Abstract

Introduction: Osteomyelitis (OM) of the jaw is considered one of the most challenging problems for dental clinicians. Many classifications of OM have been developed based on several characteristics including the clinical progression and pathogenesis of the disease. A particularly informative classification discriminates between bacterial osteomyelitis (B-OM) and non-bacterial osteomyelitis (NB-OM), presenting as diffuse sclerosing osteomyelitis (DSO). Aim: To draw on our experience and observations of osteomyelitis of the jaw to differentiate between B-OM and NB-OM with respect to clinical, radiographic and microbiological findings, as well as discussing the treatment strategies of each type of OM. Methods: The medical records of 175 patients were screened retrospectively, of which, a total of 67 patients were diagnosed with OM and treated surgically or conservatively at a single institution between January 2003 to December 2012. Demographic-, anamnesis-, clinical-, and radiological data were collected and evaluated. The patients were allocated into two groups depending on their aetiology, clinical and radiological features. Patients with history of radiation and bisphosphonate intake prior to OM diagnosis were excluded. Results: The mean age of patients diagnosed with OM was 52 years and the mandible was the most commonly affected site. Moreover, behavioural risk, such as smoking and alcohol abuse, were commonly associated with OM. Notably, surgical procedures were significantly more frequent in the treatment of the B-OM group (50 cases; 96.2%) than in the treatment of the NB-OM group (4 cases; 26.7%). Conclusion: Diffuse sclerosing osteomyelitis is distinct to other forms of osteomyelitis and the use of misleading terminology to describe DSO leads to confusion and misunderstanding of this disease.