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  1. 1. Presented by:Fasahat Ahmed Butt (36Group: C1
  2. 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. 3. • Osteon: Bone• Myelitis: Inflammation of the bone marrow• Acute or chronic inflammatory process in themedullary spaces or cortical surfaces of the bonethat extends away from the initial site ofinvolvement
  4. 4. Decreased vascularityor Vitality of bone• Trauma• Radiation injury• Paget’s disease• Osteoporosis• Major vessel diseaseImpaired host defence• Immune deficiency state• Immunosuppression• Diabetes Mellitus• Malnutrition• Extremes of ageLocal factors Systemic factors
  7. 7. • Bacteroids• Porphyromonas• PrevotellaStaphylococcus (open fractures)
  8. 8. Organism enters the jaw (mandible) blood supplyMedullary infection spreads through marrow spacesThrombosis, bone necrosisLacunae empty of osteoid filled with neutrophil & bacteriaproliferate in dead tissueProliferation of periosteum & sinus formationSequestrum separated once removed, new bone isformed (INVOLUCRUM)
  9. 9. • Location: Mandible• Male: Adult males• Pain• Soft tissue swelling• Fever• Lymphadenopathy
  10. 10. • It may be normal in the early stages of the disease, butafter 10-14 days sufficient bone resorption may haveoccurred to produce irregular, MOTH-EATEN areas ofradiolucency.
  11. 11. C/F• Swelling• Pain• Sinus formation• Tooth loss• Sequestrum formation
  12. 12. • ILL-defined radiolucency that often contains central radiopaquesequestra.
  13. 13. C/F• Age: Children and young adults• Location: Mandibular premolar and molar• Bone sclerozing associated with non vitalpulpitic tooth
  14. 14. • Increased areas of radiodensity surround the apicesof non-vital mandibular 1st molar
  15. 15. C/F• Age: Adults• No sex predilection• Location: Mandible• Sclerosing around the site of periapical/PD inflammation• Persistent pain• No swelling
  16. 16. • Radiodencities• Sclerotic bone seen in tooth bearing area
  17. 17. C/F• Age: Children and young adults.• Location: Lower border of the mandible.• No sex predominance.
  18. 18. • New periosteal bone formation along the inferior border ofthe mandible• CT image: new periosteal bone growth with onionskinlamination
  19. 19. Essential measures:Bacterial sampling andcultureVigorous (empirical)antibiotic treatmentDrainageAnalgesicSpecific antibioticsDebridementAdjunctive treatment:SequestrectomyDecorticationResection andreconstruction forextensive bonedestructionHyperbaric oxygenFor acute osteomyelitis antibiotic treatment for 4-6wksFor chronic osteomyelitis treatment is carried for12 wks
  20. 20. • 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 followingtooth extraction
  21. 21. Food debris Bacteria SalivaEmpty socketBone becomesinfected &necroticInflammatoryreactions in theadjacent marrowLocalizes it tothe socket wallOsteomyelitisNecrotic bone isseparated byosteoclastTinysequestraProliferation ofgranulation tissue fromsurrounding vital boneHEALING
  22. 22. • Location: Mandible in posterior areas.• No sex predilection• Severe pain• Radiates to ear and neck• Foul odor• Lymphadenopathy• Trismus
  23. 23. • 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.
  24. 24. • Chlorhexidine mouth rinses should be done gently.• Patient should not smoke minimum for 48 hours afterextraction.• Patient should avoid sucking, spitting or drinking throughthe straw.• Patient should try to maintain good oral hygiene
  25. 25. • CAWSON• J.V. SOAMES & J.C. SOUTHAM• NEVILLE & DAMM• GOOGLE for images