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Questions and Answers
What is the primary difference between osteitis and osteomyelitis?
Which of the following is NOT a common cause of osteomyelitis?
What is the typical radiographic appearance of acute suppurative osteomyelitis?
Which of the following is a common symptom of acute suppurative osteomyelitis?
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What is the typical histological feature of acute suppurative osteomyelitis?
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Which of the following bacteria is commonly cultured from acute osteomyelitis?
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What is the effect of radiation therapy on bone?
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What is the factor that predisposes patients to osteomyelitis?
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What is the primary mechanism leading to chronic suppurative osteomyelitis?
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Which region of the jaw is most commonly affected by chronic suppurative osteomyelitis?
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What is the characteristic radiographic appearance of chronic suppurative osteomyelitis?
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What is the histopathological characteristic of soft tissue in chronic suppurative osteomyelitis?
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What is the term for the focal bone reaction to a low-grade inflammatory stimulus?
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What is the typical age range for focal sclerosing osteomyelitis?
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What is the characteristic clinical presentation of chronic suppurative osteomyelitis?
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What is the term for the new bone formation around sequestra in advanced chronic suppurative osteomyelitis?
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What is the primary cause of periapical inflammatory lesions and osteomyelitis?
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What is the result of prolonged apical hyperemia?
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What is the characteristic of apical hyperemia?
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What occurs if the irritation is not removed in apical hyperemia?
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What is the characteristic of acute apical periodontitis?
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What is the radiographic finding in the first week of apical hyperemia?
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What is the clinical feature of acute apical periodontitis?
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What is the progression of periapical inflammatory lesions?
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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
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Description
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.
