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Diagnostic Oral Medicine
chronic focal sclerosing osteomyelitis which is limited
to the alveolar process and may occur in both jaws.
Chronic diffuse sclerosing osteomyelitis
Chronic diffuse sclerosing osteomyelitis is charac-
terised by the proliferation of bone to a low-grade
infection, the infection being an extension of diffuse
periodontal disease.
CLINICAL FEATURES
Chronic diffuse sclerosing
osteomyelitis occurs in adults and has no sex predi-
lection or racial predilection. It involves the mandi-
ble, affects both the basal bone and the alveolar
process, and is usually unilateral. During acute exac-
erbation, there is mild pain and the bone is tender
with mild suppuration. Fever and leukocytosis usu-
ally do not occur, although erythrocyte sedimenta-
tion rate may be increased (Table 15.1).
RADIOGRAPHIC FEATURES
Radiograph shows
patchy areas of radiolucency and radiopacity, some-
times bilateral, involving extensive areas of bone giv-
ing a cotton-wool appearance. Rarely, the maxilla
may also show similar picture. It resembles Paget’s
disease (generalised hypercementosis of the teeth)
and cemento-osseous dysplasia (initially radiolucent,
later becomes radiopaque predominantly with a thin
peripheral radiolucent rim) (Table 15.1).
HISTOPATHOLOGIC FEATURES
Histological pic-
ture shows dense irregular trabeculae of the bone
some of which are bordered by osteoblasts. Foci of
osteoclasts are seen. Bone trabeculae are separated
by fibrous tissue with small capillaries, proliferating
fibroblasts and occasional lymphocytes and plasma
cells. Alternating resorption and deposition of the
new bone gives the bone a mosaic pattern.
TREATMENT
High doses of antibiotics are indi-
cated for acute exacerbation. Tooth present in the
sclerotic area may have to be extracted. Chances of
infection and delayed healing of the extracted socket
must be explained to the patient. This is due to
hypovascularity of the sclerotic bone.
Chronic focal sclerosing osteomyelitis
(Condensing osteitis)
It is an unusual reaction of
the bone to infection, the source being a large cari-
ous cavity in an associated tooth or deep coronal
restoration.
Condensing osteitis is commonly seen in children
and young adults and mostly involves mandibular
premolars. Mild pain may be associated with an
infected pulp.
HISTOPATHOLOGIC FEATURES
The bony trabec-
ulae are thick and the interstitial marrow tissue is
scanty, fibrotic and infiltrated with a few lympho-
cytes. Osteocytic lacunae appear empty. Many rever-
sal and resting lines are present leading to a pagetoid
appearance.
DIFFERENTIAL DIAGNOSIS
It has to be differenti-
ated from
1.
Benign cementoblastoma:
Periodontal membrane
space obliterated. Well-circumscribed dense
radiopacity limited by a uniform thin radiolu-
cent line.
2.
Focal cemento-osseous dysplasia:
This has a
radiolucent border.
TREATMENT
Depending on the condition of the
associated tooth, endodontic therapy or extraction is
indicated. In some patients, dense bone of extracted
socket may not show remodelling on the roentgeno-
gram, when the condition is referred to as
bone scar
.
Osteoradionecrosis (ORN)
Radiotherapy treatment of head and neck cancers
has its own short-term and long-term side effects.
ORN (Table 15.1) is necrosis or death of the bone of
maxilla or mandible following radiation therapy for
cancer of the head and neck regions, when these
bones are directly in the field of radiation. The inci-
dence of ORN of those undergoing radiotherapy is
about 8%.
PATHOGENESIS
The damage to the capillaries and
arterioles results in an initial hyperaemia, endarteri-
tis, thrombosis and eventual obliteration leading to a
restricted blood flow followed by complete elimina-
tion of the blood flow. This leads to hypocellularity,
hypoxia and hypovascularity.
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