Comment on reactive hyperplasia of bone

Radiographic evaluation of possible etiology of diffuse sclerosing osteomyelitis of the mandible

To examine the cause and site of origin of diffuse sclerosing osteomyelitis of the mandible, we compared various radiographic findings for the mandibular lesions in 20 patients with diffuse sclerosing osteomyelitis with those in 48 patients with osteomyelitis caused by bacterial infection. In osteomyelitis of infectious origin, a typical radiographic feature was a radiolucent lesion spreading in the cancellous bone, with cortical bone perforation and lamellated periosteal reaction. In diffuse sclerosing osteomyelitis, intermingled sclerotic and osteolytic lesions with solid periosteal reaction or external bone resorption were a common finding, and in some patients the cortical bone was initially affected by the fresh or recurrent lesion. Based on these distinct differences, we suggest that the cause of diffuse sclerosing osteomyelitis is not bacterial infection and that the site of origin is not in the bone but in the periosteum.

Isolation of Actinomyces species and Eikenella corrodens from patients with chronic diffuse sclerosing osteomyelitis

Cultures from 26 patients with chronic diffuse sclerosing osteomyelitis of the mandible were studied. In most cases there was a mutualistic infection involving any one of the known human Actinomyces species together with Eikenella corrodens. In a few cases, Arachnia species were substituted for Actinomyces and gram-negative anaerobes for E corrodens. The specific culture protocol used to identify these organisms from clinical specimens is described. Taxonomic and experimental evidence that supports an infectious etiology are presented.

Diffuse sclerosing osteomyelitis of the mandible: a new concept of its etiology

Diffuse sclerosing osteomyelitis of the mandible is a disease of unknown etiology. The clinical and radiographic findings suggest an infectious origin, but bacteriologic and histologic findings do not support this concept. Analysis of clinical symptoms, localization of the condition, and posttreatment findings in a group of 27 patients suggest a chronic tendoperiostitis due to muscular overuse as an etiologic factor in diffuse sclerosing osteomyelitis of the mandible. This hypothesis was supported by the initial results of muscle relaxation treatment in 13 of these patients.

Differences between florid osseous dysplasia and chronic diffuse sclerosing osteomyelitis

Florid osseous dysplasia (FOD) is confused in the literature with chronic diffuse sclerosing osteomyelitis. Two cases of each condition are presented to demonstrate the differences between them. In FOD, there are multiple lobulated sclerotic masses in several quadrants of the jaws, usually in black females. In some cases, the sclerotic masses are exposed to the oral cavity, resulting in a secondary osteomyelitis. Periapical cemental dysplasia is often found in association with FOD. Chronic diffuse sclerosing osteomyelitis is a primary inflammatory condition of the mandible. Patients have cyclic episodes of unilateral pain and swelling. The affected region of the mandible exhibits a diffuse opacity with poorly defined borders. Although women are affected more often than men, black persons are not particularly susceptible.

A proliferative inflammation in the mandible caused by implantation of an infected dental root. A possible experimental model for chronic osteomyelitis

In order to provide a better understanding of the reactions of bone affected by an infectious stimulus, infected dental roots were implanted into the mandibular bone of 5 monkeys (Macaca fascicularis). The roots were infected by micro-organisms belonging to the monkeys' oral plaque flora. Following an observation period of 6 months, the monkeys were sacrificed. The mandibles were dissected. Radiographs were taken and then the mandibles were prepared for histology. In the mandibles where the infected roots had been implanted, advanced inflammatory changes were seen. Bacteria, however, were only found within the implanted roots, not in the surrounding tissue in spite of a heavy inflammatory reaction. The interaction between infection and inflammation is discussed on the basis of these observations. The role of possible neural transmittor substances in the pathogenesis of the inflammatory disease is also discussed. The signs and symptoms of the proliferative inflammatory changes provoked in this experiment are compared to those of chronic osteomyelitis.

Diffuse sclerosing osteomyelitis of the mandible: clinical radiographic and histologic findings in twenty-seven patients

Diffuse sclerosing osteomyelitis of the mandible is a disease of obscure origin that may give rise to diagnostic problems. In the literature most authors suggest an infectious etiology. However, the results of treatment are generally poor. Clinical and radiographic findings in this study of 27 patients suggested an infectious origin of the disease. However, bacteriologic findings in 11 of these cases did not support this suggestion. The histologic findings showed a reactive hyperplasia of bone. The results of treatment, based on the assumption of an infectious etiology, were poor. It was concluded that the findings in this group of patients did not support an infectious etiology of the disease.

Hyperbaric oxygen treatment of chronic osteomyelitis of the jaws

A review of the literature on treatment of chronic osteomyelitis of the jaws shows that hyperbaric oxygen is often recommended as an adjunct in treatment of this disease. Definite criteria to indicate this treatment and to evaluate the results have not been reported. The results of hyperbaric oxygen treatment of chronic osteomyelitis of the jaws in 16 patients are presented. In contrast to the good results reported in the literature, only 7 of our patients could be considered as cured. The reasons for this discrepancy are discussed. Our results, as well as the data from the literature, indicate that a combined antibiotic and surgical approach is the treatment of choice in chronic suppurative osteomyelitis. However, in chronic diffuse sclerosing osteomyelitis and in patients in whom decortication and antibiotic therapy have failed, hyperbaric oxygen treatment in combination with antibiotics and surgery seems to be indicated.

Diffuse sclerosing osteomyelitis of the mandible

The medical care of patients with diffuse sclerosing osteomyelitis (DSO) of the mandible has been unsatisfactory. The main reasons for this have been insufficient knowledge of the disease and its natural history, difficulties in establishing the correct diagnosis, and the unknown etiology. The clinical features and natural history of the disease were studied by means of repeated radiographic and scintigraphic recordings. The biopsy technique was improved by using a slowly rotating coarse trepan bur. Histological and enzyme histochemical investigations were performed for determination of the histopathological diagnosis. Orthopantomograms in combination with intraoral views and 99mTc-scintigraphy were used for the radiographic diagnosis and follow-up studies. Bacteriological and serological investigations were performed in attempt to clarify the obscure etiology. The occurrence in the patients' sera of antibodies to antigens prepared from cultured bacteria was studied. ASTA, IgM, IgG, and IgA were determined and lymphocyte stimulation tests were performed. The investigations made it possible to distinguish DSO as a separate entity with rather characteristic clinical, histological and radiographic features. The histological diagnosis was facilitated by an improved biopsy technique and enzyme histochemical recordings. Different rather unspecific tissue reactions were together found to form a pattern which was strongly indicative of DSO. The radiographic and scintigraphic investigations gave valuable findings which increased the diagnostic accuracy and improved the prognostic and therapeutic judgements. The bacteriological and serological investigations indicated that propionibacterium acnes and peptostreptococcus intermedius were of etiological importance but could not explain the chronicity of the disease. The results of the different investigations gave a better understanding of DSO and made it possible to provide more appropriate care for patients in different stages of the disease. Long-term antibiotic therapy was found to have a positive influence on the course of the disease in its early stages, while cortisone therapy, and sometimes decortication, were found to be more effective in chronic stages.

Bacteriologic and serologic investigation in diffuse sclerosing osteomyelitis (DSO) of the mandible

An attempt was made to clarify the obscure origin of diffuse sclerosing osteomyelitis (DSO) of the mandible. Bacteriologic investigations of specimens from diseased mandibles were performed with special attention to anaerobic culture technique. Propionibacterium acnes and Peptostreptococcus intermedius were in some patients found to be of etiologic importance. Sampling techniques and associated problems are discussed. An examination was made for antibodies in the patients' sera against antigens prepared from bacterial isolates. ASTA, IgM, IgG, and IgA were determined. Lymphocyte-stimulation tests were performed. The inflammatory events and chronicity of the disease could not be explained by the immunologic findings.

Treatment and prognosis of diffuse sclerosing osteomyelitis (DSO) of the mandible

Twenty-one patients with diffuse sclerosing osteomyelitis (DSO) of the mandible were investigated and treated in Göteborg. Sixteen of these patients ( twelve women and four men) participated in a long-term follow-up study in order to evaluate different therapeutic procedures. Cortisone was found to be a valuable aid to the therapy arsenal. Clinical and radiographic observations are presented. Etiology, therapy, and prognosis of DSO are discussed.

Osteomyelitis of the jaws

Material consisting of 16 patients examined and/or treated under the diagnosis osteomyelitis is reported. A description is given of the history, etiology, clinical and radiographic findings, results of histologic and microbiologic examinations, blood chemistry, diagnostic subgroups, findings at operation and the surgical and antibiotic therapy used. The results of treatment at short-term follow-up are given. Of nine patients observed 5 months or longer, six showed signs of healing, while the result was judged as uncertain in two cases and unsuccessful in one.

Chronic sclerosing osteomyelitis of the mandible. Histologic and histochemical findings

The histologic features of chronic sclerosing osteomyelitis of the mandible were studied. Four different types of tissue reaction were found to be characteristic of the disease. Histochemical recordings were used in an attempt to facilitate differential diagnosis. Similar types of fibro-osseous lesions and biopsy technique are discussed.