15b - Jawbone Infections

jaw infection and cancer

can look very similar radiographically

• both can have poorly-defined margins

• both can be widespread

• both can look irregular

pathogenesis

apical periodontitis is not the same thing as periodontal disease

• caries/trauma cause necrotic pulp and apical periodontitis

  • acute → periapical abscess that becomes osteomyelitis

  • chronic → periapical granuloma that becomes periapical cyst

osteomyelitis

infection invades bone

• body tries to “wall off” dental infection

• if body does not succeed, osteomyelitis can occur

• mixed radiolucencies/radiopacities in irregular manner

• enlarged tonsils, indicating presence of infection

periosteal reaction

reactive process in which new bone is deposited within periosteum for bone expansion

• consider osteomyelitis, osteosarcoma (cancer), langerhans cell histiocytosis (cancer)

fistula

path of drainage for pus (neutrophils)

• referred as sinus tract, fistulous tract, abscess

• can have presence of periosteal reaction

osteonecrosis

dead bone caused by osteomyelitis

• with H&E → nuclei are absent from lacunae in bone

• bacteria seen all over surface of bone

• caused by severe physical trauma, high amounts of radiation, certain medications (bisphosphonates)

pericoronitis

inflammation around the crown

• commonly seen with wisdom teeth

• diagnosis made clinically, but can see radiographic evidence similar to periodontitis

• dense, reactive bone formation may present around follicle