E2: Lesions of the jaw Flashcards
What are the different types of inflammatory lesions of the jaw?
What are the two types of periapical lesion?
cysts and osteomyelitis
What are the two types of osteomyelitis?
lytic and sclerotic
What are the characteristics and clinical features of pericoronitis?
- Inflammation of the tissues surrounding the crown of
partially erupted tooth - Third molars
- Inflamed gingiva, pain, swelling
- Trismus
- Cellulitis
- Mostly young adults
What is the location and border of pericoronitis?
In early stages, minimal radiographic changes
- Location: Radiolucency adjacent to the crown
- Border: Ill-defined periphery, Sclerotic border in late stage
Severe cases of pericoronitis becomes ___
osteomyelitis
What are the clinical features of osteomyelitis?
*Infection of bone
*Involves marrow, cortex, periosteum
*Usually local source of infection
* May have hematogenous source
Osteomyelitis is the infection of ____ segment of the bone.
medullary
____ is the acute or chronic inflammatory process in the medullary spaces or cortical surfaces of bone that is away from the primary site of involvement.
osteomyelitis
Classification of osteomyelitis based on time
- Acute: two weeks after disease onset
- Subacute: One to several months
- Chronic: After a few months
Classification: Cierny-Mader (1985)
- Stage 1: Medullary
- Stage 2: Superficial
- Stage 3: Localized
- Stage 4: Diffuse
Classification of osteomyelitis
*Hematogenous
* Secondary to contiguous focus of infection
* Chronic osteomyelitis
Most common cause of acute osteomyelitis
dental infection
secondary: fracture, wound, hematogenous spread
What are common organisms that cause acute osteomyelitis?
Staph. aureus, Staph. albus,
tuberculosis, actinomycosis, syphilis, mixed organisms
What are the clinical features of acute osteomyelitis?
- Any age, more in males
- May involve either jaw
- Localized in maxilla, diffuse in mandible
- Severe pain
- Fever, increased WBC count
What are the radiographic features of acute osteomyelitis?
- Early stages: no radiographic changes
*Ill-defined periphery, fading into normal trabecula
*Decrease in the density of bone: localized or discrete - Followed by increased radiolucency
- Sclerosis at later stages
- Sequestra: nonvital bone
What are the radiographic features of osteomyelitis?
- Resorption
- Periosteal new bone formation
- Proliferative periostitis
- Fistula formation
- Pathologic fracture
- Radiographic features similar to malignant lesions
What are the clinical features of chronic osteomyelitis?
*Duration of symptoms
* Mottled, predominantly lucent
* Focal overgrowth of bone
* “Onion-skin” appearance : layering of cortical bone
What are the clinical features of osteoradionecrosis?
- Radiotherapy (40 to 80 Gy)
*Decreased vascularity - Low defense
*High susceptibility to extraction, perio, pulpal disease,
denture sore - Radiographic feature: similar to osteomyelitis
*Diagnosis established by history
ONJ stands for
Osteonecrosis of the jaw
BON stands for
Bisphosphonate-associated osteonecrosis of the jaw
BRONJ stands for
Bisphosphonate-related osteonecrosis of the jaw
MRONJ stands for
Medication-related osteonecrosis of the jaw
What are the clinical features of MRONJ?
- 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
- Potential risk factors:
*Dentoalveolar trauma
*Duration of BP treatment - Type of BP: i.v. BP is more problematic
What are the staging: Details in AAOMS Position paper?
- At risk: No apparent necrotic bone
- Stage 0: Non-specific clinical and radiographic findings
- Stage 1: exposed, necrotic bone that is asymptomatic
- Stage 2: exposed, necrotic bone, with pain and
infection - Stage 3: Exposed, necrotic bone in patients with pain,
infection, and pathologic fracture, extraoral fistula, or
osteolysis extending to the inferior border
