OSTEOMYELITIS: Acute and Chronic

Osteomyelitis is a spreading infection of the bone marrow space. It can start as an acute apical periodontitis following death of a pulp (good old-fashioned toothache) and due to virulent organisms or reduced resistance by the patient spread to the nearby bone marrow. Since it is acute (sudden onset), after a couple of weeks the changes are predominantly ill-defined bone destruction such as shown in the periapical radiographs below.

 

 

After 2-3 months the inflammatory process is mainly chronic with lymphocytes, plasma cells, osteoclasts, osteoblasts and fibroblasts. The resulting mixture of bone destruction and repair results in lucent and opaque areas of bone. In the occlusal and panoramic views below the black arrows show an irregular shaped opacity which is a piece of dead bone (sequestrum) which may develop a sinus tract. The white arrows point to new bone formation under the periosteum. The appearance of osteomyelitis can be similar to malignant bone destruction bu the formation of sequestra are the hallmark of osteomyelitis.

Osteomyelitis is not rare so always be on the lookout for it!