Bony sequestrum refers to a fragment of dead bone that has separated from healthy bone tissue. This condition often arises in the jaw following dental procedures or infections. The term “sequestrum” comes from Latin, meaning “something set apart,” accurately describing how this dead bone acts as a foreign object within the body.
What Leads to Bony Sequestrum
Bony sequestrum can develop due to various factors that compromise the blood supply to the bone, leading to its death. Dental infections, such as abscesses or chronic osteomyelitis, are common culprits. Osteomyelitis can cause inflammation and pus accumulation, increasing pressure within the bone marrow and obstructing local blood flow, leading to bone necrosis and sequestrum formation.
Trauma to the jawbone also contributes to bony sequestrum formation. Severe injuries or fractures can disrupt the bone’s blood supply, resulting in bone death and fragment separation. Dental extractions or other oral surgeries can also lead to this condition, especially if the blood supply is compromised during the procedure or if post-operative infection occurs. Surgical extractions involving bone sectioning carry a higher chance of sequestra forming.
Certain medical conditions and medications are also associated with bony sequestrum. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a known complication in patients taking bisphosphonate medications, which are used to treat conditions like osteoporosis or cancer-related bone issues. These drugs can reduce bone turnover and impair wound healing, making the jawbone susceptible to necrosis, often triggered by trauma like a tooth extraction. Radiation therapy for head and neck cancers can also lead to osteoradionecrosis, potentially resulting in sequestrum formation.
Recognizing and Diagnosing Bony Sequestrum
Identifying bony sequestrum involves recognizing distinct signs and symptoms. People might experience pain, swelling, and redness in the affected area of the jaw. A discharge of pus or a foul taste in the mouth can also be present, indicating an underlying infection. The exposure of a hard, white, or gray piece of bone through the gum tissue, which may feel sharp or movable, is a common indicator.
Difficulty eating or speaking can also occur due to discomfort or the physical presence of the sequestrum. If these signs appear, particularly after a recent tooth extraction, dental evaluation is recommended.
A dentist diagnoses bony sequestrum through visual examination and palpation of the affected area to identify exposed bone or tenderness. Imaging techniques are then employed to confirm the presence and extent of the dead bone. X-rays can reveal the bone fragment, though it might appear similar to healthy bone in early stages before it fully separates. Cone-beam computed tomography (CBCT) scans offer a more detailed, three-dimensional view, aiding in precise localization and assessment of the sequestrum’s size.
Treatment and Healing Process
Treatment for bony sequestrum primarily involves surgical removal, or sequestrectomy. This is often a minor in-office procedure performed under local anesthesia. The goal is to remove the dead bone fragment, allowing the surrounding healthy tissues to heal properly. If the fragment is small and already loosening, sometimes it can be gently dislodged without extensive surgery.
After the sequestrectomy, post-treatment care is important for healing and complication prevention. This typically includes wound care, which might involve rinsing the mouth with antiseptic solutions. Pain is managed with prescribed medications. Antibiotics are often prescribed to manage or prevent infection, especially if osteomyelitis is present. Follow-up appointments are scheduled to monitor the healing progress.
The healing process after sequestrum removal generally takes several weeks. The empty socket will gradually fill with new bone over time, and the surrounding gum tissue will smooth over. It is important to avoid disturbing the healing site, such as poking it with the tongue. While complications are not common, untreated bony sequestrum can lead to prolonged pain, chronic infection, and delayed healing.