Radiographic Interpretation of Infections of Jaws

Pericoronitis

Pericoronitis
Erupting or partially impacted third molars
Inflamed gingiva
Trismus
Cellulitis

Pericoronitis (R/F)
In early stages, minimal radiographic changes
Radiolucency adjacent to the crown
Ill-defined periphery
Sclerotic border in late stage
Osteomyelitis, in sever cases

Normal Follicular Space

Acute Suppurative Osteomyelitis

Acute Suppurative Osteomyelitis
Dental infection – most common cause
Other causes: fracture, wound, hematogenous spread
Common organisms: Staph. aureus, Staph. albus, tuberculosis, actinomycosis, syphilis, mixed organisms

Suppurative Osteomyelitis
May involve either jaw
Localized in maxilla, diffuse in mandible
Severe pain
temperature, WBC count

Suppurative Osteomyelitis (R/F)
Early stages: no radiographic changes
Ill-defined periphery
Decrease in the density of bone
Followed by increased radiolucency
Sclerosis at later stages
Sequestra: nonvital bone

Suppurative Osteomyelitis (R/F)
Resorption
Periosteal new bone formation
Proliferative periostitis
Fistula formation
Radiographic features similar to malignant lesions

Sequestrum

In-class Exercise: Case 1

4 month old baby
Meningitis

Nuclear Medicine Study

In-class Quiz : Case 2

Chronic Focal Sclerosing Osteomyelitis

Chr. Focal Sclerosing Osteomyelitis
Sclerosing or condensing osteitis
Younger, < 20 yrs
Mostly mandibular first molar
Large carious lesion

Focal Sclerosing Osteomyelitis (R/F)
Initial stage – no radiographic signs
Rarefying osteitis – radiolucent area
Sclerosing osteitis – dense sclerotic bone, trabeculation difficult to identify
Difference with idiopathic osteosclerosis

Chronic Diffuse Sclerosing Osteomyelitis

Chr. Diffuse Sclerosing Osteomyelitis
May not be associated with carious teeth
Intermittent, recurrent episodes of swelling, pain, fever
Any age, mostly elderly patients
Prevalence in African American
Chronic low grade infection
Pain, if present, is often mild
Acute exacerbation

Chronic Osteomyelitis With Proliferative Periostitis
Garre’s Periostitis

Chronic Osteomyelitis With Proliferative Periostitis
Garre’s Periostitis (1893)
Younger, <25 yrs
Mostly mandible

Garre’s Periostitis (R/F)
Often associated with a carious tooth
Mottled, predominantly lucent
Focal overgrowth of bone
“Onion-skin” appearance : layering of cortical bone

In-class exercise: Case 3

Osteoradionecrosis

Osteoradionecrosis
Radiotherapy (40 to 80 Gy)
Decreased vascularity
Low defense
High susceptibility to extraction, perio, pulpal disease, denture sore

Osteoradionecrosis (R/F)
Similar to osteomyelitis
Diagnosis established by history

Florid Cemento-osseous Dysplasia

Florid Cemento-osseous Dysplasia
Wide-spread form of periapical cemental dysplasia
Mostly female, middle-aged, African, Asian
May not be symptomatic

Florid Cemento-osseous Dysplasia
Poor vascular supply – prone to infection
Osteomyelitis, if infected
Preventive management

Florid C-O Dysplasia (R/F)
Usually bilateral, both jaws
Well-defined sclerotic border
Internal content of mixed density
Large irregular masses
Hypercementosis