Bone pathology I - inflammatory disease of bone - osteitis Flashcards
name types of inflammatory diseases of bone?
alveolar osteitis (dry socket)
focal sclerosing (condensing) osteitis
osteomyelitis
radiation injury and osteoradionecrosis
medication related osteonecrosis of the jaw
types of osteomyelitis?
- Suppurative osteomyelitis.
- Sclerosing osteomyelitis.
- Chronic osteomyelitis with proliferative periostitis
(Garre’s osteomyelitis, periostitis ossificans).
osteitis?
localised inflammation of the bone with no progression through medullary cavity
osteomyelitis?
inflammation of the interior of the bone usually involving the medullary cavity; may progress to erode or even perforate the cortex
periostitis?
inflammation of the periosteal surface of the bone; may cause superficial erosion of the cortex
osteonecrosis?
death of one tissue; areas of non-vital bone are separated by osteoclasts and form sequestra;
occurs in osteomyelitis, after radiotherapy, bone infarction, and in relation to drugs
(bisphosphonates and denosumab) and chemicals (phosphorus exposure)
bisphosphonates?
reduce osteoclast activity by decreasing osteoclast progenitor development and recruitment and by promoting osteoclast apoptosis
Medication related osteonecrosis of the jaw (MRONJ)
MRONJ?
medication-related osteonecrosis of the jaw
osteonecrosis vs osteomyelitis?
Both ONJ and osteomyelitis cause painful bone loss.
But bacteria or fungi cause osteomyelitis, which is a type of bone infection.
When the infection affects your jawbone, you may have symptoms similar to ONJ.
Healing of extraction sockets?
- After tooth extraction, the
socket fills with blood which
forms a clot. - The clot is organized to form
granulation tissue. - Resorption of the crestal bone
and other bony fragments. - Gingival migration and
proliferation over the gap. - Replacement of granulation
tissue with woven bone. - Remodelling of the woven
bone.
after 4 weeks, trabecular bone formed in socket and gingival migration = seal and keratinised
dry socket aka?
alveolar osteitis
is alveolar osteitis a complication of extraction?
yes 1-3%
what teeth have a higher risk of alveolar osteitis?
lower molars have higher risk
when is alveolar osteitis more common?
difficult extractions
highest incidence follows extraction of impacted mandibular third molars
risk factor of dry socket?
smoking / tobacco use
- have certain systemic disease which affect the vasculature
- traumatic extraction
- hypercementosis
- ankylosis
- aggressive in extraction
what is dry socket?
localised inflammation of bone following the failure of a blood clot to form, or the premature loss of disintegration of the blood clot
why is dry socket more common in the mandible?
vasculature not as rich in mandible compared to maxilla
why can blood clot fail to form?
- Poor blood supply:
- Osteopetrosis.
- Paget’s disease of bone.
- Following radiotherapy.
- Excessive use of vasoconstrictors in local anaesthesia.
why can premature loss of blood clot occur?
- Clot washed away by excessive mouth rinsing.
- Disintegration due to fibrinolysis (infection by proteolytic bacteria).
if a blood clot does not form or loss of blood clot cause dry socket?
- Food debris, bacteria and saliva collect in the empty socket.
- The bone becomes infected and necrotic.
- The infection is limited to the socket walls by the
inflammatory reaction in the adjacent marrow. - Sequestra are formed by the separation of dead bone by
osteoclasts.
usually bone marrow produced inflammatory reaction to this so it limits the infection to the bony socket
osteoclasts activated and separate infected bone, so might be sequesta of one in the socket
clinical appearance of alveolar osteitis?
- Severe pain 2-3 days after extraction.
- Radiating pain to the ear could be reported.
- Socket contains foul tasting and smelling decomposing food
debris. - Debris could be washed away to reveal the denuded bone.
How to prevent alveolar osteitis?
- Identification of risk factors (history and clinical examination).
- Treating infection.
- Improving oral hygiene.
- Smoking- cessation advice.
- Minimizing trauma during extractions.
- Advising the patient to avoid excessive rinsing.
management of alveolar osteitis?
- Radiograph to exclude retained fragments of tooth or foreign
material. - Socket should be irrigated with warmed saline and debris
gently dislodged. - Socket should be lightly packed with a dressing (obtundant for pain relief and a non- irritant antiseptic).
- Analgesics should be prescribed and the patient kept under review until they are pain- free and socket healing is ensured.
- May persist for 40 days and irrigation with application of a
dressing may need to be repeated.
Focal Sclerosing (Condensing) Osteitis?
low-grade infection that affects the tooth
- could spread to periapical bone
if immune system string could be and very low grade infection - you get sclerosis and excess bone in response to periapical inflammation
- see steosclerosis
- A bony reaction to a low grade periapical inflammation.
- At the apex of teeth especially the first permanent molar.
even after tooth treated endodontically, it will remain
need to make sure there is not ankylosis or it will need extraction
What teeth do you see focal sclerosing (condensing) osteitis?
- At the apex of teeth especially the first permanent molar
what disease is shown?
Focal Sclerosing (Condensing) Osteitis
dental ankylosis?
Tooth ankylosis occurs when the periodontal ligament dissolves, causing the tooth to become fused directly to the jawbone
what do you want to make sure doesn’t occur here?
ankylosis - tooth will need extracted
this image shown focal sclerosing osteitis
differential diagnosis?
periapical cementoma
one of the fibro-osseous dysplasias
it is FOCAL SCLEROSING (CONDENSING) OSTEITIS
- if pt has has RCT or pulpitis then suspect bony sclerosis
if you extract tooth does this sclerosis remian?
yes
called bone island
can also just be bony islands in bone - not necessarily related to infection
what is shown?
focal sclerosing (condensing) osteitis
may remain after extraction (dense bone island)
histology of focal sclerosing (condensing) osteitis?
- Localized increase in the number and thickness of bony trabiculae.
- Scattered lymphocytes and
plasma cells. - Scanty fibrosed marrow.
appear more radiopaque than normal bone
why does Focal Sclerosing (Condensing) Osteitis appear more radiopaque than bone?
- Localized increase in the number and thickness of bony trabiculae.
