OSTEOMYELITIS OF THE JAW

Inflammation of the medullary portion of the jaw bone which extends to involve the periosteum of the affected
area. Infection in the bone ends up with pus formation in the medullary cavity or beneath the periosteum, and obstructs the blood supply. The infected bone becomes necrotic following ischaemia.

Clinical features

Initial stage

  • Malaise and fever; there is no swelling
  • Enlargement of regional lymphnodes
  • Teeth in affected area become painful and loose, thus causing difficulty in chewing

Later stage

  • Bone undergoes necrosis and area becomes very painful and swollen
  • Pus ruptures through the periosteum into the muscular and subcutaneous fascia. Eventually it is discharged on to the skin surface through a sinus

Investigations

  • X-ray- Orthopantomograph (OPG) will show characteristic features (e.g. widening of periodontal
    spaces, changes in bone trabeculation, areas of radiolucency and sequestra formation in chronic stage)
  • Culture and sensitivity of pus

MANAGEMENT

  • Incision and adequate drainage of confirmed pus accumulation which is accessible
  • Amoxicillin 500 mg every 8 hours for 7-10 days
  • Or cloxacillin 500 mg every 6 hours
  • Plus metronidazole 400 mg every 8 hours

Surgery

  • Removal of the sequestrum by surgical intervention
Notes
  • Change medication according to the results of culture and sensitivity testing
  • Refer to regional referral hospital in case of longstanding pus discharge and sinuses from the jaws