Radiographic Interpretation of Infections of Jaws Pericoronitis

Radiographic Interpretation of
Infections of Jaws
Pericoronitis
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Pericoronitis
• Erupting or partially impacted third
molars
• Inflamed gingiva
• Trismus
• Cellulitis
Pericoronitis (R/F)
• In early stages
stages, minimal radiographic
changes
• Radiolucency adjacent to the crown
• Ill-defined periphery
• Sclerotic border in late stage
• Osteomyelitis, in sever cases
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Normal Follicular Space
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Acute Suppurative Osteomyelitis
Acute Suppurative Osteomyelitis
• Dental infection – most common cause
• Other causes: fracture, wound,
hematogenous spread
• Common organisms: Staph. aureus,
Staph.
S
ap a
albus,
bus, tuberculosis,
ube cu os s,
actinomycosis, syphilis, mixed
organisms
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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
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Suppurative Osteomyelitis (R/F)
•
•
•
•
•
Resorption
Periosteal new bone formation
Proliferative periostitis
Fistula formation
Radiographic features similar to
malignant lesions
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Sequestrum
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In-class Exercise: Case 1
• 4 month old
baby
• Meningitis
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Nuclear Medicine Study
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In-class Quiz : Case 2
Chronic Focal Sclerosing Osteomyelitis
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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
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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
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Chronic Osteomyelitis With
Proliferative Periostitis
Garre’s Periostitis
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Chronic Osteomyelitis With
Proliferative Periostitis
• Garre’s
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
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In-class exercise: Case 3
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Osteoradionecrosis
Osteoradionecrosis
•
•
•
•
Radiotherapy (40 to 80 Gy)
Decreased vascularity
Low defense
High susceptibility to extraction, perio,
pulpal disease,
disease denture sore
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Osteoradionecrosis (R/F)
• Similar to osteomyelitis
• Diagnosis established by history
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ONJ, BON, BRON
• Osteonecrosis of the jaw
• Bisphosphonate-associated
osteonecrosis of the jaw
• Bisphosphonate-related osteonecrosis
of the
o
e ja
jaw
Clinical features of ONJ
• Spontaneous or after extraction
• Initially asymptomatic
• Pain, tooth mobility, mucosal swelling,
erythema, ulceration
• Early stage: minimal radiographic
changes
• Late stage: R/F of osteomyelitis or cancer
• Widened PDL spaces
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Potential risk factors
• Dentoalveolar trauma
• Duration of BP treatment
• Type of BP: i.v. BP is more problematic
Staging
• Stage 1: exposed, necrotic bone that is
asymptomatic
• Stage 2: exposed, necrotic bone, with
pain and infection
• Stage 3: Exposed, necrotic bone in
patients
ti t with
ith pain,
i iinfection,
f ti
and
d
pathologic fracture, extraoral fistula, or
osteolysis extending to the inferior
border
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Florid Cemento-osseous Dysplasia
Florid Cemento-osseous Dysplasia
• Wide
Wide-spread
spread form of periapical
cemental dysplasia
• Mostly female, middle-aged, African,
Asian
• May
ay not
o be sy
symptomatic
po a c
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Florid Cemento-osseous Dysplasia
• Poor vascular supply – prone to
infection
• Osteomyelitis, if infected
• Preventive management
Florid C-O Dysplasia (R/F)
•
•
•
•
•
Usually bilateral
bilateral, both jaws
Well-defined sclerotic border
Internal content of mixed density
Large irregular masses
Hypercementosis
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Maxillary Sinusitis
(will discuss in Unit 12)
Maxillary Sinusitis
•
•
•
•
Acute, chronic and recurrent
Acute
Allergic
Infectious
Dental sources
– Periapical lesions
– Traumatic extractions (Oro-antral fistula)
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Maxillary Sinusitis (R/F)
• Thickening of mucosal lining
• Cloudy appearance in periapical or
panoramic
• Bony erosion
– Fungal infection
– Carcinoma
– Chronic infection
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