Osteomyelitis of the Jaws

Abstract

Osteomyelitis of the jaws is frequently associated with the extraction of or other dental trauma to teeth during the
acute stage of an infection. It may also occur spontaneously, most frequently around an area of neglected dental caries or apical abscess formation, less frequently associated with upper respiratory or general diseases, and in association with osteomyelitis elsewhere in the body. It occurs far oftener in the lower than in the upper jaw in those cases
associated with extraction, due to the poor drainage afforded a mandibular tooth socket and the excellent drainage
from a maxillary. Prevention or early care of dental caries, and avoidance of dental trauma or extraction during the
acute phase of an infection, will do much toward eliminating osteomyelitis of the jaw. The treatment of osteomyelitis
should be conservative as far as operative attacks on the bone itself are concerned. Osteomyelitis is an infection and
inflammation of the bone or the bone marrow. It can happen if a bacterial or fungal infection enters the bone tissue
from the bloodstream, due to injury or surgery. Osteomyelitis of the jaws can be intensely painful, and it can result
from caries or periodontal disease. The jawbone is unusual because the teeth provide a direct entry point for infection.
Malignancy, radiation therapy, osteoporosis, Immune deficiency states, Diabetes mellitus, malnutrition, and extremes
of age increase a person's risk of osteomyelitis of the jaws. Failure of microcirculation in cancellous bone plays big
role in establishment of osteomyelitis, because the involved area becomes ischemic and cellular component of bone
becomes necrotic. A sinus, gum, or tooth infection can spread to the skull. The mandible jaw becomes more frequently involved in osteomyelitis than Maxilla. Because Blood supply to the maxilla is much richer. Mandible on the
other hand gets its primary blood supply from inferior alveolar artery and because the overlying cortical bone of the
mandible limits penetration of periosteal blood vessels. The signs and symptoms depend upon the type of OM, and
may include: Pain, which is severe, throbbing and deep seated. Fever which may be present in the acute phase and is
high and intermittent. Initially fistula is not present. Chronic fatigue syndrome, dental pain, but headache or other
facial pain Trismus (difficulty opening the mouth), which may be present in some cases and is caused by edema in
the muscles. Dysphagia (difficulty swallowing), which may be present in some cases and is caused by edema in the
muscles Pus may later be visible, which exudes from around the necks of teeth, from an open socket, or from other
sites within the mouth or on the skin over the involved bone according to the length of time the inflammation has
been present. In acute osteomyelitis, infection develops within 2 weeks of an injury, initial infection, or the start of an
underlying disease. The pain can be intense, and the condition can be life-threatening. A course of antibiotics or antifungal medicine is normally effective. For adults, this is usually a 4- to 6-week course of intravenous, or sometimes
oral, antibiotics or antifungals. In chronic osteomyelitis, infection starts at least 2 months after an injury, initial infection, or the start of an underlying disease. Patients usually need both antibiotics and surgery to repair any bone damage. Treatment Acute Osteomyelitis is managed by administration of surgical debridement, removal of causative factors (removal of reasons) and appropriate antibiotics. If there is fracture of the mandible, the area must be fixed and
stabilized. Surgically, we must remove non vital teeth in the area of infection. Remove necrotic, loose pieces of bone.
Antibiotic therapy is continued for a much longer time than is usual for Odontogenic Infections. For mild osteomyelitis antibiotics should continue at least 6 weeks. For severe chronic Osteomyelitis antibiotics administration may continue for up to 6 months. Prevention: Patients with a weakened immune system should Cleaning and dressing an open
wound can prevent infection. Have a well-balanced healthy diet and suitable exercise, to boost the immune system.
Avoid smoking, as this weakens the immune system and contributes to poor circulation patients, smoking, it worsens
the circulation. Avoid excessive regular alcohol consumption as this raises the risk of hypertension, or high blood
pressure, and high cholesterol.