Therapy

Therapy depends on the spread of the inflammation and the pathogen that triggers it. If several bones and the surrounding soft tissue are affected or if a multi-resistant pathogen is present, the prognosis worsens and more aggressive therapy measures are necessary. If the bone inflammation is caused by bacteria, as is usually the case, the cause can be treated causally with antibiotics.

The antibiotics can be administered in tablet form or as an infusion to reach the site of action. Optimally, antibiotic therapy is targeted after identification of the causative bacterium. If bone or soft tissue has died (necrosis), surgical removal may be necessary in order to prevent further spread and damage.

During such an operation, the affected area can also be rinsed with antibacterial and sterilizing solutions and a drainage can be applied to drain pus. Furthermore, antibiotic-soaked sponges can be used, which dissolve by themselves and do not need to be removed. In this way, high concentrations of the antibiotic can be achieved on site. Subsequently, further operations may become necessary to maintain the stability of the bone and thus the mobility of the patient.

Diagnosis

The diagnosis of inflammation in bone can be made clinically, laboratory chemistries and by imaging. Typical clinical symptoms are redness, swelling and severe pain as well as lymph node swelling in the affected area. In most cases, functional impairment as well as fever and fatigue occur.

Fistula and abscess formation is also possible. During a blood test, inflammation parameters such as BSG (blood sedimentation rate) or the leukocyte count are increased.Imaging procedures such as x-rays, MRI and CT can show how far the inflammation has spread and how badly the bone has been damaged. Finally, a biopsy, i.e. the removal of tissue, can rule out further differential diagnoses (e.g. bone tumor).

Inflammation of bones in the jaw

Inflammation of the bone in the jaw is not uncommon and can often originate from the dental system (odontogenic infection). Infections in the oral cavity or even the paranasal sinuses can spread to the bone. Common pathogens of bone inflammation in the jaw are Staphylococcus aureus and streptococci.

In general, the lower jaw is affected many times more frequently than the upper jaw because its blood supply is less well organized. Infections such as caries, inflammation of the periodontal apparatus (periodontitis), a purulent sinusitis or those resulting from a fracture of the upper or lower jaw can spread to the jaw bone and cause an inflammation there. Furthermore, cysts and abscesses in the oral cavity can be the cause of an inflammation of the jaw bone.

A spread of bacteria from the oral cavity via wounds into the bone can occur when a tooth is extracted (tooth extraction). In rare cases, bacteria can also be transported via the bloodstream into the jawbone and cause an inflammation of the jawbone. If the severity of the inflammation allows it, an attempt should first be made to get the inflammation under control with antibiotics.

The therapy should be carried out consistently for at least three to four weeks. If the drug treatment is not promising, the inflammation must be surgically removed. It may be necessary to remove individual teeth.

In the extreme case, the affected jawbone is removed and a transplant is inserted in its place. However, the primary goal of the therapy is to preserve the bone and its function. The treating physician can often diagnose an inflammation in the jawbone from the clinical picture.

In addition to redness and swelling in the affected area of the jaw, there is also sometimes severe pain. It is not uncommon for fistulas (connecting passages) or abscesses to form. Sometimes the swelling can be visible from the outside as “thick cheek“.

A swelling of neighboring lymph nodes in the neck area (see: Swelling of lymph nodes in the neck) is also conceivable. Some of the affected patients complain of severe bad breath. Furthermore, fever and an increase in inflammatory parameters such as the blood sedimentation rate (BSG) or the leukocyte count in the blood may occur.

Finally, an X-ray of the jaw can provide information about the presence and progression of the inflammation in the bone. However, an inflammation of the jawbone is often visible late in the X-ray, whereas it can be seen much earlier in more complex procedures such as CT, MRI or bone scintigraphy. However, a reliable diagnosis can only be made by taking a tissue sample (biopsy). Here the most important differential diagnosis, a bone tumor in the jaw, can also be excluded. There is also a difference between an acute and a chronic form, which can remain untreated for months and years.