1. Presented by:
Fasahat Ahmed Butt (36
Group: C1

2. • What is osteomyelitis?
• Predisposing factors of osteomyelitis?
• Classification
Clinical features
Radiographic features
• Management of osteomyelitis
• What is Alveolar osteitis?
• Pathogenesis
Clinical features
• Treatment

3. • Osteon: Bone
• Myelitis: Inflammation of the bone marrow
• Acute or chronic inflammatory process in the
medullary spaces or cortical surfaces of the bone
that extends away from the initial site of
involvement

4. Decreased vascularity
or Vitality of bone
• Trauma
• Radiation injury
• Paget’s disease
• Osteoporosis
• Major vessel disease
Impaired host defence
• Immune deficiency state
• Immunosuppression
• Diabetes Mellitus
• Malnutrition
• Extremes of age
Local factors Systemic factors

5. • SUPPURATIVE OSTEOMYELITIS
• FOCAL SCLEROSING OSTEOMYELITIS
• DIFFUSE SCLEROSING OSTEOMYELITIS
• PROLIFERATIVE PERIOSTITIS

6. ACUTE CHRONIC

7. • Bacteroids
• Porphyromonas
• Prevotella
Staphylococcus (open fractures)

8. Organism enters the jaw (mandible) blood supply
Medullary infection spreads through marrow spaces
Thrombosis, bone necrosis
Lacunae empty of osteoid filled with neutrophil & bacteria
proliferate in dead tissue
Proliferation of periosteum & sinus formation
Sequestrum separated once removed, new bone is
formed (INVOLUCRUM)

10. • Location: Mandible
• Male: Adult males
• Pain
• Soft tissue swelling
• Fever
• Lymphadenopathy

11. • It may be normal in the early stages of the disease, but
after 10-14 days sufficient bone resorption may have
occurred to produce irregular, MOTH-EATEN areas of
radiolucency.

12. C/F
• Swelling
• Pain
• Sinus formation
• Tooth loss
• Sequestrum formation

13. • ILL-defined radiolucency that often contains central radiopaque
sequestra.

15. C/F
• Age: Children and young adults
• Location: Mandibular premolar and molar
• Bone sclerozing associated with non vital
pulpitic tooth

16. • Increased areas of radiodensity surround the apices
of non-vital mandibular 1st molar

17. C/F
• Age: Adults
• No sex predilection
• Location: Mandible
• Sclerosing around the site of periapical/PD inflammation
• Persistent pain
• No swelling

18. • Radiodencities
• Sclerotic bone seen in tooth bearing area

19. C/F
• Age: Children and young adults.
• Location: Lower border of the mandible.
• No sex predominance.

20. • New periosteal bone formation along the inferior border of
the mandible
• CT image: new periosteal bone growth with onionskin
lamination

21. Essential measures:
Bacterial sampling and
culture
Vigorous (empirical)
antibiotic treatment
Drainage
Analgesic
Specific antibiotics
Debridement
Adjunctive treatment:
Sequestrectomy
Decortication
Resection and
reconstruction for
extensive bone
destruction
Hyperbaric oxygen
For acute osteomyelitis antibiotic treatment for 4-6
wks
For chronic osteomyelitis treatment is carried for
12 wks

23. • Localized inflammation of the bone following:
Failure of blood clot to form in the socket
Premature loss of the clot
Disintegration of the clot
• Common complication following
tooth extraction

24. Food debris Bacteria Saliva
Empty socket
Bone becomes
infected &
necrotic
Inflammatory
reactions in the
adjacent marrow
Localizes it to
the socket wall
Osteomyelitis
Necrotic bone is
separated by
osteoclast
Tiny
sequestra
Proliferation of
granulation tissue from
surrounding vital bone
HEALING

25. • Location: Mandible in posterior areas.
• No sex predilection
• Severe pain
• Radiates to ear and neck
• Foul odor
• Lymphadenopathy
• Trismus

27. • Administration of regional local anesthesia
• Debridement of socket wall
• Irrigate with normal saline
• Antiseptic/analgesic
Alvogel
Zinc oxide/eugenol pack
Chlorhexidine gel
Tetracycline pack
NO drainage.

28. • Chlorhexidine mouth rinses should be done gently.
• Patient should not smoke minimum for 48 hours after
extraction.
• Patient should avoid sucking, spitting or drinking through
the straw.
• Patient should try to maintain good oral hygiene

29. • CAWSON
• J.V. SOAMES & J.C. SOUTHAM
• NEVILLE & DAMM
• GOOGLE for images