Pathogenesis (disease development)
In addition to confirmed bacterial infection, some subtypes of osteomyelitis of the jawbone have unconfirmed hypotheses regarding pathogenesis.
Primary chronic osteomyelitis
This form of the disease is characterized by unknown etiology and the absence of pus (pus), fistula and sequestrum formation (dead tissue demarcated from healthy tissue). An initiating event cannot be determined, and an acute phase is absent. Proteins of the tumor necrosis factor (RANKL) family appear to play a role in bone resorption.
Acute and secondary chronic osteomyelitis.
They are caused by local infection or, very rarely, by hematogenous (“by the bloodstream”) spread. The local infections may originate from jaw fractures (jaw bone fractures), which usually pass through germ-populated alveoli (tooth compartments). Other possible routes of infection include infected pulps (dental pulp) and periapical ostitis (bone inflammation in the root tip area of marketot teeth), deep periodontal lesions (pocket infections), impacted teeth (impacted refers to a tooth that has not yet appeared in the oral cavity at its normal eruption time), and an infected alveolus after tooth extraction (tooth removal).
Etiology (causes)
Behavioral causes
- Diet
- Malnutrition
- Poor oral hygiene
- Consumption of stimulants
- Tobacco
Disease-related causes
Infectious and parasitic diseases (A00-B99).
- Hematogenous (“in the bloodstream”) dissemination of existing inflammatory foci.
- Local infection
- Perioperative infection (“originated around the operation”).
- Development of resistant microorganisms
Injuries, poisoning, and other consequences of external causes (S00-T98).
- Jaw fracture (jaw fracture)
- Injuries with skin involvement
Other causes
- Operations on the jaw
Systemic risk factors
Biographical causes
- Age
- Old people
- Newborns
Behavioral causes
- Nutrition
- Malnutrition (malnutrition
- Consumption of stimulants
- Tobacco (smoking)
Causes related to disease
- Immunodeficiency (immunodeficiency)
- Diabetes mellitus
- Circulatory disorders of the bone
- Osteoporosis (bone loss)
- Vascular diseases (vascular diseases)
Medication
- Bisphosphonates
- Corticosteroids
- Cytostatics – drugs used to treat cancer such as cisplatin.
Local risk factors
- Insufficient blood supply to the traumatized bone
- Florid osseous dysplasia (FOD) – sclerosis mostly of the alveolar processes, favoring the development of osteomyelitis.
- Fracture
- Complicated
- Fragments mechanically unstable
- Foreign materials/graft/implants
- Operation duration
- Predominance of the mandible (lower jaw) due to anatomical features.
- Soft tissue coverage insufficient
- Soft tissue damage extended
- Additional trauma to a pre-existing chronic local infection.
- X-rays
- Radiation therapy in the head and neck region [“radioosteomyelitis”: infected osteoradionecrosis; IORN]