From the Guidelines
For possible osteomyelitis or avascular necrosis of the jaw, you should consult an oral surgeon, maxillofacial surgeon, oral oncologist, or dentist as your primary specialist. These specialists have extensive training in diagnosing and treating bone conditions affecting the jaw, as recommended by the American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline 1. Additionally, you may need to see an infectious disease specialist if osteomyelitis is suspected, as they can help determine appropriate antibiotic therapy. Your dentist or primary care physician can provide the initial referral. Early diagnosis is critical for both conditions, as delayed treatment can lead to significant complications including bone destruction, pathological fractures, and chronic pain.
Some key points to consider when evaluating these conditions include:
- Monitoring for swelling of the jaw and/or jaw pain, indicating possible osteonecrosis, as recommended by the American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline 1
- Administering conservative treatment protocols, such as broad-spectrum antibiotics and daily saline or aqueous chlorhexidine gluconate irrigations, for early stage lesions, as recommended by the American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline 1
- Referring to a specialist, such as an oral surgeon, maxillofacial surgeon, oral oncologist, or dentist, for thorough evaluation and treatment, as recommended by the American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline 1
- Using imaging studies, such as MRI with contrast, which is the modality of choice in the evaluation of osteomyelitis, as recommended by the American College of Radiology 1
- Considering joint aspiration for evaluation of septic arthritis, and labeled leukocyte scan and sulfur colloid marrow scan for evaluation of active infection if orthopedic hardware is present, as recommended by the American College of Radiology 1
Diagnosis typically involves imaging studies, along with possible bone biopsy to confirm the diagnosis and identify causative organisms in cases of osteomyelitis. Treatment approaches differ significantly between the two conditions, with osteomyelitis requiring aggressive antibiotic therapy and possible surgical debridement, while avascular necrosis management focuses on preserving remaining bone and function.
From the Research
Diagnosis and Treatment of Osteomyelitis and Avascular Necrosis of the Jaw
To determine whether you have osteomyelitis (infection of the bone) or avascular necrosis (death of bone tissue due to lack of blood supply) of the jaw, you should consult:
- Oral and maxillofacial surgeons, as they specialize in the diagnosis and treatment of diseases affecting the jaw and face 2, 3, 4
- Infectiologists, who can help diagnose and manage infections such as osteomyelitis 2
- Microbiologists, who can assist in identifying the causative microorganisms of osteomyelitis 2
- A multidisciplinary team, as the management of osteomyelitis of the jaw requires a collaborative approach involving various specialists 2, 3, 4
Important Considerations
- A detailed anamnesis, clinical findings, laboratory tests, and imaging are essential for diagnosing osteomyelitis of the jaw 3, 4
- The treatment of osteomyelitis consists of surgical treatment, which is considered the mainstay of treatment, and antibiotic treatment, which is considered complementary therapy 3
- In cases of avascular necrosis, it is crucial to identify the underlying cause, such as bisphosphonate-related osteonecrosis of the jaw, to provide appropriate treatment 5