7/10/17

Diseases of the Periapical tissue

  The spread of infection from dental pulp is in the direction of Periapical region. A number of tissue reactions may occur depending on the variety of circumstances.
There is transformation from one lesion to another in most cases.

What is Osteomyelitis?

Osteomyelitis is an inflammation of the interior of bone especially involving the marrow spaces.
  So, osteomyelitis is an inflammation of bone and bone marrow. It may develop in jaws from bone infection or from other odontogenic causes.
   It is either acute, sub acute or chronic and presents different clinical course depending on its nature.

Acute Suppurative osteomyelitis

  This is a serious sequelae of Periapical infection that results in diffuse spread of infection in medullary spaces with necrosis of variable amount of bone.
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What are the common causes of osteomyelitis?

  - Dental infection.
  - Gun shot wounds.
  - Haematogenous spread.
     Dental infection is the most common and frequent cause, but osteomyelitis is not a common disease per se.
It may be well localized or involve a great volume of bone through violent Periapical abscess, chronic Periapical granuloma or cyst undergoing acute exercabation without established drainage.
   Most common organisms involved are staph.aureus, staph. albus or mixed organisms.
Specific infection osteomyelitis is seen secondary to actinomycosis, Syphilis and tuberculosis.

Osteomyelitis in children

  Maxillary osteomyelitis is common in children and often well circumscribed. Mandibular osteomyelitis is common in adults and here the bony involvement is more diffuse and widespread. Osteomyelitis may involve maxilla or mandible.

Osteomyelitis signs and symptoms

   Osteomyelitis of infants may be haematogenous with features of
   - Severe pains
   - fever
   - regional
   - lymphadenitis
   - Increased WBC count, loosening of affected teeth and difficulty with mastication.
   - Paraesthesia and Anaesthesis may be seen in the Mandibular type at the acute phase.
   - Swelling and reddening of skin and or mucosa may result from periostitis.

Treatment and Prognosis of Osteomyelitis

  Establish drainage and treat with antibiotics.
Uder treatment dead bone may lose vitality and separate from living bone to form sequestrum which may exfoliate if small but requires surgical removal if large.
Involucrum is the surrounding new living bone.

Complications

  - Periostitis

  - Soft tissue abscess

  - Cellulitis
  
  - pathological fracture.
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