Diseases of the bone

Question 1

Acute alveolar osteitis

Answer 1

post extraction condition
painful
loss of clot from socket

Question 2

Osteomyelitis

Answer 2

“infection of the bone and bone marrow spaces with a variety of clinical and radiographic appearances”

Question 3

Supparative osteomyelitis

Answer 3

infection of the bone and bone marrow spaces resulting in bone necrosis and the production of pus
mandible commonest site
predisposing factors include diabetes mellitus, immunodeficiency, Paget’s disease
pain/swelling/regional lymphadenopathy
large, ill-defined, mottled radiolucency with focal radiodense areas
infection triggers acute inflammatory response
fluid exudation is enclosed space of bone
bone becomes necrotic and acts as a foreign body, allowing bacterial proliferation
necrotic bone projects bacteria from neutrophils
vital bone attempts sequestration via osteoclasts and begins to form new bone
surgical debridement

Question 4

chronic sclerosing

Answer 4

form of osteomyelitis characterised by bone sclerosis rather than bone destruction and without formation of pus
Focal vs Diffuse

Question 5

osteogenesis imperfecta

Answer 5

group of genetically determined disorders of bone characterised by excessive fragility and tendency for easy fracturing
teeth may be abnormal
reduced bone density with sparse trabeculation and poor cortical markings

Question 6

giant cell granuloma

Answer 6

relatively uncommon benign tumour like lesion of jaw bones characterised by numerous osteoclast like giant cells

Question 7

hyperparathyroidism

Answer 7

state of excessive parathyroid hormone secretion

Question 8

Symptoms of dry socket

Answer 8

halitosis and bad breath
severe throbbing pain 24-72hrs post extraction
mucosa round socket
debris and saliva in socket
lymphadenopathy

Question 9

dry socket treatment

Answer 9

explain the nature of the problem
wash out socket with warm saline
place protective obtundent dressing into pocket:
- alvogyl
- butamben
- iodoform
- eugenol

Question 10

predisposing factors of dry socket

Answer 10

traumatic extractions
impaired blood supply
smoking
oral contraceptives
osteosclerotic disease

Question 11

pathogenesis of dry socket

Answer 11

destruction of blood clots by fibronlytic enzymes
trauma to bone will activate tissue-based fibrinolytic enzymes
bacteria may play a role in secreting proteolytic enzymes

Question 12

prevention of dry socket

Answer 12

reduce unnecessary trauma
prophylactic chlorhexidine helpful in patients with difficult extractions, osteosclerotic disease
prescription of metronidazole