Inflammatory Bone Disorders Flashcards
How does alveolar osteoitis occur?
Dry socket
Post-dental extraction complication in healing – Failure of blood clot formation, premature clot loss or clot disintegration which leads to localised inflammation of bone
Which teeth are the most susceptible to dry socket?
Mandibular molars
More likely in difficult extractions
What are some predisposing factors for dry socket?
- Smoking
- Poor OH
- Oral contraceptive use (female)
- Difficult extraction – Mandibular molars most susceptible
- Active or recent acute ulcerative gingivitis or periodontitis
- Previous history of dry socket following XLA
Describe the presentation of healing in a patient with dry socket
Slow & delayed healing with granulation tissue proliferation from surrounding vital bone
What may a patient complain of with dry socket?
Severe pain developing 2-3 days following extraction & progressively worsening
Foul smell
Foul taste
Halitosis
What is the managment of dry socket?
Gentle socket irrigation with saline or chlorhexidine
Pack with Alvogyl
Analgesic advise/prescribe
Radiograph – Exclude possibility of retained root fragments or foreign body
OH advice & review
What are the contents of Alvogyl?
Contents:
LA (pain relief)
Iodine (antiseptic)
Eugenol (obtundent)
obtundent = reducing irritation
What organisms can cause osteomyelitis?
Staphylococcus
Streptococcus
Escherichia coli
Neisseria gonorrhoea
Haemophilus influenza
What are some sources of infection for osteomyelitis?
1) Haematogenous – Rare in jaws but may occur in children
2) Non-Haematogenous – Open wounds (e.g. dental extraction, surgery or fracture), direct spread from blood stream or middle ear infection
Haematogenous = Originitating from blood
What are some local predisposing factors of osteomyelitis?
Decreased vascularity or vitality (e.g. due to trauma)
Irradiation (exposed to radiation)
Bisphosphonate medication
Paget’s disease*
Osteoporosis (weakened bones)
*disrupts the normal cycle of bone renewal, causing bones to become weak
What are some systemic predisposing factors of osteomyelitis?
Immunodeficiency
Diabetes
Leukaemia
Agranulocytosis*
Systemic corticosteroids
Chemotherapy
Extremities of age
*deficiency of granulocytes in blood, more vulnerability to infection
What is this?
Dry Socket
What is this?
Dry Socket
What is this?
Osteomyelitis
What symptoms may a patient with osteomyelitis present with?
What would you see clinically?
Pain, swelling, pyrexia, malaise, trismus, paraesthesia with altered sensation
Exposed necrotic bone +/- suppuration with discharge of pus through one or more intra- oral or extra-oral sinuses
What is this?
Osteomyelitis
