Dry socket, Osteomyelitis & Osteoradionecrosis Flashcards
What is the aetiology of a dry socket?
- Loss of the organised blood clot in the immediate extraction socket due to excessive fibrinolytic activity
- Bacteria colonise the socket and proliferate escaping the host defences
- Further bacterial colonisation will encourage further clot lysis.
What investigations need to be carried out for suspected osteomyelitis?
- Pus sample/swab
- Radiographs – plain film, CBCT, CT (urgently)
- Blood tests (Leukocytosis)
Leukocytosis - High levels of WBC
What is the managment of dry socket?
- Reassurance
- Socket irrigation (with saline)
- Place a dressing (alvogyl)
- Stop smoking
- Analgesia
- Review
- Repeat if necessary
Still no resolution – consider an alternative diagnosis!
Define Osteoradionecrosis
Non-healing region of devitalised bone in a radiated field
Which persists for a minimum of 3 months in the absence of recurrent malignancy
What are some clinical features of osteomyelitis?
- Deep-seated throbbing pan
- Swelling
- Lymphadenopathy
- Fever
- Non healing necoritic bone
- Sequestrum formation
- Trismus
- Halitosis
- E/O draining sinus
What is osteomyelitis
Osteomyelitis (OM) is an infection in the bone which usually affects the mandible.
It is the result of bacterial infection of odontogenic origin or trauma causing bone death and necrosis
(infection of the medullary cavity of the bone)
What do you need to check in a patient when they have a suspected dry socket?
- Lymphadenopathy?
- Swellings?
- Temperature?
- Observations? (BP, O2 saturation, pulse)
- Mouth opening? (Ruler from incisal tips)
- Warmth over the skin?
- Tenderness over the skin?
What is a major risk of clindamycin?
Psuedomembranous collitis
(If pts see black stools then stop it)
If you see a patient with osteomyelitis how do you manage this?
Needs to be in specialist care therefor refer pt
What is the correct terminology of dry socket?
Alveolar Osteitis
What are the risk factors of dry socket?
- Traumatic extraction (inc.surgical)
- Mandibular extractions (esp. lower molar region)
- Females
- Smokers (vaping too)
- Periodontal disease
- Bone disease affecting blood supply (e.g. Paget’s/COD/RT)
- Previous dry socket
- Oral contraceptive pill
- Use of excessive vasoconstrictor
What are some local factors affecting socket healing?
- Inflammation
- Presence of foreign bodies (including dressings!)
- Bony fragments
- Tooth tissue
- Radiation Exposure
What gender is more affected by osteomyelitis?
Male > Female
What was previous tx for Osteoradionecrosis?
What is the new tx for Osteoradionecrosis?
- Surgery
- Hyperbaric oxygen therapy
- Abx (where secondary infection present)
New Tx:
- Pentoxifylline and tocopherol
What is the role of the inflammation caused in a dry socket?
Inflammation in the region stops the spread of infection beyond the confines of the socket
What usualy causes osteomyelitis?
What happens after an infection?
Usually as a result of the spread of infection from a periapical infection
Infection forms in the confined spaces of the mandible
Eventually necrosis ensues which leads to liquefaction and development of pus
How is osteomyelitis treated? (+ special tests)
- Comprehensive clinical assessment
- Radiographs, CT/CBCT and MRI scans
- Microbiological sampling, culturing and antimicrobial sensitivity testing
- Removal of necrotic bone/sequestrum
- Surgical debridement
- Initially prescribe IV antimicrobials followed by oral antimicrobials until resolution
- Prescribe analgesics
Review
