A lecture for 4th stage dentistry students

1. Infective bone disease
Dr.Mohamed Rahil
(( Maxillofacial surgeon ))
Tikrit dentistry college
2015 – 2016

2. definition
• Osteomyelitis is an infection in a bone. Infections
can reach a bone by traveling through the
bloodstream or spreading from nearby tissue.
Infections can also begin in the bone itself if an
injury exposes the bone to germs.

3. Predisposing factors
• Decrease blood supply
• Decrease in host defence mechanism

4. osteomylitis
• More in mandible
Decreased dramatically due to ;
• AB
• Improve nutrition
• Better medical and dental care
• Improvement of diagnostic modality

5. pathogenesis
In maxillofacial region main causes of osteomlyitis;
• Spreading of odontogenic infection
• Trauma
• Hematogenous spread (very rare)
Mechanism :
o bacteria introduce to the bone
o Induce inflamatory respons
o Edema and hyperemia occure
o Increase in the intrameduulary pressure lead to compromise
blood supply to the bone which aggrivate the condition
o End point occurs when the pus exits the soft tissues and
form sinusis

6. Microbiology
• Staphylococcal species consider the most
pathogen in osteomylitis of the jaw
• Other organisms as streptococcus , anaerobic
MO as bacteroid ,peptostreptococcus

7. classification
• 1. Acute osteomylitis
a. Contiguous focus
b. Progressive
c. Hematogenous
2. chronic osteomylitis
a. Recurrent multifocal
b. Garre’s osteomylitis
c. Suppurative or nonsuppurative
d. sclerosing

8. Clinical presentation
Pain (deep )
Swelling
Lymphadenopathey
Fever
malaise
Paresthesia of inferior alveolar nerve
Trismus
fistulas

9. Radiograph
• Acut osteomylitis usually show normal OPG
• Chronic osteomylitis classicaaly show moth eaten
appearance , and bone sequestration
• Ct scan is the standard imaging in evalaution of
osteomylitis
• MRI usfel in early detection of osteomylitis
• PET scan can be used in detection of osteomylitis

13. Treatment
• Correct diagnosis is so important
• History , clinical examination ,radiographical
evaluation
• Biopsy ,culture and sensetivity
• Medical evaluation and treating any
immunocompromised cases

14. Surgical treatment
• Sequestrectomy
• Saucerization
• Decortication
• Hyperbaric oxygen

19. Osteoradionecrosis
• Bone necrosis as complication of radiotherapy
• Occur due to trauma to the jaw (dental
extraction) or may occur spontanousely
• Radiation dose above 5000 – 6000 rads
• Clinically manifestated as pain and exposed
bone
• Radiographically appear as osteomylitis

22. Treatment
• Debridment of exposed bone with hyperbaric
oxygen
• HBO protocol ; 2,4 atm 90 min for each
session
• 20 – 30 dives preoperatively before any
surgical intervention followed by 10
additional div.
• If no response then resection of necrotic
tissue and replased by free flap

23. osteochemonecrosis
• Biphosphanate therapy (zoledronate ,pamidronate
)act as osteoclast inhibitor
• Used in treatment of ; osteoporosis,paget’s
disease,multiple myeloma ,metastaic cancer
• Biphosphanate bone necrosis seen today as side effect
to use these drugs
• Mechanism of bone necrosis differ from that occur
due to radiotherapy
• In biphosphanate necrosis bone failed to regenerate
after trauma as tooth extraction

24. Role of dentist in BRONJ treatment
• Medical consultation about the drugs that used by the
patient
• Routine dental care
• All dental procedures should be performed as
atraumatically as possible with little tissue trauma,
bleeding ,and risk of postoperative infection
• If BRONJ occur, only sharp edges of exposed bone
should be removed ,there is no definitive treatment till
now
• In case of any infection aggressive use of systemic
antibiotic is indicated

25. Actinomycosis
• Is a long-term (chronic) bacterial infection
that commonly affects the face and neck.
• caused by bacterium called Actinomyces
israelii
• Charactraised by Multiple sinuses discharge
• Other symptoms ; Fever , Minimal or no pain ,
Swelling or a hard, red to reddish-purple
lump on the face or upper neck ,Weight loss

27. Treatment
• Drainage of abscess
• Removal of causative factors
• Long term use of antibiotic ,mainly pencillin

28. mucormycosis
• Mucormycosis refers to several different diseases caused by
infection with fungi
• occur mainly in immunocompromised patient .
• Most mucormycosis infections are life-threatening
• Severe infection of the facial sinuses, which may extend into
the brain, is the most common presentation.
• Treatment requires correction of the underlying risk
factor(s), antifungal therapy with amphotericin B, and
aggressive surgery .

31. Thank you for listening