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Osteomyelitis is a chronic inflammatory bone disease, which can present management difficulties owing to its complex pathogenic process and increasingly virulent micro-organisms. The incidence of the condition has decreased in recent years, primarily due to the availability of antimicrobial therapy; however, this alone does not always resolve symptoms. Once established osteomyelitis can be challenging to manage. This case demonstrates that in certain instances a more aggressive form of multidisciplinary treatment is required to improve the condition and alleviate the patient's symptoms, allowing for a better quality of life.
CPD/Clinical Relevance: Knowledge of osteomyelitis is relevant to both general dental practitioners and specialists involved in the management of patients with complex medical needs.
Article
Osteomyelitis has been a relatively rare condition since the development of antimicrobial therapy.1 In the oral cavity, the mandibular jawbone is primarily affected owing to its bone density and poorly vascularized cortical plates, with additional vascularization being supplied by the inferior alveolar neurovascular bundle. Maxillary bone is less dense and has an abundant vascular supply from surrounding vessels and is consequently more resistant to developing osteomyelitis.2
Odontogenic micro-organisms are the predominant pathogenic driver in cases of osteomyelitis of the jaws.1 Host defences can also play a role, however, and systemic diseases such as diabetes mellitus, autoimmune conditions, compromised vascularity (as in osteoporosis and malignancy) can all influence progression of the condition. Additional local factors may also play a part, including bone pathology, the direct effects of radiation to the bone, non-compliance in patients, patient age, nutritional status and the role of certain medications that can affect immunity (eg steroids, chemotherapeutic agents and bisphosphonates).2,3
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