Infection in the jawbones may be localized or generalized. Generally, the localized forms of infection are the most common, with the focal osteitis/alveolitis(dry socket) occurring 1 to 7 days following a dental extraction. This probably is the most common bone after dental extraction. Patients will complain so much more severe pain than a toothache. The pain is usually throbbing and deep seated. NB: Analgesics often offer little help
Examination revealed a denuled, open tooth-socket with a scanty necrotic clot while the bone often appears literally dry hence the term, dry socket. On the other hand, infection may involve a large part of the jawbone, most often the mandible. An infective source may be anywhere within the oral cavity.
Such infection would then be rightly designated as osteomyelitis. In its acute form, severe pain and fever are significant presentations and may eventually develop suppurative osteomyelitis that may lead to sequestration. In other situations the acute phase may progress in the chronic sclerosing type of osteomyelitis that is not associated with sequestration. Fortunately, osteomyelitis of the jawbones has remained relatively uncommon with the improvement of oral health facilities and availability of antimicrobial therapy in general.
Management of Focal Osteitis/Alveolitis
- Investigate using appropriate radiographs. BBW/IOPA
- Under local anaesthesia, perform measures to debride the sparse necrotic clot and provoke fresh clot formation. Perform surgical; curettage and irrigate copiously with normal saline.
- Pack the socket with alvogyl.
- Give tabs ibuprofen 400mg orally 8 hourly.
- Administer metronidazole 400mg 8 hourly and amoxicillin 5090mg orally 8 hourly as these may be of benefit where there is evidence of infection.
Management of Jaw Osteomyelitis
- Initiate ibuprofen 400mg orally 8 hourly to control pain.
- Acute forms will require parenteral administration of an appropriate antimicrobial agent, e.g., clindamycin 300mg IM 6 hourly
- Eliminate abny focus of infection where diagnosed.
- For chronic suppurative types, consider surgical intervention where sequestration has occurred.
- Investigate all patients to ascertain their immunological status.