Exam 6- bone inflammation-OSTEOMYELITIS Flashcards
What is “by strict definition” the definition of Osteomyelitis?
bone MARROW inflammation
HERES THAT GLOBAL QUESTION AGAIN….What are the 6 types of Osteomyelitis?
1.Acute Osteomyelitis 2.Chronic osteomyelitis 3.Focal sclerosing osteomyelitis (condensing osteitis) 4.Diffuse sclerosing osteomyelitis 5.Osteomyelitis with proliferative periostitis (Garre’s osteomyelitis) 6.Alveolar Osteitis (Dry socket)
Acute Osteomyelitis: Short duration, usually less than ______
one month
Acute Osteomyelitis: Significant ____ usually accompanies it
PAIN
Acute Osteomyelitis: What are the 3 systemic symptoms?
1.Fever 2.Lymph node swelling 3.elevated WBC count
Acute Osteomyelitis: ________ of overlying soft tissue
Swelling
Acute Osteomyelitis: ________ drainage may be seen
Purulent
Acute Osteomyelitis WHAT IS ONE OF THE HALLMARK features that may be exfoliated?
Necrotic bone SEQUESTRA may be exfoliated
Acute Osteomyelitis: May cause ________ in the distribution of nerves passing through the involved area
paresthesia
Acute Osteomyelitis: In the _______ stages, no changes are seen radiographically.
earliest
Acute Osteomyelitis: As the infection progresses, an ILL-DEFINED, often asymmetric radio______ is usually seen
radioLUCENCY
Acute Osteomyelitis: How is it treated? What might be necessary??
ANTIBIOTICS…surgial drainage (COOL!)
Which form of osteomyelitis has pain, but its variable pain; variable intensity of pain and its usually not consistent sharp pain
Chronic osteomyelitis
Much like actue osteomyelitis, WHAT classic sign of chronic osteomyelitis can possibly be seen clinically or radiographically?
Bone sequestra
What is one possible sequelae of chronic osteomyelitis that involves the teeth?
possible tooth loss in the area of osteomyelitis
What 2 descriptors would you use to describe chronic osteomyelitis on a radiograph? What could possibly happen to the bone surrounding the lesion?
1.ill-defined 2.asymmetric…the bone could become denser to wall of the infection
What is unique about the antibiotic treatment for Chronic Osteomyelitis? (along with surgical resection)
long duration and often IV delivered
What is the official name for condensing osteitis? (be careful its 4 freaking words)
Chronic Focal Sclerosing OsteoMyelitis
Condensing osteitis is generally considered to be a reaction of periapical bone to ________ odontogenic infection
low grade
What type of osteomyelitis is this describing?? Low grade inflammation in an immune competent host can result in increased density (sclerosis) of the bone as the body tries to wall off the infection
Chronic Focal Sclerosing OsteoMyelitis (condensing osteitis)
What is the CRITIAL fact about Chronic Focal Sclerosing Osteomyelitis??
the tooth is NON-VITAL
Radio of condensing osteitis: ________ area of opacity, may be ________ and often blends with surrounding bone
irregular and asymmetric
What are the two treatment options for condensing osteitis?
RCT or EXT
What are the chances the bone returns to normal after extracting a tooth that is undergoing condensing osteitis?
85% chance the bone will remodel
What is the CONTROVERSIAL bony condition that is often confused with other pathologic conditions, particularly cemento-osseous dysplasia which frequently becomes secondarily infected?
Chronic Diffuse Sclerosing Osteomyelitis
Chronic Diffuse Scelerosing Osteomyelitis is the controversial bony condition that is often confused with other pathologic conditions, particularly ___________ which frequently becomes secondarily infected
cemento-osseous dysplasia
Chronic diffuse sclerosing osteomyelitis is considered to be a reaction to LOW GRADE odontogenic infection, often following ______ or surgery
TRAUMA
Chronic DIFFUSE sclerosing osteomyelitis is equivalent to chronic FOCAL sclerosing osteomyelitis but it affects a ______ area of bone in _____ quadrant
LARGE…ONE
Where in the mouth does Chronic diffuse sclerosing osteomyelitis CHARACTERISTICALLY affect??
posterior mandible
Why are antibiotics NOT effective in chronic diffuse sclerosing ostromyelitis?
the slcerotic bone is HYPOVASCULARIZED..abx will never get there
What is the nickname for Chronic Osteomyelitis w/ proliferative periostitis??
Garre’s Osteomyelitis
What is the offical term for Garre’s Osteomyelitis? (again be careful, there are 5 freggin’ words here)
Chronic Osteomyelitis with proliferative periostitis
Which form of osteomyelitis is this?? Low grade osteomyelitis Immune competent host…Usually YOUNGER patients therefore Inflammation involves PERIOSTEUM
Chronic Osteomyelitis with Proliferative Periostitis (Garre’s Osteomyelitis)
In Garre’s Osteomyelitis it is a ________ osteomyelitis Immune competent host…Usually _______ patients therefore Inflammation involves ________
low grade…younger…periosteum
Since Garre’s ostomyelitis involves the periosteum, it will be ON or NEAR the ________
coritcal surface
Which ostomyelitis is this describing? Draining sinus tract from an infected tooth most often Periosteal inflammation stimulates bone production
Garre’s osteomyelitis (chronic osteomyelitis with proliferative periostitis)
What is the clinical presentation of Garre’s Osteomyelitis? What causes this swelling?
Bony hard swelling…a thin layering of cortical bone produces the expansion
Which arch is more affected in Garre’s Osteomyelitis?
the mandible
In the radiographic findings of Garre’s Osteomyelitis Immature bone is laid down outside the _______ but under the ________..ALSO may leave some degree of ______ under the cortex
cortex…periosteum…lucency
What is the characteristic radiographic pattern for Garre’s Osteomyelitis?
ONION SKIN pattern
Radiographically in Garre’s osteomyelitis ______ bone is weakly opaque, usually less dense than ______ bone
layered…cortical
Which radiographic view in Garre’s osteomyelitis is best for visualizing the “layering” of the bone?
occlusal films
What are the two treatment possibilites for Garre’s Osteomyelitis?
RCT or Ext
Do you Rx Abx for Garre’s Osteomyelitis?
NO, they do not alter the process
What is the clinical term for dry socket?
Alveolar Osteitis
Where is alveolar osteitis most likely to occur and what contidtion increases its likeliness?
Mandibular 3rd molars and infection increases likeliness
Which gender is more associated with alveolar osteitis and why?
female…birth control pills
Alveolar osteitis is caused by loss/breakdown of the WHAT in the socket??
blood clot
When does alveolar osteitis typically occur after ext? The site can produce severe _____ and ______
3-4 days after ext….pain and foul odor
How is Alveolar Osteitis treated?
pack the socket with protective dressing
In BRONJ (MRONJ), they are drugs that inhibit action of _______
osteoclasts
BRONJ meds not only affect osteoclasts, they are also known to affect ________ and ________
angiogenesis and osteoblasts
HOLY SHIT! What is the estimated drug half-life of bisphosphonates?
12 years or greater!
Why are people on Bisphosphonates? To attempt to control malignant disease in bone or ________ of
malignancy
hypercalcemia
Why are people on Bisphosphonates? THIS condition is the PRIMARY OFFENDER for why people are on these meds,,
Multiple myeloma
Why are people on Bisphosphonates? Metastatic disease, particularly _______ and _______ carcinoma
breast and prostate
Why are people on Bisphosphonates? to increase bone density in older individuals suffering from ________
osteoperosis
Why are people on Bisphosphonates? In the treatment of _______ disease and other metabolic bone diseases
Paget’s
What is a big factor on the severity of bisphosphonate drug complications?
DOSE..the reactions are dose dependent
What is the prevalence of BRONJ in cancer patients on IV BPs? What about oral BPs?
6-10%…unknown for oral but estimated at 1/100,000
BRONJ occurs in ___% of cases in patiens with myeloma or metastatic breast cancer
85%
What are the two biggest risk factors for the TYPE of BisPhos drug that can lead to BRONJ?
Nitrogen containing and IV route of administration
IF IV and Nitrogen containing drugs are the biggest risk factors for BRONJ, then what are the two worst offenders?
- ARE-DIA (pam-id-ron-ate) 2.ZO-META (zo-le-dron-ic acid)
Clinically BRONJ shows bone necrosis and it often follows surgical procedures–to the tune of ___% of the cases…BUT this can also be seen following simple tx or occur _______
60% of the cases…spontaneously!
What is the most crucial form of treatment for BRONJ?
PREVENTION
What is a CONTRAINDICATED treatment for BRONJ??
wide excision (can work in osteoradionecrosis)
What are two treatments for BRONJ with variable sucess?
local debridement and abx mouthwash
