Infections of Jaws.ppt (2)

1Radiographic Interpretation of Infections of Jaws

Pericoronitis

2Pericoronitis

Erupting or partially impacted third Erupting or partially impacted third molars

Inflamed gingiva Trismus Cellulitis Cellulitis

Pericoronitis (R/F)

In early stages minimal radiographic In early stages, minimal radiographic changes

Radiolucency adjacent to the crown Ill-defined periphery Sclerotic border in late stage Sclerotic border in late stage Osteomyelitis, in sever cases

3Normal Follicular Space

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5Acute Suppurative Osteomyelitis

Acute Suppurative Osteomyelitis

Dental infection most common cause Dental infection most common cause Other causes: fracture, wound,

hematogenous spread Common organisms: Staph. aureus,

Staph. albus, tuberculosis, S ap a bus, ube cu os s,actinomycosis, syphilis, mixed organisms

6Suppurative Osteomyelitis

May involve either jaw May involve either jaw Localized in maxilla, diffuse in mandible Severe pain temperature, WBC count

Suppurative Osteomyelitis (R/F)

Early stages: no radiographic changes Early stages: no radiographic changes Ill-defined periphery Decrease in the density of bone Followed by increased radiolucency Sclerosis at later stages Sclerosis at later stages Sequestra: nonvital bone

7Suppurative Osteomyelitis (R/F)

Resorption Resorption Periosteal new bone formation Proliferative periostitis Fistula formation Radiographic features similar to Radiographic features similar to

malignant lesions

8Sequestrum

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In-class Exercise: Case 1

4 month old 4 month old baby

Meningitis

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Nuclear Medicine Study

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In-class Quiz : Case 2

Chronic Focal Sclerosing Osteomyelitis

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Chr. Focal Sclerosing Osteomyelitis

Sclerosing or condensing osteitis Sclerosing or condensing osteitis Younger, < 20 yrs Mostly mandibular first molar Large carious lesion

Focal Sclerosing Osteomyelitis (R/F)

Initial stage no radiographic signs Initial stage no radiographic signs Rarefying osteitis radiolucent area Sclerosing osteitis dense sclerotic

bone, trabeculation difficult to identify Difference with idiopathic osteosclerosis Difference with idiopathic osteosclerosis

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Chronic Diffuse Sclerosing Osteomyelitis

Chr. Diffuse Sclerosing Osteomyelitis

May not be associated with carious teeth May not be associated with carious teeth Intermittent, recurrent episodes of swelling,

pain, fever Any age, mostly elderly patients Prevalence in African American Chronic low grade infection Pain, if present, is often mild Acute exacerbation

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Chronic Osteomyelitis With Proliferative Periostitis

Garres Periostitis

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Chronic Osteomyelitis With Proliferative Periostitis

Garres Periostitis (1893) Garre s Periostitis (1893) Younger,

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In-class exercise: Case 3

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Osteoradionecrosis

Osteoradionecrosis

Radiotherapy (40 to 80 Gy) Radiotherapy (40 to 80 Gy) Decreased vascularity Low defense High susceptibility to extraction, perio,

pulpal disease denture sorepulpal disease, denture sore

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Osteoradionecrosis (R/F)

Similar to osteomyelitis Similar to osteomyelitis Diagnosis established by history

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ONJ, BON, BRON

Osteonecrosis of the jaw Osteonecrosis of the jaw Bisphosphonate-associated

osteonecrosis of the jaw Bisphosphonate-related osteonecrosis

of the jawo e ja

Clinical features of ONJ

Spontaneous or after extraction Initially asymptomatic Pain, tooth mobility, mucosal swelling,

erythema, ulceration Early stage: minimal radiographic

changes Late stage: R/F of osteomyelitis or cancer Widened PDL spaces

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Potential risk factors

Dentoalveolar trauma Dentoalveolar trauma Duration of BP treatment Type of BP: i.v. BP is more problematic

Staging

Stage 1: exposed, necrotic bone that is asymptomatic

Stage 2: exposed, necrotic bone, with pain and infection

Stage 3: Exposed, necrotic bone in ti t ith i i f ti dpatients with pain, infection, and

pathologic fracture, extraoral fistula, or osteolysis extending to the inferior border

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Florid Cemento-osseous Dysplasia

Florid Cemento-osseous Dysplasia

Wide spread form of periapical Wide-spread form of periapical cemental dysplasia

Mostly female, middle-aged, African, Asian

May not be symptomaticay o be sy p o a c

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Florid Cemento-osseous Dysplasia

Poor vascular supply prone to Poor vascular supply prone to infection

Osteomyelitis, if infected Preventive management

Florid C-O Dysplasia (R/F)

Usually bilateral both jaws Usually bilateral, both jaws Well-defined sclerotic border Internal content of mixed density Large irregular masses Hypercementosis Hypercementosis

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Maxillary Sinusitis(will discuss in Unit 12)

Maxillary Sinusitis

Acute chronic and recurrent Acute, chronic and recurrent Allergic Infectious Dental sources

Periapical lesions Periapical lesions Traumatic extractions (Oro-antral fistula)

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Maxillary Sinusitis (R/F)

Thickening of mucosal lining Thickening of mucosal lining Cloudy appearance in periapical or

panoramic Bony erosion

Fungal infectionFungal infection Carcinoma Chronic infection

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