Ch 3 Pulpal Pathology Flashcards
What are the vast majority of osteomyelitis cases caused by? What are three appropriate names for this situation?
bacterial infection: supperative osteomyelitis, bacterial osteomyelitis, secondary osteomyelitis
What is the term for idiopathic inflammatory disorders of bone not responding to antibiotics and have no supperation or sequestrum formation?
primary chronic osteomyelitis, diffuse sclerosing osteomyelitis
What are the two main causes of supperative osteomyelitis in developed countries?
s/p odontogenic infection or traumatic fracture of the jaw
What are some disorders associated with osteomyelitis? (there are 11 listed in Neville)
- Tobacco use,
- alcohol abuse
- IV drug abuse
- diabetes mellitus
- exanthematous fevers
- malaria
- sickle cell anemia
- malnutrition
- malignancy
- collagen vascular diseases
- AIDS
- osteopetrosis,
- dysosteosclerosis
- late Paget disease
- end-stage cementoosseous dysplasia
What is the term for an acute inflammatory process that spreads through the medullary spaces of the bone and insufficient time has passed for the body to react to the presence of the inflammatory infiltrate
acute supperative osteomyelitis
What is the term for when the defensive response leads to the production of granulation tissue, which subsequently forms dense scar tissue in an attempt to wall off the infected area…The encircled dead space acts as a reservoir for bacteria, and antibiotic medications have great difficulty reaching the site?
chronic supperative osteomyelitis
How long does it take for chronic supperative osteomyelitis to develop?
about 1 month after the spread of the acute infection
Gender & location of osteomyelitis?
Male (75%), mandible
What age group is more often affected with maxillary osteomyelitis? Why?
Pediatric patients: NUG or noma patients (Africa)
What % of bone mineral density loss is required to be visualized on a radiograph?
50%
What is the term for a fragment of necrotic bone that has been surrounded by new vital bone?
involucrum
What are 4 histo features of the necrotic bone in acute supperative osteomyelitis? What will the submitted material be diagnosed as UNLESS good CPC points to the appropriate diagnosis of acute osteomyelitis?
- loss of osteocytes from their lacunae
- peripheral resorption
- bacterial colonization
- PMNs at periphery and haversian
Diagnosed as a sequestrum unless CPC for osteomyelitis
What is the most significant component of chronic supperative osteomyelitis on histology?
soft tissue component with chronic or subacute inflammation
What are the three types of diffuse sclerosing osteomyelitis?
- Diffuse sclerosing osteomyelitis
- Primary chronic osteomyelitis
- chronic tendoperiostitis
Which term–within the category of diffuse sclerosing osteomyelitis–should be used only when an obvious infectious process directly is responsible for sclerosis of bone?
diffuse sclerosing osteomyelitis
What is the difference between primary chronic osteomyelitis and chronic supperative osteomyelitis (secondary chronic osteomyelitis)?
Primary chronic osteomyelitis:
no obvious bacterial infection (ergo no response to abx)
supperation and sequestration absent
primary focus not proven
Chronic supperative osteomyelitis (secondary chronic osteomyelitis:
bacterial cause
sequestration
treated with abx
What are the variants of primary chronic osteomyelitis with systemic manifestations
CRMO: chronic recurrent multifocal osteomyelitis
SAPHO: synovitis, acne, pustulosis, hyperostosis, osteitis
What form of primary chronic osteomyelitis have the osseous lesions of CRMO, but also present with 4 other bony and dermal findings?
SAPHO syndrome:
Synovitis (inflammation in the synovium of the joint)
Acne
Pustulosis (inflammatory skin condition resulting in pustules on palms and/or soles)
Hyperostosis (excess bone growth)
Osteitis
What is A (not the only) suspected pathogen for the development of SAPHO syndrome?
Propionibacterium acnes
What entity represents a reactive alteration
of bone that is initiated and exacerbated by chronic
overuse of the masticatory muscles?
chronic tendoperiostitis
What are the two most common muscles overused leading to tendoperiostitis?
predominantly the masseter and digastric (bruxism, clenching, nail biting, co-contraction, and inability to relax jaw musculature)
What is the age distribution for primary chronic osteomyelitis?
Bimodal: adolescence and 5th decade of life
What is the predominant radiographic alteration of primary chronic osteomyelitis?
medullary sclerosis
What is thought to represent the pediatric variant of SAPHO?
CRMO (chronic recurrent multifocal osteomyelitis)
What are the 6 neutrophilic skin diseases associated with SAPHO and CRMO?
- palmoplantar pustulosis (blisters on palms and feet)
- severe acne
- hidradenitis suppurativa (AKA: acne inversa, lumps, underarms, under the breasts, and the groin)
- psoriasis
- Sweet syndrome (AKA acute febrile neutrophilic dermatosis, fever, elevated WBC, papules and plaques w PMN on histo)
- pyoderma gangrenosum (pustules or nodules become ulcers that progressively grow)
SAPHO usually is noted in adults, classically affects the axial skeleton (where specifically?), and MORE frequently demonstrates concurrent neutrophilic skin lesions.
anterior chest wall
What is the mean age for chronic tendoperiostitis patients?
40 years, can occur in all ages tho
What are three classic symptoms for chronic tendoperiostitis?
- recurrent pain
- swelling of the cheek
- trismus
Treatment for Primary chronic osteomyelitis, CRMO, and SAPHO?
IV bisphosphonates (surgery contraindicated, can also use in conjunction: corticosteriods, NSAIDS, calcitonin, and TNFa inhibitors)
Treatment for chronic tendoperiostitis?
resolution of the muscle overuse (splint,drugs,therapy, etc)
Age for condensing osteitis?
most freq in children and young adults, but can occur in older adults
What is the term for a residual area of condensing osteitis?
bone scar
What is the alternate name for osteomyelitis with proliferative periostitis?
periostitis ossificans
What are the two most common culprits for the formation of bone within a periosteal reaction?
- osteomyelitis
2. malignant neoplasm (ewing sarc, osteogenic sarc, etc)
What is a buzzword for the radiographic appearance of osteomyelitis with proliferative periostitis?
“onion-skinning”
Whats the mean age for proliferative periostitis patients? Whats the most frequent cause? Location?
13 years, dental caries, premolar/molar area of lower border of mandible
What is the treatment for proliferative periostitis and how long might it take to resolve?
remove source of infection (usually a carious tooth)…bone should resolve in 6 to 12 months)
What are the 2 alternate names for alveolar osteitis?
- dry socket
2. fibrinolytic alveolitis
Premature ________ of the initial clot is thought to be responsible for the clinical condition known as alveolar osteitis.
fibrinolysis
What is the most common locatoin for alveolar osteitis?
posterior mandible
While the overall prevalence of alveolar osteitis is highest between 20 and 40 years, the likelihood of developing it is highest at what age range?
40-45
What are the 4 steps for treating alveolar osteitis?
- radiograph to r/o root tip/foreign body
- remove all sutures
- irrigate with warm saline
- analgesics and home irrigation with saline or chlorhexidine for 3-4weeks
(use of an antiseptic dressing is controversial)
