Periodontal Infection Leading to Periostitis Ossificans (“Garré's Osteomyelitis”) of the Mandible. Report of a Case

Abstract

Periostitis ossifications ("Garrè's osteomyelitis") of the mandible is a rather rare pathology that occurs as a hard swelling at the mandibular angle, persists for a long period, and is mostly painful on palpation. Clinical signs of infection are rarely noted. The etiological factor is generally a carious first permanent molar with a periapical infection or a fracture of the jaw. In this case, a 10 year-old girl showed a fixed painful swelling of the right mandibular angle. This revealed to be periostitis ossificans, although none of the classical causes were present. The symptoms were evoked by a periodontal infection: there was an osseous crater and a probing pocket depth of more than 10 mm disto-lingually of the first right permanent molar of the mandible. This was likely the etiological factor. Extraction of the first and second permanent right molar, curettage of the corresponding alveoli, and antibiotic treatment resulted in complete healing, clinically and radiologically, after 9 months.

Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma

“…There is currently no clinical evidence to suggest that the two pathological conditions are significantly associated in the St. Mary Graces cemetery because of the spread of infection from the mouth to the tibia. Numerous cases of oral infections causing, or at least preceding (and therefore strongly suspected of causing), infections elsewhere in the body have been documented in living populations (e.g., Kao and Wang,1992; Van den Bossche et al,1993; Caruso et al,2006; Rallis et al,2006). However, it is not clear that periodontal pathogens cause periosteal new bone growth elsewhere in the body.…”

Extraoral cutaneous sinus tracts of dental origin in the paediatric patient. A report of three cases and a review of the literature

“…If endodontic therapy is not feasible or the tooth is not restorable then extraction of the tooth is recommended. Periodontal infections resulting in extraoral cutaneous sinus tracts have been reported in children presenting with Garré's osteomyelitis especially when the permanent molar teeth are partially erupted. There are conditions relating to the periodontium; chronic and aggressive periodontitis and when associated with systemic disease or syndromes could feasibly present as a source of such infection in the paediatric patient if not diagnosed early.…”

“…The odontogenic infection might initially be localized and present as a periapical or peri-odontal abscess [1][2][3][5][6][7][8][9][10][11][12][14][15][16][18][19][20] before spreading into the surrounding tissues. The sequelae of the resulting infection will depend on (i) the regional anatomy, (ii) virulence of the bacteria, and (iii) host resistance factors [1][2][3][5][6][7][8][10][11][12]21 .…”

“…These include ultrasound scans, magnetic resonance imaging (MRI), and surgical investigations 1,[5][6][7][8][9][10][11][12]16 . These investigations are relatively invasive, rarely the investigation of choice, and of minimal diagnostic yield for the diagnoses of odontogenic-related infections 1,[5][6][7][8][9][10][11][12][14][15][16][17][18][19][20] . In addition to this, if the child has been subjected to numerous unnecessary invasive investigations, with different specialties, especially if the diagnoses are not confirmed or the lesion recurs, then psychologically this will affect the child and family in terms of stress, fear, and anxiety especially if the lesion is considered to be of a sinister nature.…”

“…In addition to this, if the child has been subjected to numerous unnecessary invasive investigations, with different specialties, especially if the diagnoses are not confirmed or the lesion recurs, then psychologically this will affect the child and family in terms of stress, fear, and anxiety especially if the lesion is considered to be of a sinister nature. The lesion may also cause disfigurement and scarring 1,[5][6][7][9][10][11]16,20 .…”