Osteitis and Osteomyelitis of the Jawbones

By Dr. Vishaal Bhat on Monday, 3 December, 2007 with 0 comments

Although there is a little difference between these two forms of the bony tissue inflammations from the pathological anatomy point of view, for the clinical classification the term osteitis means a localized, delineated inflammation of bone, while the term osteomyelitis (inflammation of the bone marrow) is used to describe a diffuse extension of an inflammatory process to a large extent.

Osteitis originates by transfer of infection from a gangrenous tooth root into a bony tissue around the tooth apex, after an extraction or an alveolar socket inflammation. Clinical signs are identical to those of an acute periostitis or subperiosteal abscess of the alveolar ridge. It is a painful disease, alveolar mucosa around the affected tooth is swollen, a purulent discharge appears and an internal fistula is formed.

Osteomyelitis of the upper jaw is usually restricted to the alveolar ridge and its course is similar to an extensive osteitis. It is accompanied by high fevers with shivering, pronounced edema of cheeks, upper lip and lower eye lids. The danger of this disease lies at a possibility of the inflammation transfer to veins of the face and possible infection of orbits and intracranial infection of sinus cavernosus.

Osteomyelitis of the lower jaw affects adults more often than osteomyelitis of the upper jaw. An acute inflammation extends rapidly into surrounding soft tissues. High fevers with shivering, teeth loosening at an affected area and puss discharge from alveolar sockets. A diagnosis is confirmed by hypesthesia or anesthesia of the lower lip (Vincent’s sign). An X-ray examination of the lower jaw does not show any significant changes during the early stage (up to 10 days). Only after this period, an irregular dense and light areas of the bony tissue (spotted bone) and a gradual necrotization of bone together with sequestra appear. Therapy includes a combination of surgeries (incision of abscesses, sequestrectomy) and high doses of antibiotics (Lincomycin). An immobilization of jaws is employed in cases of large damage of a jaw in order to prevent a pathological fracture.

Osteomyelitis of child’s age.

This disease has usually odontogenous causes (streptococcal or staphylococcal infections). Hematogenous infections or general infectious diseases are other etiological factors. Serious complications of this disease are disorders of jaws development that can result from an inflammatory process near the growth centers. Lateral deviation of jaws, microgenia, pseudoprogenia or ankylosis of the mandibular joint can occur. Osteomyelitis of either upper or lower jawbone at infants can be caused by a tooth’s germ, infected by injured oral mucosa or by a hematogenous way. During this very serious disease, a child suffers from high fevers and refuses food. If a therapy is not started on time, the disease could be lethal in several days.

Inflammations around the jaws belong to serious stomatologic diseases. They are treated preferentially by a surgery supported by a targeted antibiotic therapy. Prevention of these diseases is based on regular and specialized stomatological examinations and treatment.

Category: Oral Pathology Notes



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