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81 Cards in this Set
- Front
- Back
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osteomyelitis -pointing to periosteum |
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acute apical periodontitis signs |
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Acute inflammation signs |
PAIN! |
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Chronic inflammation signs |
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Location of periapical inflamm. lesions |
-epicenter usually at apex -may along be along lateral root surface due to accessory canals, root fracture |
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Endo lesions look? |
J shaped |
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Periodontal lesion location |
-epicenter is usually at alveolar crest -inflam. changes in bone may extend to apex and into furcation in post teeth |
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Osteomyelitis location |
-post. mandible -maxilla involvement is rare (bc greater vascularity in maxilla) |
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Inflam. lesions borders usually look |
-poorly demarcated -blending into normal trabeculation |
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Internal architecture of inflam. lesions |
-resorption looks r-lucent -formation looks r-opaque
*usually lesion will be mixed |
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Where do you see bone formation in inflamm lesions? |
-osteosclerosis |
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Osteomyelitis patients will probably show? |
sequestra of bone (r-opaque) |
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Inflamm. lesions on adjacent bone |
-stimulation of surrounding bone, producing a sclerotic border -bone resorption (r-lucent area) -widening of pdl (greatest widening at epicenter) |
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Define PA inflamm. lesion |
-local response of bone around apex of tooth that occurs as a result of necrosis of pulp or through destruction of periapical tissues by extensive perio disease |
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radio-endo -perio issue --> bone --> pulp |
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endo-radio -caries to pulp |
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PA inflamm lesions clinical features |
-asymptomatic OR pain, swelling, fever -lymphadenopathy |
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Internal changes in early PA inflamm. lesion |
none |
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Internal changes in apical periodontitis |
-loss of bone density/widening of pdl |
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When the lesion is mostly lucent |
apical rarefying osteitis |
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When the lesion is mostly sclerotic? |
apical sclerosing osteitis |
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-you see carious lesion in tooth -r-lucency at apex -widened pdl |
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arrow = decay but no PA changes
Tooth on L, r-lucency at apex; widened pdl |
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loss of bone density/widened pdl |
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mixture of rarefying and sclerosing osteitis
rarefying = black sclerosing = white |
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mixture of rarefying and sclerosing osteitis |
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PA inflam. lesions affects on adjacent structures |
-could be bone deposition or resorption -halo effect (displacement or remodeling of mx sinus) -root resorption -mucositis (localized thickening of membrane of mx sinus) |
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HALO EFFECT -displacement/remodeling of mx sinus -mucosal thickening -non-odontogenic bc don't see cortication at arrow -pushes floor of mx sinus up |
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When you think you see PA inflammatory lesion on Rx, it could also be: |
-POD (periapical osseous dysplasia) -enostosis -PA scar -surgical defects |
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POD -no caries -non-odontogenic then -pdl fine
no tx
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ARO -apical rarefying osteitis -caries -widened pdl
*must do pulp vitality test to differentiate between POD and ARO
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DBI/enostosis |
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DBI/enostosis -idiopathic osteosclerosis -non-odontogenic
don't tx DBI |
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If you have a pt with more than 5 DBI, you should worry about: |
Gardner's |
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PA scar after endo |
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What is pericoronitis? |
-inflamm. of tissues surrounding crown -esp. if tooth hasn't erupted yet
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Clinical signs of pericoronitis? |
-TRISMUS -pain and swelling |
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Pericoronitis on a Rx |
-early lesions may show nothing -follicular space around crown may be expanded (over 3mm you should be worried)
-borders could be ill-defined -sclerotic border NOT unusual |
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pericoronitis -sclerotic bone rxn adjacent to follicular cortex (back) and a periosteal rxn (white) |
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Pericoronitis internal structure and effect on surrounding |
-sclerotic bone rxn adjacent to follicular cortex and a periosteal rxn
-you may see periosteal/new bone formation at inferior cortex |
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If you think it's pericoronitis, you should also be suspicious of: |
-enostosis/osteosclerosis -fibrous dysplasia/osseous dysplasia -malignancies (SCC or osteosarcoma) |
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Tx pericoronitis? |
-remove partially erupted tooth -trismus may prevent access, antibiotic therapy and reduction in occlusion of the opposing tooth |
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Where may osteomyelitis spread? |
-first of all, it's inflammation of bone 1. spread to involve cortex periosteum 2. spread to involve cancellous portion
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Sources of osteomyelitis? |
1. pyogenic (from tooth) 2. hematogenous (blood) |
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Osteomyelitis looks like what on rx? |
fibrous dysplasia |
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What is hallmark of osteomyelitis? |
sequestrum! -it's a segment of bone that has become necrotic because of ischemic injury caused by the inflammatory process |
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Types of osteomyelitis? |
-acute -chronic -Garre's -diffuse sclerosing osteomyelitis |
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Acute osteomyelitis details/source |
-spread of infection to bone marrow -predominantly PMNs
source: non vital tooth, trauma, blood |
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Actue Osteomyelitis clinical signs |
-males -mandible
-quick onset, painful, swelling of adj tissues -fever, swollen LN -leukocytosis |
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Rx examination of acute osteomyelitis |
CT - periosteal new bone detecting sequestra
When you expect this is the problem, use CT! |
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acute osteomyelitis w/ sequestra -irreg. borders
CORONAL, bone window |
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acute osteomyelitis w/ sequestra -irregl. borders
AXIAL, bone window |
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Rx features of acute osteomyelitis: |
-post body of mandible -ill-defined borders
initially, there is an decrease in radiodensity (more black) of bone, with trabeculae becoming less well defined
-can have sclerotic border |
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Acute Osteomyelitis effect on BONE on Rx |
-cortical bone may be resorbed -could have bone formation (involucrum) -onion skin appearance --> prolif. periostitis |
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proliferative periostitis (acute osteomyelitis form)
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If you saw acute osteomyelitis on Rx, you might also be suspicious of? |
fibrous dysplasia -esp if in kids
you don't tx fibrous dysplasia; you DO tx osteomyelitis |
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What makes fibrous dysplasia unique though? |
-anatomical expansion (whole anatomy epxands) -new bone is made on inside of cortex--the outer cortex could be thinned and contains the lesion
KIDS! |
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How should you manage acute osteomyelitis? |
-identify source of inflammation -antimicrobial therapy -establish drainage
BIOPSY |
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How do you get chronic osteomyelitis? |
-could be sequelae of acute type -could arise de novo
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What is diffuse sclerosing osteom.? |
-a chronic osteomyelitis in which the balance of bone metab is tipped -INCREASE in bone formation -produces sclerotic appearance |
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What are clinical symptoms of chronic osteomyelitis? |
-pain -recurrent swelling -fever -swollen LN -paresthesia (this usually means malignant) |
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Which rx should you use if you think your patient has chronic osteomyelitis? |
CT bc it has ability to demonstrate sequestra and new periosteal bone |
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Where/what would you find on a rx of osteomyelitis? |
-post mn -the periphery may be better defined
internal structure: -regions of greater and lesser density of bone compared to normal surrounding bone -most of lesion is composed of r-opaque or sclerotic bone pattern -sequestrum looks more r-opaque than surrounding bone
Bone looks GRANULAR, obscuring individual bone trabeculae |
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chronic osteomyelitis -on R, you see normal cortical border -on L, see onion
In FD, you would no longer see cortical border (even on inside) |
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chronic osteomyelitis |
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So, you tx osteomyelitis by? |
resection |
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you see that the lesion has extended into soft tissue -fistulous tract extending inferiorly from apex fo first molar through the inferior cortex of the mandible |
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If you think you have a case of chronic osteomyelitis, you should be suspicious also of: |
-fibrous dysplasia -osteosarcoma -paget's |
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What would let you know it's osteomyelitis and not FD? |
Because in FD: -new bone formed on inside -mandible is expanding outward |
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What would let you know it's osteomyelitis and not Pagets? |
In paget's -entire mandible is affected |
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What would let you know it's osteomyelitis and not osteosarcoma? |
-increase bone destruction would be expected with SUNRAY spicules in periosteum |
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How should you treat chronic osteomyelitis? |
-lack of good blood supply hinders tx -hyperbaric o2 tx -long term antibiotic therapy -surgical options: resection, sequestrotomy, decortication |
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What is osteoradionecrosis? |
-inflammatory condition of bone (osteomyelitis) -occurs AFTER the bone has been exposed to therapeutic doses of radiation
-presence of exposed bone for a period of at least 3 mo
-see pain, swelling, pus |
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Osteoradionecrosis looks like? |
-chronic osteomyelitis, except early changes include resorption of outer plate -post mandible is also most common place |
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osteoradionecrosis |
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How do you manage osteoradionecrosis? |
-hyperbaric o2 -sequestration -ab therapy -PREVENTION is KEY |
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osteoradionecrosis -arrow at bone destruction -black hole is AIR |
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Describe the features of bisphosphonate-related osteonecrosis of jaws |
These drugs are: -pyrophosphates that act to inhibit osteoclasts and reduce bone metab
-they are good for: osteoporosis, multiple myeloma, mets bone tumors, hypercalcemia of malignancy |
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Clinical features of bisphosph. related osteonecrosis |
-exposed bone after an invasive dental procedure -post mn (60%) -maxilla (40%)
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bisphosph-related osteonecrosis of jaw |
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How do you manage bisphosphonate-related osteonecrosis of jaw? |
-PREVENTIVE -if bone is exposed, tx is aimed at controlling the sympotms of pain and infection with ab mouth rinses and systemic ab therapy |
