This document summarizes different types and stages of chronic osteomyelitis. It begins by defining subacute and chronic osteomyelitis, noting that the disease typically transitions from acute to chronic between 3-5 weeks. It then describes key features of different chronic forms, including hyperplastic (thickened bone), sequestering (decreased blood flow causes bone necrosis), and rarefying (diffuse process with small sequesters). The treatment section outlines extracting causative teeth, long-term antibiotic therapy, antifungal therapy to prevent dysbacteriosis, and surgical procedures like sequesterectomy to remove bone fragments. It concludes by differentiating osteomyelitis from related conditions like apical periodontitis and peri

1. CHRONIC OSTEOMYELITIS
R.N Hamufungu

2. Content
● Subacute osteomyelitis
● Chronic osteomyelitis
● Clinical and radiological features of various forms of chronic
osteomyelitis (sequester,rarefying,hyperplastic, primary-chronic)
● Differential diagnosis of Acute periodontitis,periostitis and
odontogenic osteomyelitis.
● Treatment

3. ● Acute osteomyelitis phase last upto 3 weeks and only then subacute phase
occur after which last for 2 weeks
●
Usually on the 3rd
to 5th
week the disease transform to chronic stage.

4. Sub-acute osteomyelitis stage
● The clinical signs and Symptoms are less severe compared to the acute
condition, it is the stage of stabilization of inflammatory process.
● Clinical signs :
Dull pain
Temperature decreases but doesn’t fall to normal
Edema of face decreases
Teeth in the inflammation area are more mobile

5. Chronic osteomyelitis
● Chronic osteomyelitis is characterized by a clinical course
lasting over a month. It may occur after the acute phase or
it may be a complication of tooth-related infection without a
preceding acute phase. The clinical presentation is milder,
with painful exacerbations and discharge of pus or sinus
tracts.

6. Clinical Picture
• Acute odontogenic osteomyelitis.
• Acute intensive pain in 1 tooth area, several teeth area, jaw area.
- intoxication
- Body temperature of 39,5-40 degrees Celsius
- Edema after 2-3 days
- Abscess and phlegmona.
- Lymphadenitis.
- Hard mouth opening (inflammatory contracture of the m.masseter), painful swallowing
- edema of the mucous membrane, hyperemia of the gum, halitosis
- Tooth mobility, painful percussion, pus
- Positive Vincent syndrome

8. Hyperplastic form of chronic
osteomyelitis
● Also called primary chronic process of osteomyelitis
● Common in young people
● On X-ray it shows the thickness of the bone mass.

10. Sequestering form
● Caused by decreased vascularity
● Decrease in blood flow cause bone necrosis

11. Rarefying form
● It is a diffuse process with small sequesters
● Thickening of the bone scars on the past fistula
● X-ray shows bone destruction with inner sequesters

13. Treatment of chronic osteomyelitis
● Extraction of causative tooth
● Antibacterial Therapy : metronidazole, 500 mg IV, 48-72 hrs,switch to
penicillin 500mg PO for 4 weeks. Patients allergic to penicillin : clindamycin
450 mg PO
● Antifungal therapy to avoid dysbacteriosis (levorine and nystatin)
● Stimulating Therapy : Vitamins to boost immune system
● Surgical treatment (sequesterectomy) perfomed under Local anesthesia

14. sequesterectomy
● Local or General anesthesia
● Incision and mobilization of mucoperiosteal flap
● Bone is trepanated at the sequester area
● Big sequesters are removed using forceps and small sequesters are removed
with curettage
● Sequester cavity is washed with Hydrogen peroxide
● Bone is filled with Bone graft materials
● The wound is stitched and drained

15. DIFFERENTIAL DIAGNOSIS OF APICAL
PERIODONTITIS, PERIOSTITIS AND
OSTEOMYELITIS

16. Apical periodontitis periostitis osteomyelitis
complains Pain on percussion and
bite,localized pain
Patients feel like tooth is
high
Severe pain,swelling Intense pain,swelling more than
periostitis
Clinical picture Pus formation,pain on
percussion,
Change in shape of the
face,unilateral
swelling,pulsation in the
swelling,tooth
mobility,lymphadenitis,restrict
ed mouth opening
Fever,Fistula,bilateral
swelling,restricted mouth
opening,parasthesia of lower lip
Pathohistological
features
Leukocytes,neutrophils and
macrophages infiltration
Increased leukocytes Increased leukocytes,blood
vessels dilation,inflammatory
exudate with fibrins,plasma cells
infiltration
Radiological picture Rounded depression of bone
tissue on apical area
Opaque shadow like flames
around the root apex
Distinctive bone
loss,sequesters,bone
thickness
Treatment Root canal treatment and
tooth extraction
Antibitics(broad spectrum),
pus drainage,causative tooth
extraction
Sequesterectomy,incision and
drainage,antibacterial
therapy(intravenous),
prophylaxis Good oral hygiene Treatment of caries on time Treatment of immune disorders
on time ,teeth treatment on time

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