24 Questions
What is the primary difference between osteitis and osteomyelitis?
Osteitis affects only bone, while osteomyelitis affects both bone and bone marrow
Which of the following is NOT a common cause of osteomyelitis?
Viral infection
What is the typical radiographic appearance of acute suppurative osteomyelitis?
A diffuse, ill-defined lytic radiolucency
Which of the following is a common symptom of acute suppurative osteomyelitis?
Paresthesia of the lower lip
What is the typical histological feature of acute suppurative osteomyelitis?
Necrotic bone within a purulent exudate
Which of the following bacteria is commonly cultured from acute osteomyelitis?
Staphylococcus aureus
What is the effect of radiation therapy on bone?
It decreases vascularity and leads to osteoradionecrosis
What is the factor that predisposes patients to osteomyelitis?
Chronic systemic diseases
What is the primary mechanism leading to chronic suppurative osteomyelitis?
The formation of a dense scar to wall-off the infected area
Which region of the jaw is most commonly affected by chronic suppurative osteomyelitis?
Mandibular molar region
What is the characteristic radiographic appearance of chronic suppurative osteomyelitis?
Mottled (moth-eaten) appearance with patchy ill-defined radiolucency
What is the histopathological characteristic of soft tissue in chronic suppurative osteomyelitis?
Infiltrated chronic or mixed inflammatory cells
What is the term for the focal bone reaction to a low-grade inflammatory stimulus?
Focal sclerosing osteomyelitis
What is the typical age range for focal sclerosing osteomyelitis?
Children and young adults
What is the characteristic clinical presentation of chronic suppurative osteomyelitis?
Painful jaw swelling with sinus formation, purulent discharge, and sequestra exfoliation
What is the term for the new bone formation around sequestra in advanced chronic suppurative osteomyelitis?
Invulcrum
What is the primary cause of periapical inflammatory lesions and osteomyelitis?
Bacterial cells or their toxins, or necrotic debris reaching the apical region
What is the result of prolonged apical hyperemia?
Bone resorption
What is the characteristic of apical hyperemia?
Dilatation of apical vascular bed and fluid escape
What occurs if the irritation is not removed in apical hyperemia?
Bone resorption
What is the characteristic of acute apical periodontitis?
Infiltration of PMNLs, dilated vessels, life and dead RBCs, and macrophages
What is the radiographic finding in the first week of apical hyperemia?
No radiographic changes
What is the clinical feature of acute apical periodontitis?
Severe pain on slight touch that is relieved by strong pressure
What is the progression of periapical inflammatory lesions?
Apical hyperemia, acute apical periodontitis, chronic apical periodontitis, apical granuloma, osteomyelitis
Study Notes
Osteomyelitis
- Inflammation of bone and bone marrow, while osteitis means inflammation of bone only
- Results from:
- Extension of periapical abscess
- Physical injury (fracture or surgery)
- Bacteremia
- Non-bacterial osteomyelitis secondary to radiation therapy or low-grade chronic irritation
- Chronic systemic diseases, immunocompromised states, or decreased vascularity
Acute Suppurative Osteomyelitis
- Clinically:
- Fever (pyrexia)
- Leukocytosis
- Lymphadenopathy
- Soft tissue swelling of the affected area
- Drainage, with or without exfoliation of necrotic bone fragments (sequestrum)
- Paresthesia of the lower lip, in case of mandibular bone involvement
- Radiographic appearance:
- Diffuse ill-defined lytic radiolucency
- Individual trabeculae become fuzzy and indistinct, giving a moth-eaten appearance
- Histologically:
- Necrotic bone (sequestrum) is seen within a purulent exudate, occupying the marrow spaces
- The necrotic bone shows loss of osteoblasts and osteocytes, with peripheral resorption (osteoclastic activity) and bacterial colonization
Chronic Suppurative Osteomyelitis
- Develops from unresolved acute osteomyelitis or as a chronic reaction due to long-term, low-grade inflammatory reaction
- Mandibular molar region mostly affected, due to more diffuse blood supply and possibly early involvement of lower molars with caries
- Clinically:
- Painful jaw swelling
- Sinus formation
- Purulent discharge with sequestra exfoliation
- Tooth loss or pathologic fracture
- Radiographically:
- Mottled (moth-eaten) appearance, of patchy ill-defined radiolucency
- Focal opacities representing sequestra
- The cortical plate may reveal osteogenic periosteal hyperplasia
- Histopathology:
- Soft tissue consists of infiltrated chronic or mixed inflammatory to the connective fibrous tissue, filling the inter-trabecular area
- Scattered sequestra and pockets of abscess formation are common, with lymphocytes, plasma cells, and macrophages
Focal Sclerosing Osteomyelitis (Condensing Osteitis or Bony Scar)
- Means focal bone reaction to a low-grade inflammatory stimulus
- An area of bone sclerosis associated with the apices of non-vital teeth with large carious lesions (usually lower premolar/molar area)
- Mostly in children or young adults
- Hypercementosis (low-grade irritation) and inflammatory radicular cyst formation
This quiz covers the definition, causes, and characteristics of chronic suppurative osteomyelitis, a complication of unresolved acute osteomyelitis or long-term low-grade inflammation. Learn about the clinical presentation and affected areas, particularly the mandibular molar region.
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