Chronic infections of jaw (oral infections)

957 views

Published on

Published in: Education, Health & Medicine
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
957
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
90
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Chronic infections of jaw (oral infections)

  1. 1. CHRONIC INFECTIONSCHRONIC INFECTIONS OF JAWSOF JAWS OROR INFLAMMATORINFLAMMATOR DISEASES OF BONEDISEASES OF BONE
  2. 2. OSTEOMYELITIS.OSTEOMYELITIS. • It is an inflammatory process of boneIt is an inflammatory process of bone which involves;which involves; • bone marrowbone marrow • cancellouscancellous • cortexcortex • periosteumperiosteum
  3. 3. PATHOPHYSIOLOGYPATHOPHYSIOLOGY • InfectionInfection • Infected exudate spreads throughout→Infected exudate spreads throughout→ cancellous spaces of bone Thrombosis of→cancellous spaces of bone Thrombosis of→ nutrient vesselsnutrient vessels • Ischemia Infaction Osteomylitis→ →Ischemia Infaction Osteomylitis→ → • MandibleMandible • Reduced endosteal blood supply_ osteomylitisReduced endosteal blood supply_ osteomylitis commoncommon • MaxillaMaxilla • Plexiform blood supply _osteomylitis lessPlexiform blood supply _osteomylitis less commoncommon
  4. 4. CLASSIFICATIONCLASSIFICATION • SUPPURATIVE (PYOGENIC) OSTOMYLITISSUPPURATIVE (PYOGENIC) OSTOMYLITIS • ACUTEACUTE • CHRONICCHRONIC  CHRONIC SCLEROSING NONCHRONIC SCLEROSING NON SUPPARATIVE OSTEOMYLITIS OR GARRE’SSUPPARATIVE OSTEOMYLITIS OR GARRE’S OSTEOMYLITISOSTEOMYLITIS • OSTEOMYLITIS IN SYSTEMIC DISEASESOSTEOMYLITIS IN SYSTEMIC DISEASES • TB , ACTINOMYCOSIS , SYPHILISTB , ACTINOMYCOSIS , SYPHILIS • IRRADIATION (OSTEORADIO NECROSIS)IRRADIATION (OSTEORADIO NECROSIS) • PAGETS DISEASE, OSTEOPETROSISPAGETS DISEASE, OSTEOPETROSIS • CHEMICALS, ELECTRO COAGULATION.CHEMICALS, ELECTRO COAGULATION.
  5. 5. ACUTE PYOGENICACUTE PYOGENIC OSTEOMYLITISOSTEOMYLITIS
  6. 6. PREDISPOSING FACTORSPREDISPOSING FACTORS • IMPAIRED IMMUNE DEFENCESIMPAIRED IMMUNE DEFENCES • SYSTEMICSYSTEMIC • ACUTE LEUKAEMIASACUTE LEUKAEMIAS • AIDSAIDS • UNCONTROLLED DIABETESUNCONTROLLED DIABETES • MALNUTRITION, ALCOHLICSMALNUTRITION, ALCOHLICS • LOCALLOCAL • IRRADIATIONIRRADIATION • PAGETS DISEASEPAGETS DISEASE
  7. 7. ETIOLOGYETIOLOGY • ODONTOGENIC INFECTIONSODONTOGENIC INFECTIONS • PERIAPICAL INEECTIONPERIAPICAL INEECTION • PERIODONTAL INFECTIONPERIODONTAL INFECTION • LONG_ STANDING PERICORONAL INFECTIONLONG_ STANDING PERICORONAL INFECTION • EXTRACTED WOUND INFECTIONEXTRACTED WOUND INFECTION • INFECTION OF ODONTOGENIC CYST/ TUMOURINFECTION OF ODONTOGENIC CYST/ TUMOUR • COMPOUND FRACTURE/GUN SHOT WOUNDSCOMPOUND FRACTURE/GUN SHOT WOUNDS • LOCAL TRAUMATIC INJURIES OF GINGIVALOCAL TRAUMATIC INJURIES OF GINGIVA • PERI TONSILLAR ABSCESS/ MIDDLE EARPERI TONSILLAR ABSCESS/ MIDDLE EAR INFECTIONINFECTION • FURUNCULOSIS/ BOIL OF CHINFURUNCULOSIS/ BOIL OF CHIN • HAEMATOGENOUS INFECTIONHAEMATOGENOUS INFECTION
  8. 8. MICROBIOLOGYMICROBIOLOGY • MIXED INFECTIONMIXED INFECTION • ANAEROBES PLAYS MAJOR ROLEANAEROBES PLAYS MAJOR ROLE • STAPHYLOCOCCUSSTAPHYLOCOCCUS • AUREUS (PREDOMINENT)AUREUS (PREDOMINENT) • ALBUSALBUS • STREPTOCOCCUSSTREPTOCOCCUS • BACTEROIDESBACTEROIDES
  9. 9. CLINICAL FEATURESCLINICAL FEATURES • M > FM > F • MAND > MAXMAND > MAX • LIMITED BLOOD SUPPLYLIMITED BLOOD SUPPLY • MORE DENSE BONEMORE DENSE BONE • PAINPAIN • SEVERE, THROBBING, DEEP SEATEDSEVERE, THROBBING, DEEP SEATED • SWELLINGSWELLING • FIRM / INDURATED / MODERATE SIZEFIRM / INDURATED / MODERATE SIZE • OVERLYING GUM RED / SWOLLEN / TENDEROVERLYING GUM RED / SWOLLEN / TENDER • TEETHTEETH • NO OF TEETH TENDER ON PERCUSSIONNO OF TEETH TENDER ON PERCUSSION • MOBILITY OF TEETH IN AFFCTED JAW SEGMENTMOBILITY OF TEETH IN AFFCTED JAW SEGMENT • PUS EXUDATES AROUND NECKPUS EXUDATES AROUND NECK
  10. 10. CLINICAL FEATURESCLINICAL FEATURES • TRISMUSTRISMUS • LABIAL PARESTHESIALABIAL PARESTHESIA • DUE TO INCREASE PRESSURE IN INFERIOR ALVEOLARDUE TO INCREASE PRESSURE IN INFERIOR ALVEOLAR CANALCANAL • DISTINGUISHED FROM ALVEOLAR ABSCESSDISTINGUISHED FROM ALVEOLAR ABSCESS • DISCHARGING SINUSDISCHARGING SINUS • FACEFACE • ALVOLAR PROCESS/PERIODONTAL LIGAMENTALVOLAR PROCESS/PERIODONTAL LIGAMENT • PATHLOGICAL FRACTUREPATHLOGICAL FRACTURE • LYMPHADENOPATHYLYMPHADENOPATHY • SIGNS OF TOXEMIASIGNS OF TOXEMIA • FEVER.CHILLS,DEHYDRATIONFEVER.CHILLS,DEHYDRATION • ANEMIA, LEUKOCYTOSIS, INCREASED POLYSANEMIA, LEUKOCYTOSIS, INCREASED POLYS • MATURE/IMMATUREMATURE/IMMATURE
  11. 11. RADIOGRAPHIC FINDINGSRADIOGRAPHIC FINDINGS • FINDINGS APPEAR AFTER 1-3 WEEKSFINDINGS APPEAR AFTER 1-3 WEEKS • MARGINSMARGINS • APPEARANCEAPPEARANCE • RESORPTION OF BONERESORPTION OF BONE • WIDENING OF MEDULLARY SPACESWIDENING OF MEDULLARY SPACES • LOSS OF SHARP TRABECULAR PATTERN OF BONELOSS OF SHARP TRABECULAR PATTERN OF BONE • RADIOLUCENCYRADIOLUCENCY • ILL DEFINED MARGINSILL DEFINED MARGINS • MOTH EATEN APPERANCEMOTH EATEN APPERANCE • SEQUESTURMSEQUESTURM • DEAD BONE SEPERATED FROM ADJACENT BONE BYDEAD BONE SEPERATED FROM ADJACENT BONE BY RADIOLUCENT AREARADIOLUCENT AREA • INVOLUCRUMINVOLUCRUM • SUBPERIOSTEAL NEW BONE FORMATIONSUBPERIOSTEAL NEW BONE FORMATION • RADIOPACITYRADIOPACITY • PARALLEL TO SURFACE OF CORTEX LOWER BORDERPARALLEL TO SURFACE OF CORTEX LOWER BORDER • LINEAR/LAMINATED LIKE ONION SKINLINEAR/LAMINATED LIKE ONION SKIN
  12. 12. TREATMENTTREATMENT (MEDICINAL)(MEDICINAL) • SUPPORTIVESUPPORTIVE • BED RESTBED REST • DEHYDRATIONDEHYDRATION • DIET / NG TUBEDIET / NG TUBE • BLOOD TRANSFUSIONSBLOOD TRANSFUSIONS • ANTIBIOTICSANTIBIOTICS • CULTURE & SENSITIVITYCULTURE & SENSITIVITY • AMOXYCILLIN 500MG /8 HRLY / I / VAMOXYCILLIN 500MG /8 HRLY / I / V • CLINDAMYCIN 300MG 6 HRLYCLINDAMYCIN 300MG 6 HRLY • DURATIONDURATION • 2 WEEKS TO 8 WEEKS2 WEEKS TO 8 WEEKS • ERTHROMYCIN, LINCOMYCIN, CEPHLOSPORINSERTHROMYCIN, LINCOMYCIN, CEPHLOSPORINS
  13. 13. TREATMENTTREATMENT (SURGICAL)(SURGICAL) • INCISION & DRAINAGEINCISION & DRAINAGE • To relieve pain & pressureTo relieve pain & pressure • Reduces absorption of toxic productsReduces absorption of toxic products • ExtractionExtraction • Extraction of offending tooth /teethExtraction of offending tooth /teeth • SequestrectomySequestrectomy • Introral submadibular approachIntroral submadibular approach • SaucerizationSaucerization • To eliminate dead spaceTo eliminate dead space • ImmobilizationImmobilization • To avoid pathologic fractureTo avoid pathologic fracture
  14. 14. COURSE OF DISEASECOURSE OF DISEASE • Acute, sub acute, chronicAcute, sub acute, chronic stagesstages • Infection resolves by proper treatment andInfection resolves by proper treatment and never recurnever recur • It may heal but recur after certain periodIt may heal but recur after certain period • It may persist and continue with activeIt may persist and continue with active suppurationsuppuration • It may quiet down and pursue a chronicIt may quiet down and pursue a chronic coursecourse • Reasons--?Reasons--?
  15. 15. CHRONICCHRONIC OSTEOMYLITISOSTEOMYLITIS
  16. 16. COURSECOURSE • Acute infection leading to chronicAcute infection leading to chronic • Chronic osteomylitis may be primary,Chronic osteomylitis may be primary, due to infection by subvirulent microdue to infection by subvirulent micro organismsorganisms
  17. 17. CLINICAL FEATURESCLINICAL FEATURES • Pain /dischargePain /discharge • MinimumMinimum • Bone / madibular enlargementBone / madibular enlargement • Due to subperiosteal deposition of new boneDue to subperiosteal deposition of new bone • SequestraSequestra • Single or multipleSingle or multiple • May shed periodicallyMay shed periodically • Preservation of mental/ labial sensationPreservation of mental/ labial sensation
  18. 18. RADIOGRAPHIC FINDINGSRADIOGRAPHIC FINDINGS • Areas of radiolucenciesAreas of radiolucencies superimposed on areas of radiosuperimposed on areas of radio opacitiesopacities • Radiopacity is due to:Radiopacity is due to: • Subperiosteal bone depositionSubperiosteal bone deposition • Sequestra attracts calciumSequestra attracts calcium
  19. 19. TREATMENTTREATMENT • Antibiotic coverAntibiotic cover • 10 days to 2weeks10 days to 2weeks • Metronidazole for anerobesMetronidazole for anerobes • SequestrectomySequestrectomy • Sequestrum removed from surroundingSequestrum removed from surrounding granulation tissuegranulation tissue • Removal of granulation tissueRemoval of granulation tissue • C&SC&S • Microbiologic studies – TBMicrobiologic studies – TB • Histo pathological examHisto pathological exam • DecorticationDecortication • Done with bur/hand pieceDone with bur/hand piece • Dense sclerosed medullary bone removedDense sclerosed medullary bone removed • Bone removed until healthy bleeding boneBone removed until healthy bleeding bone appearsappears
  20. 20. TREATMENTTREATMENT • SaucerizationSaucerization • The bony margins over hanging the cavityThe bony margins over hanging the cavity resulting from removal of sequestrum areresulting from removal of sequestrum are removedremoved • Reduces dead space / haematoma FormationReduces dead space / haematoma Formation • Drain/pressure dressingDrain/pressure dressing • Antiseptic dressingAntiseptic dressing • If primarily closure not possibleIf primarily closure not possible • BiPP / whiteheads varnishBiPP / whiteheads varnish • ImmoblilzationImmoblilzation • IMFIMF • Splinting adjacent teeth by arch barSplinting adjacent teeth by arch bar • Hyperbaric oxygenHyperbaric oxygen • Resection & secondary bone graftingResection & secondary bone grafting
  21. 21. CHRONIC NON SUPPURTIVECHRONIC NON SUPPURTIVE SCLEROSING OSTEOMYELITISSCLEROSING OSTEOMYELITIS • It is response to a low gradeIt is response to a low grade infection/traumainfection/trauma • Seen in older people/Negro femalesSeen in older people/Negro females • Infection source usually not identifiableInfection source usually not identifiable • Usually in mandibleUsually in mandible • Teeth are vital with inflamed pulpTeeth are vital with inflamed pulp • Sequestrum formationSequestrum formation • Expansion of cortices is lackingExpansion of cortices is lacking • RadiographicRadiographic • Initially radiolucentInitially radiolucent • Later radio opaqueLater radio opaque
  22. 22. TUBERCULOUS OSTEOMYLITISTUBERCULOUS OSTEOMYLITIS • Hematogenous spread from pulmonary TBHematogenous spread from pulmonary TB • Localized osteomylitis may follow tooth extractionLocalized osteomylitis may follow tooth extraction performed on TB patientperformed on TB patient • Infected socketInfected socket • PainlessPainless • Pus dischargePus discharge • Bone destruction replaced by granulationBone destruction replaced by granulation tissuetissue • No sequestrum formationNo sequestrum formation • If untreated it extends in soft tissuesIf untreated it extends in soft tissues • Diagnosis-Biopsy for tubercle bacilliDiagnosis-Biopsy for tubercle bacilli • Treatment-Treatment- • Local surgeryLocal surgery • Anti tuberculous drugAnti tuberculous drug
  23. 23. OSTEORADIONECROSISOSTEORADIONECROSIS • It isIt is defineddefined as Inflammatoryas Inflammatory Conition (osteomylitis) of irradiatedConition (osteomylitis) of irradiated bone that has been exposed and hasbone that has been exposed and has failed to heal over a period of 3failed to heal over a period of 3 months in the absence of localmonths in the absence of local tumor.tumor. • Doses above 50Gy are required toDoses above 50Gy are required to cause this irreversible damagecause this irreversible damage
  24. 24. PATHOGENESISPATHOGENESIS • HypoxiaHypoxia • HypovascularityHypovascularity • Endarteritis ObliteransEndarteritis Obliterans • HyocellularityHyocellularity • Marrow DamageMarrow Damage • Periosteum DamagePeriosteum Damage • Decrease Production of osteoblasts &Decrease Production of osteoblasts & osteoclastsosteoclasts
  25. 25. CLINICAL FEATURESCLINICAL FEATURES • Sever deep boring pain-InitiallySever deep boring pain-Initially • Alveolar boneAlveolar bone •Mandible more affectedMandible more affected •Exposed, black, Dark Brown in colorExposed, black, Dark Brown in color •Sequestrum formation – slowSequestrum formation – slow •No involcurum formationNo involcurum formation • Persistent draining sinusPersistent draining sinus • TrismusTrismus • Pathological FracturePathological Fracture • RadiographRadiograph • Moth eaten appearance Of devitalized boneMoth eaten appearance Of devitalized bone
  26. 26. TREATMENTTREATMENT • AIM :- To Promote neovascularity &AIM :- To Promote neovascularity & NeocellularityNeocellularity • AntibioticsAntibiotics • Hyperbaric Oxygen therapyHyperbaric Oxygen therapy • SequestrectomySequestrectomy • Local flap coverLocal flap cover • Resection / Reconstruction.Resection / Reconstruction.
  27. 27. PROPHYLACTIC MEASURESPROPHYLACTIC MEASURES • Dental Extractions / osseous surgeryDental Extractions / osseous surgery should be avoided duringshould be avoided during • active radiotherapyactive radiotherapy • In early post irradiation Period (9 Months)In early post irradiation Period (9 Months) • Extract all teeth with dubious prognosisExtract all teeth with dubious prognosis lying with in radiation fieldlying with in radiation field • At least 7-10 days before commencement ofAt least 7-10 days before commencement of RadiotherapyRadiotherapy • Within 7-10 days after commencement ofWithin 7-10 days after commencement of radiotherapy with antibiotic coverradiotherapy with antibiotic cover
  28. 28. ACTINOMYCOSISACTINOMYCOSIS It is a chronic, Suppurative cervico-It is a chronic, Suppurative cervico- facial infection of soft tissues,facial infection of soft tissues, characterized by formation ofcharacterized by formation of multiple sinuses & widespreadmultiple sinuses & widespread fibrosis.fibrosis.
  29. 29. ETIOLOGYETIOLOGY • It is a bacterial infection.It is a bacterial infection. • G + Bacteria – Actinomyces IsraeliG + Bacteria – Actinomyces Israeli • Normal oral commencalNormal oral commencal • Injuries, fracture, extraction, humanInjuries, fracture, extraction, human bitebite
  30. 30. CLINICAL FEATURESCLINICAL FEATURES • Males more affected, 30-60 yearsMales more affected, 30-60 years • SwellingSwelling • Soft tissue / angle, neckSoft tissue / angle, neck • Dusky red, purplish in colourDusky red, purplish in colour • Firm, slightly tenderFirm, slightly tender • Skin- fixed to under lying tissuesSkin- fixed to under lying tissues • Multiple discharging sinusesMultiple discharging sinuses • Pain is mild or absentPain is mild or absent • Healing with scarring & puckering of skinHealing with scarring & puckering of skin • TrismusTrismus • Lymph nodes usually not enlargedLymph nodes usually not enlarged • Actinomycotic osteomylitis occurs if soft tissueActinomycotic osteomylitis occurs if soft tissue infection spreads to underlying boneinfection spreads to underlying bone
  31. 31. DIAGNOSISDIAGNOSIS • Sulphur granules In discharging pusSulphur granules In discharging pus • Sulphur granules are colonies ofSulphur granules are colonies of actinomycesactinomyces • Anaerobic culture for 10 days may beAnaerobic culture for 10 days may be required for identificationrequired for identification • RadiographyicallyRadiographyically • In actinomycotic osteomylitis Moth eaten /In actinomycotic osteomylitis Moth eaten / irregular areas of bone destruction similar toirregular areas of bone destruction similar to pyogenic osteomylitispyogenic osteomylitis
  32. 32. TREATMENTTREATMENT • Prolonged antibiotic therapyProlonged antibiotic therapy • Organisms survive in depth of lesionOrganisms survive in depth of lesion and causes relapse after a shortand causes relapse after a short course of antibiotics.course of antibiotics. • Penicillin -2gm / day, 6 weeks to 6Penicillin -2gm / day, 6 weeks to 6 monthsmonths • In actinomycotic osteomylitisIn actinomycotic osteomylitis treatment is same as for pyogenictreatment is same as for pyogenic osteomylitis.osteomylitis.
  33. 33. FUNGAL INFECTIONFUNGAL INFECTION

×