This document discusses osteomyelitis, an inflammation of bone and bone marrow that can result from odontogenic infection. It describes the different types of osteomyelitis including acute suppurative, chronic suppurative, chronic focal sclerosing (condensing osteitis), and chronic diffuse sclerosing osteomyelitis. Specific details are provided on the clinical, radiographic, and histopathologic features of acute suppurative osteomyelitis as well as chronic osteomyelitis with proliferative periostitis (Garre's osteomyelitis). The pathogenesis and potential complications of acute suppurative osteomyelitis are also summarized.

1. DR VINOD KUMAR R.B
PROF & HEAD
DEPT OF ORAL PATHOLOGY & MICROBIOLOGY
MALABAR DENTAL COLLEGE & RESEARCH CENTRE

3. OSTEOMYELITIS
An inflammation of bone and bone marrow(medullary
bone).
- Result of odontogenic infection.
- Acute, subacute or chronic depending upon
duration.

5. Types: (1) Acute suppurative osteomyelitis.
(2) Chronic suppurative osteomyelitis.
(3) Chronic focal sclerosing osteomyelitis
(Condensing osteitis)
(4) Chronic diffuse sclerosing osteomyelitis.
(5) Chronic osteomyelitis with proliferative periostitis
(Garre’s osteomyelitis).

6. ACUTE SUPPURATIVE OSTEOMYELITIS
Acute inflammatory process spreading through medullary
spaces of the bone and with insufficient time for body to
react
Well localized in maxilla ,diffuse and widespread in
mandible

7. ACUTE SUPPURATIVE OM-C/F
Severe pain and fever
Regional lymphadenopathy
Leukocytosis
Soft tissue swelling
Paresthesia/anesthesia of lip
Loose and sore tooth in the area of involvement

10. Abscessed tooth periapical radiograph

11. Severe pain and fever

12. Regional lymphadenopathy

13. Regional lymphadenopathy

14. Soft tissue swelling

15. Soft tissue swelling

16. Loose and sore tooth in the area of
involvement

17. Osteomyelitis-R/F
Diffuse lytic changes in the bone begin to appear,Individual trabeculae
become fuzzy and indistinct and radiolucent areas begin to appear

18. Suppurative Osteomyelitis:
Radiographic Features
 Normal in early stages.
 In 10-14 days, sufficient bone
resorption occurs to produce
irregular, moth-eaten areas of
radiolucency.
 Sequestra may be seen.

21. Pathogenesis of Osteomyelitis
Infection from periapical
region enters bone marrow
and then it extends into the
cancellous bone

22. Pathogenesis of Osteomyelitis
As infection is established lumina of nutrient
vessels get occluded by thrombus(dead/viable
neutrophils,bacteria & necrotic tissue debris)
Due to thrombosis of vessels and pressure from
inflammatory exudate in the confined space
,nutritional supply to bone cells is cut off
resulting in death of cancellous bony trabeculae
with formation of sequestrum

24. Pathogenesis of Osteomyelitis
Infection spreads via volkmans canals to reach
external surface of bone below periosteum
resulting in periosteitis
Further extension of inflammation leads to
single or multiple sinus tracts formation

25. continued……

26. ACUTE SUPPURATIVE OM-H/F
Bone shows loss of osteocytes
from their lacunae,peripheral
resorption and bacterial
colonization
Periphery of bone contains
necrotic debris and acute
inflammatory infiltrate
consisting of PMNL’s

27. Suppurative Osteomyelitis:
Histopathologic Features
 Suppurative osteomyelitis, note the
devitalized lamellar bone sequestrum with
scalloped edges and absence of stainable
osteocytes and osteoblasts. An osteoclast
in a resorption area is seen.

28. ACUTE SUPPURATIVE OM-PROGNOSIS
The bone that has lost its vitality separates from the
living bone.The separated fragment is called
“sequestrum”
When the sequestrum becomes surrounded by new
living bone it is called “involucrum”
Pathological #’s may occur due to weakening of the
jaw by the destructive process

29. ACUTE SUPPURATIVE OM-PROGNOSIS
Pathological #’s may occur due to weakening of the
jaw by the destructive process

30. CHRONIC SUPPURATIVE OSTEOMYELITIS:
CLINICAL FEATURES
Discharge of pus
through one or more
intraoral or extraoral
sinuses.

32. CHRONIC FOCAL SCLEROSING OSTEOMYELITIS
(CONDENSING OSTEITIS)
Localized areas of bone sclerosis in relation to the
apices of teeth with pulpitis or pulp necrosis
Unusual reaction of bone to infection occurring in
instances of extremely high tissue resistance or in
low grade infection

33. CONDENSING OSTEITIS
More in children and young adults
Most commonly involved tooth is
mandibular 1st molar with large
carious lesion

34. CONDENSING OSTEITIS-R/F
Localized area of increased radiodensity adjacent to the apex of the
tooth that exhibits a thickened periodontal ligament space
Differential diagnosis
Benign cementoblastoma

35. Radiopacity is attached to the tooth apex in benign
cementoblastoma

36. CHRONIC OSTEOMYELITIS WITH PROLIFERATIVE
PERIOSTITIS (GARRE’S OSTEOMYELITIS)
Focal gross thickening of the periosteum with
peripheral reactive bone formation resulting from mild
irritation or infection
Common in children and young adults especially in
mandible
Most common cause is dental caries with periapical
infection or overlying soft tissue infection

38. An occlusal radiograph of the mandible showed the enhancement in
peripheral subperiosteal bone on the right buccal and lingual sides.

40. GARRE’S OSTEOMYELITIS
Toothache or pain in the jaw and
bony hard swelling on outer surface
of the jaw
Most characteristic finding is on the
radiograph

41. Chronic Osteomyelitis with Proliferative Periostitis
(Garré’s Osteomyelitis, Periostitis Ossificans)
 Radigraphs show focal subperiosteal
overgrowth of bone with smooth surface on
outer cortical plate.
 The subperiosteal mass consists of irregular
trabeculae of actively forming woven bone with
scattered chronic inflammatory cells in fibrous
marrow.

42. Chronic Osteomyelitis with Proliferative Periostitis
(Garré’s Osteomyelitis, Periostitis Ossificans)
 Periosteal new bone formation
(periosteal reaction) / Onion-peel
appearance.

43. Other conditions showing periosteal new bone
formation(neoperiostosis)
 Caffey’s disease(infantile cortical hyperostosis)
 Hypervitaminosis A
 Syphilitic osteomyelitis
 Ewing’s sarcoma
 Metastatic neuroblastoma
 Fracture callus