Classification and Epidemiology
- Acute osteomyelitis: OM present for less than one month
- Chronic osteomyelitis: OM lasting for more than one month
- Suppurative osteomyelitis of the jaws is uncommon in developed regions
- More common in developing countries
- Cases in Europe and the United States often follow dental infections, oral surgery, or mandibular fractures
- OM of the jaws can occur in all genders, races, and age groups
- Mandible is more commonly affected than the maxilla
- Spread of adjacent odontogenic infection is the most common cause globally
- Trauma, including fracture and surgery, can also lead to OM
- Incidence rates vary geographically and may be influenced by healthcare access

Signs and Symptoms
- Severe, throbbing pain that radiates along nerve pathways
- Initial absence of fistula
- Headache or facial pain
- Fibromyalgia
- Chronic fatigue syndrome

Cause and Pathogenesis
- OM is usually a polymicrobial, opportunistic infection
- Caused primarily by a mixture of alpha hemolytic streptococci and anaerobic bacteria from the oral cavity
- Common causative organisms in odontogenic infections
- Trauma can also cause OM, with staphylococcal infection being the likely cause
- Other risk factors include familial hypercoagulation tendency
- OM can occur through direct inoculation of pathogens into the bone, spread of adjacent infection, or hematogenous spread
- Hematogenous OM in the jaws is rare
- Mainly caused by spread of adjacent odontogenic infection
- Trauma, including traumatic fracture, can also cause OM
- In the long bones, a single invading pathogenic micro-organism is usually found

Mandible vs Maxilla
- The mandible is more commonly affected by OM than the maxilla
- Differences in blood supply contribute to this
- The maxilla has a better blood supply, thin cortical plates, and less medullary spaces
- Infections of the maxilla can easily spread to surrounding soft tissues and paranasal air sinuses
- The mandible has a relatively poor blood supply, thick cortical plates, and a medullary cavity

Prevention, Treatment, and Prognosis
Prevention:
- Regular dental and periodontal assessment and care
- Maintaining good oral hygiene practices
- Avoiding tobacco and excessive alcohol consumption
- Managing underlying medical conditions that compromise immune function
- Educating patients about the signs and symptoms of jaw osteomyelitis for early detection

Treatment:
- Antibiotics based on culture and sensitivity testing
- Empirical treatment in cases of low positive culture rates
- PCR testing to identify microbe DNA
- Repeated culture and sensitivity testing during prolonged treatment
- Consideration of antibiotic resistance and the need for drug changes

Prognosis:
- Pathologic fracture of the weakened mandible as a possible complication
- Prognosis varies depending on the extent of infection and response to treatment
- Early diagnosis and prompt treatment improve prognosis
- Risk of recurrence and chronic infection in some cases
- Regular follow-up and monitoring to assess healing and prevent complications