forms several

layers of reactive vital bone and as a
result the expanded cortex of bone
radiographically exhibits many
concentric or parallel opaque layers,
which often produce a typical “onion
skin” appearance.
 Histological Features
• The lesion histologically presents areas of
newly formed bone, consisting of multiple
osteoids and primitive bony tissues in the
subperiosteal region.
• Parallel rows of highly cellular and reactive
woven bones are seen.
• Osteoblastic activity dominates the outer
surface of bone while both osteoblastic as well
as osteoclastic activities can be observed in the
central part of bone.
• The marrow spaces contain fibrous tissue
showing patchy areas of chronic inflammatory
cell infiltration
 TREATMENT
TREATMENT GUIDELINE:
Disrupt infection foci.
Debride any foreign bodies ,necrotic tissue or sequestra
culture and identify specific pathogens for definitive antibiotic
treatment
Drain and irrigate the region
consider adjunctive treatment to enhance microvascular reperfusion
Reconstruction of the affected area.
 MANAGEMENT
1. CONSERVATIVE MANAGEMENT
Complete bed rest
Supportive therapy (high protein diet, high caloric diet, adequate multi vitamins
rehydration
Blood transfusion
Control of pain (analgesics and sedation)
Antibiotic therapy
2.SURGICAL MANAGEMENT

Extraction of the affected tooth

Incision and drainage
sequestectomy
 CONCLUSION
In conclusion, osteomyelitis of the jaw is a severe and potentially life-threatening condition characterized by
inflammation and infection of the bone in the jaw. It can be caused by various factors such as dental infections,
trauma, or underlying medical conditions.

Throughout this presentation, we have explored the causes, symptoms, diagnosis, and treatment options for
osteomyelitis of the jaw. We have learned that early recognition and prompt treatment are crucial to prevent
the spread of infection and minimize complications.

The symptoms of osteomyelitis of the jaw may include pain, swelling, redness, and difficulty in opening the
mouth. Diagnosis often involves a combination of clinical examination, imaging studies, and laboratory tests to
confirm the presence of infection and determine the extent of bone involvement.

Treatment typically involves a multidisciplinary approach, including the use of antibiotics to target the
underlying infection, surgical intervention to remove necrotic bone and promote healing, and supportive
measures such as pain management and oral hygiene practices.
 REFFERENCES
1. shafer's textbook of oral pathology
2. Oral And Maxillofacial Pathology By Brad Neville
3. Google for photographs
THANK
YOU!

Presented to:-
DR PRIYANKA RASTOGI MA’AM(HOD)
DR SACHIN KUMAR SIR(PROF.)
DR RUDRA BHARADWAJ MA’AM (sr.lecturer)