Quartz 4

Oral Pathology - 17 - Bone Inflammatory Lesions

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Oral Pathology

Introduction to Oral Pathology1

Oral pathology is the specialty of dentistry and discipline of pathology that addresses the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases.

Clinical Manifestations and Diagnosis

The practice of oral pathology involves the clinical examination, radiographic interpretation, and microscopic analysis of tissues to reach a definitive diagnosis. Key areas of focus include:

  • Developmental Anomalies: Structural variations occurring during the formation of oral tissues.
  • Infectious Diseases: Viral, bacterial, and fungal infections manifesting in the oral cavity.
  • Neoplasms: Benign and malignant tumors of the soft tissues and bone.
  • Immune-Mediated Disorders: Conditions where the immune system affects the mucosal surfaces.

Role of the Pathologist

The oral pathologist serves as a consultant to dental and medical practitioners, providing critical diagnostic information that guides patient treatment and management strategies. This includes the correlation of clinical findings with histopathological features to ensure accurate disease classification.

Table Of Contents

Clinical Classifications2

  • Developmental Conditions
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
  • Mucosal Lesions—Immunologic Diseases
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant
  • CT Tumors—Benign
  • CT Tumors—Malignant
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant
  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions

Inflammatory Bone Lesions

Definition

Inflammation of the bone and bone marrow in the jaws is known as osteomyelitis. These lesions typically arise as an extension of periodontal or periapical inflammation or may be associated with jaw trauma. Inflammation serves as the body’s natural response to these infections or traumatic injuries.

Pathogenesis and Etiology3

  • Most common initiating causes are odontogenic infection and trauma.
  • Infection and inflammation usually begins in the medullary space involving the cancellous bone and spreads to cortical bone, periosteum, and soft tissues.
  • Radiographic Visibility: A radiolucency will only appear on a radiograph if the infection impacts the cortical bone. If the infection is limited to the medullary space and does not involve the cortical bone, it may not be visible radiographically.

Clinical Presentation and Symptoms

Systemic Signs (FML)

Systemic signs of infection can be remembered by the acronym FML:

  • ==Fever== (high and intermittent)
  • ==Malaise==
  • ==Lymphadenopathy==

Acute Osteomyelitis

  • Deep and intense pain
  • High or intermittent fever
  • Paresthesia or anesthesia of the Inferior Alveolar Nerve (IAN)
  • Tooth is NOT loose (mobility is typically caused by periodontitis rather than acute osteomyelitis)
    • Antibiotics are prescribed specifically due to systemic involvement.

Treatment

  • Administration of antibiotics
  • Surgical drainage

Chronic Osteomyelitis

Radiographic and Clinical Features4

  • Diffuse mottled radiolucency
  • Sequestra: Presence of pieces of dead bone
  • Garre’s Osteomyelitis: A specific form of chronic osteomyelitis characterized by proliferative periosteitis, often presenting with an “onion skin” appearance on imaging.
    • Radiographic Appearance: Presents as a diffuse, mottled radiolucency because the long-standing infection has had time to impact the cortical bone.

Treatment

  • Administration of antibiotics
  • Surgical debridement

Focal Sclerosing Osteomyelitis

Clinical Characteristics5

  • Also known as Condensing Osteitis.
  • Characterized by bone sclerosis resulting from low-grade inflammation, such as chronic pulpitis.
    • Pathology: The body creates a wall of diffuse, dense bone as a natural inflammatory response to wall off the infection.

Treatment

  • No specific treatment for the bone lesion itself; management focuses on addressing the underlying cause (e.g., endodontic therapy or extraction of the affected tooth).
    • Outcome: The sclerosis may or may not resolve once the infection is cleared.

Diffuse Sclerosing Osteomyelitis

Clinical Presentation6

  • Similar pathology to focal sclerosing osteomyelitis but occurring on a wider scale.
  • The extensive nature of the condition may lead to jaw fracture and secondary osteomyelitis.

Treatment

  • Administration of antibiotics
  • Addressing the underlying cause of the inflammation

Audio Appendix

Additional Audio Content

The following sections from the lecture audio did not correspond to any heading in the main document.

Case Study: Post-Extraction Complication

  • Scenario: A high-risk patient with a history of IV bisphosphonate use and periodontal disease undergoes multiple tooth extractions.
  • Presentation: Following the extractions, the body fails to heal over the sockets. The bone remains exposed and dies (osteonecrosis), leading to intense jaw pain. This condition takes a very long time to heal.

Treatment

  • Chlorhexidine Rinse: A critical component of management to rinse the necrotic area.
  • Antibiotics.
  • Conservative Surgery.

Commonly referred to as “BRONJ,” this condition involves the death of bone tissue in patients using bisphosphonates.

  • Risk Factors: The risk is significantly higher for patients receiving intravenous (IV) bisphosphonates compared to those taking them orally.
  • Medication Identification: Bisphosphonates typically end in the suffix “-dronate” (e.g., zoledronate).

Footnotes

  1. Original PDF page 1: Oral Pathology - 17 - Bone Inflammatory Lesions, p.1 ↩

  2. Original PDF page 2: Oral Pathology - 17 - Bone Inflammatory Lesions, p.2 ↩

  3. Original PDF page 3: Oral Pathology - 17 - Bone Inflammatory Lesions, p.3 ↩

  4. Original PDF page 4: Oral Pathology - 17 - Bone Inflammatory Lesions, p.4 ↩

  5. Original PDF page 5: Oral Pathology - 17 - Bone Inflammatory Lesions, p.5 ↩

  6. Original PDF page 6: Oral Pathology - 17 - Bone Inflammatory Lesions, p.6 ↩

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