What is Osteomyelitis?
The term Osteomyelitis refers to inflammation of the bone which prevents normal healing after an injury or indirect trauma. It can be caused in almost any part of the body including the jaws. Osteomyelitis is a rare condition which is seen in patients that are suffering from a pre-existing condition or are immunocompromised.
Some of the common diseases that increase the likelihood of the occurrence of osteomyelitis include diabetes, HIV, cancer, autoimmune diseases, and the presence of severe malnutrition. The normal bone metabolism can also be affected by a number of therapeutic agents which once again increase the chances of a non-healing bone injury.
The use of chemotherapeutic agents, radiation therapy, and bisphosphonates affects bone metabolism has the aforementioned effect of altering bone metabolism.
Treatment of osteomyelitis
The treatment of osteomyelitis can fall under non-surgical and surgical methods.
A patient suffering osteomyelitis is often treated surgically because it has been found to be the most effective method available. An oral surgeon will anesthetize the area and then attempt to remove the necrotized portions of the bone. The idea os to leave behind the healthy bone with an improved blood supply.
If there are any infected teeth present which are causing osteomyelitis then these will have to be removed as well.
Non Surgical treatment
The first line of treatment will be the use of antibiotics. The currently recommended protocol for the treatment of osteomyelitis suggests that antibiotics should be started even before the diagnosis has been confirmed.
While the exact choice of antibiotic will depend on the clinical situation, any history of allergies, resistance etc., the use of amoxicillin is considered to be the best option to start with. The drug may be delivered via injection at first and then continued for two weeks by the oral route.
Some case reports have reported a positive result with the use of local drug delivery agents and newer synthetic antibiotics.
These nonsteroidal anti-inflammatory drugs are very useful in the treatment of osteomyelitis since they are designed to counter the mediators if inflammation in the body. Care should be taken to alert the doctor of any allergies or pre-existing kidney/liver condition which could affect the choice of drug being used.
Steroids are another effective option for fighting the inflammatory process that takes place in osteomyelitis. The drawback with the use of osteomyelitis is that it may actually increase the susceptibility of the body to infection, something that is very dangerous in immunocompromised individuals.
The use of extremely high concentrations of oxygen to try and increase the blood supply in the necrotized bone has been proven to be very effective in the treatment of osteomyelitis. There are several opinions on the number of ‘dives’ needed in a hyperbaric chamber but that is a decision that will be left to the attending surgeon.
The treatment of osteomyelitis is quite complex and often requires the use of concurrent therapies. Surgery remains the most effective and by some accounts the quickest way to treat the conditions. It should be remembered that osteomyelitis can actually become life-threatening if it is not controlled in time.
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