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ORAL PATHOLOGY! > Exam 6- bone inflammation-OSTEOMYELITIS > Flashcards

Exam 6- bone inflammation-OSTEOMYELITIS Flashcards

1
Q

What is “by strict definition” the definition of Osteomyelitis?

A

bone MARROW inflammation

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2
Q

HERES THAT GLOBAL QUESTION AGAIN….What are the 6 types of Osteomyelitis?

A

1.Acute Osteomyelitis 2.Chronic osteomyelitis 3.Focal sclerosing osteomyelitis (condensing osteitis) 4.Diffuse sclerosing osteomyelitis 5.Osteomyelitis with proliferative periostitis (Garre’s osteomyelitis) 6.Alveolar Osteitis (Dry socket)

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3
Q

Acute Osteomyelitis: Short duration, usually less than ______

A

one month

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4
Q

Acute Osteomyelitis: Significant ____ usually accompanies it

A

PAIN

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5
Q

Acute Osteomyelitis: What are the 3 systemic symptoms?

A

1.Fever 2.Lymph node swelling 3.elevated WBC count

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6
Q

Acute Osteomyelitis: ________ of overlying soft tissue

A

Swelling

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7
Q

Acute Osteomyelitis: ________ drainage may be seen

A

Purulent

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8
Q

Acute Osteomyelitis WHAT IS ONE OF THE HALLMARK features that may be exfoliated?

A

Necrotic bone SEQUESTRA may be exfoliated

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9
Q

Acute Osteomyelitis: May cause ________ in the distribution of nerves passing through the involved area

A

paresthesia

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10
Q

Acute Osteomyelitis: In the _______ stages, no changes are seen radiographically.

A

earliest

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11
Q

Acute Osteomyelitis: As the infection progresses, an ILL-DEFINED, often asymmetric radio______ is usually seen

A

radioLUCENCY

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12
Q

Acute Osteomyelitis: How is it treated? What might be necessary??

A

ANTIBIOTICS…surgial drainage (COOL!)

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13
Q

Which form of osteomyelitis has pain, but its variable pain; variable intensity of pain and its usually not consistent sharp pain

A

Chronic osteomyelitis

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14
Q

Much like actue osteomyelitis, WHAT classic sign of chronic osteomyelitis can possibly be seen clinically or radiographically?

A

Bone sequestra

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15
Q

What is one possible sequelae of chronic osteomyelitis that involves the teeth?

A

possible tooth loss in the area of osteomyelitis

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16
Q

What 2 descriptors would you use to describe chronic osteomyelitis on a radiograph? What could possibly happen to the bone surrounding the lesion?

A

1.ill-defined 2.asymmetric…the bone could become denser to wall of the infection

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17
Q

What is unique about the antibiotic treatment for Chronic Osteomyelitis? (along with surgical resection)

A

long duration and often IV delivered

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18
Q

What is the official name for condensing osteitis? (be careful its 4 freaking words)

A

Chronic Focal Sclerosing OsteoMyelitis

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19
Q

Condensing osteitis is generally considered to be a reaction of periapical bone to ________ odontogenic infection

A

low grade

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20
Q 
What type of osteomyelitis is this describing?? Low grade inflammation in an immune competent host can result in
increased density (sclerosis) of the bone as the body tries to wall off the infection
A

Chronic Focal Sclerosing OsteoMyelitis (condensing osteitis)

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21
Q

What is the CRITIAL fact about Chronic Focal Sclerosing Osteomyelitis??

A

the tooth is NON-VITAL

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22
Q

Radio of condensing osteitis: ________ area of opacity, may be ________ and often blends with surrounding bone

A

irregular and asymmetric

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23
Q

What are the two treatment options for condensing osteitis?

A

RCT or EXT

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24
Q

What are the chances the bone returns to normal after extracting a tooth that is undergoing condensing osteitis?

A

85% chance the bone will remodel

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25
Q

What is the CONTROVERSIAL bony condition that is often confused with other pathologic conditions, particularly cemento-osseous dysplasia which frequently becomes secondarily infected?

A

Chronic Diffuse Sclerosing Osteomyelitis

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26
Q

Chronic Diffuse Scelerosing Osteomyelitis is the controversial bony condition that is often confused with other pathologic conditions, particularly ___________ which frequently becomes secondarily infected

A

cemento-osseous dysplasia

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27
Q

Chronic diffuse sclerosing osteomyelitis is considered to be a reaction to LOW GRADE odontogenic infection, often following ______ or surgery

A

TRAUMA

28
Q

Chronic DIFFUSE sclerosing osteomyelitis is equivalent to chronic FOCAL sclerosing osteomyelitis but it affects a ______ area of bone in _____ quadrant

A

LARGE…ONE

29
Q

Where in the mouth does Chronic diffuse sclerosing osteomyelitis CHARACTERISTICALLY affect??

A

posterior mandible

30
Q

Why are antibiotics NOT effective in chronic diffuse sclerosing ostromyelitis?

A

the slcerotic bone is HYPOVASCULARIZED..abx will never get there

31
Q

What is the nickname for Chronic Osteomyelitis w/ proliferative periostitis??

A

Garre’s Osteomyelitis

32
Q

What is the offical term for Garre’s Osteomyelitis? (again be careful, there are 5 freggin’ words here)

A

Chronic Osteomyelitis with proliferative periostitis

33
Q

Which form of osteomyelitis is this?? Low grade osteomyelitis Immune competent host…Usually YOUNGER patients therefore Inflammation involves PERIOSTEUM

A

Chronic Osteomyelitis with Proliferative Periostitis (Garre’s Osteomyelitis)

34
Q

In Garre’s Osteomyelitis it is a ________ osteomyelitis Immune competent host…Usually _______ patients therefore Inflammation involves ________

A

low grade…younger…periosteum

35
Q

Since Garre’s ostomyelitis involves the periosteum, it will be ON or NEAR the ________

A

coritcal surface

36
Q

Which ostomyelitis is this describing? Draining sinus tract from an infected tooth most often Periosteal inflammation stimulates bone production

A

Garre’s osteomyelitis (chronic osteomyelitis with proliferative periostitis)

37
Q

What is the clinical presentation of Garre’s Osteomyelitis? What causes this swelling?

A

Bony hard swelling…a thin layering of cortical bone produces the expansion

38
Q

Which arch is more affected in Garre’s Osteomyelitis?

A

the mandible

39
Q

In the radiographic findings of Garre’s Osteomyelitis Immature bone is laid down outside the _______ but under the ________..ALSO may leave some degree of ______ under the cortex

A

cortex…periosteum…lucency

40
Q

What is the characteristic radiographic pattern for Garre’s Osteomyelitis?

A

ONION SKIN pattern

41
Q

Radiographically in Garre’s osteomyelitis ______ bone is weakly opaque, usually less dense than ______ bone

A

layered…cortical

42
Q

Which radiographic view in Garre’s osteomyelitis is best for visualizing the “layering” of the bone?

A

occlusal films

43
Q

What are the two treatment possibilites for Garre’s Osteomyelitis?

A

RCT or Ext

44
Q

Do you Rx Abx for Garre’s Osteomyelitis?

A

NO, they do not alter the process

45
Q

What is the clinical term for dry socket?

A

Alveolar Osteitis

46
Q

Where is alveolar osteitis most likely to occur and what contidtion increases its likeliness?

A

Mandibular 3rd molars and infection increases likeliness

47
Q

Which gender is more associated with alveolar osteitis and why?

A

female…birth control pills

48
Q

Alveolar osteitis is caused by loss/breakdown of the WHAT in the socket??

A

blood clot

49
Q

When does alveolar osteitis typically occur after ext? The site can produce severe _____ and ______

A

3-4 days after ext….pain and foul odor

50
Q

How is Alveolar Osteitis treated?

A

pack the socket with protective dressing

51
Q

In BRONJ (MRONJ), they are drugs that inhibit action of _______

A

osteoclasts

52
Q

BRONJ meds not only affect osteoclasts, they are also known to affect ________ and ________

A

angiogenesis and osteoblasts

53
Q

HOLY SHIT! What is the estimated drug half-life of bisphosphonates?

A

12 years or greater!

54
Q

Why are people on Bisphosphonates? To attempt to control malignant disease in bone or ________ of
malignancy

A

hypercalcemia

55
Q

Why are people on Bisphosphonates? THIS condition is the PRIMARY OFFENDER for why people are on these meds,,

A

Multiple myeloma

56
Q

Why are people on Bisphosphonates? Metastatic disease, particularly _______ and _______ carcinoma

A

breast and prostate

57
Q

Why are people on Bisphosphonates? to increase bone density in older individuals suffering from ________

A

osteoperosis

58
Q

Why are people on Bisphosphonates? In the treatment of _______ disease and other metabolic bone diseases

A

Paget’s

59
Q

What is a big factor on the severity of bisphosphonate drug complications?

A

DOSE..the reactions are dose dependent

60
Q

What is the prevalence of BRONJ in cancer patients on IV BPs? What about oral BPs?

A

6-10%…unknown for oral but estimated at 1/100,000

61
Q

BRONJ occurs in ___% of cases in patiens with myeloma or metastatic breast cancer

A

85%

62
Q

What are the two biggest risk factors for the TYPE of BisPhos drug that can lead to BRONJ?

A

Nitrogen containing and IV route of administration

63
Q

IF IV and Nitrogen containing drugs are the biggest risk factors for BRONJ, then what are the two worst offenders?

A
  1. ARE-DIA (pam-id-ron-ate) 2.ZO-META (zo-le-dron-ic acid)
64
Q

Clinically BRONJ shows bone necrosis and it often follows surgical procedures–to the tune of ___% of the cases…BUT this can also be seen following simple tx or occur _______

A

60% of the cases…spontaneously!

65
Q

What is the most crucial form of treatment for BRONJ?

A

PREVENTION

66
Q

What is a CONTRAINDICATED treatment for BRONJ??

A

wide excision (can work in osteoradionecrosis)

67
Q

What are two treatments for BRONJ with variable sucess?

A

local debridement and abx mouthwash

ORAL PATHOLOGY! (40 decks)

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