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14 Cards in this Set
- Front
- Back
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Categorise osteomyellitis
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Supurative osteomyelitis
- acute, chronic Non-supurative osteomyelitis - sclerotic local, sclerotic diffuse, Garret's osteomyelitis |
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Causes of supurative osteomyelitis
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odontogenic infections
mandibular fractures compromised host defences |
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Differential diagnosis between Acute and Chronic supurative OSM
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Acute:
Acute pain Fever Pus in formation No ragiographical image Chronic Moderate pain No fever Draining pus Sequestrum, bone destruction in radiograph |
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Treatment of acute supurative OSM?
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Medical support
Surgical tx: drainage, debridemnt, treat the cause Antibiotics: amoxicilin, clindamycin, metronidazole, gentamycin, IV for 3 - 5 days, orally for upto 4 weeks |
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Clinical features of chronic supurative OSM?
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sign of infection
reduced sensibility to lower lip tenderness and mobility of adjacent teeth patchy, irregular bone loss Sequestration Periosteal thickening Subperiosteal new bone Pathologic fracture |
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Treatment of chrnoic supurative OSM?
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Medical support
Aggressive surgical tx: - wide incisions, drainage, removal of sequestrum until bleeding bone, primary closure, drains Culture and antibiogram Antibiotics: Amox/Metro, Clin/Genta, Clin/Metro IV for 6 - 15 days, orally for 4 to 6 weeks |
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Features of ORN?
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Area of exposed bone in the mouth for more than 2 months in a previously irradiated field
Hypoxia Hypovascularity Hypocellularity |
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Risk factors of ORN?
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Brachytherapy
Extraction Trauma |
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If a pt require extraction and require radiotherapy, in order to prevent ORN when should the tooth be extracted?
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2 weeks before RT
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If a pt require extraction and already had radiotherapy, in order to prevent ORN how should the extraction be managed?
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HBO or US
20 sessions before and 10 after Fluorides artificial saliva CHX tx early caries |
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Mechanisms of action of bisphosphonates?
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decrease osteoclast activity and no, -> reduce bone turnover
Reduced angiogenesis - avascular bone Effects last for long time (up to 10 years) |
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Indication of bisphosphonates?
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Osteoporosis
Multiple myeloma Paget's disease Bony metastasis Hypercalcemia |
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Name common bisphosphonates
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Alendronate (fosamax) oral
Risedronate (actonel) oral Zoledronic acid (Aclasta) IV |
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How to prevent BRONJ?
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dental check/work prior to commencement of bisphosphnate drug therapy
Avoid extractions Sutures Avoid adrenaline Provide soft denture lniing Monitoring |
