Diffuse sclerosing osteomyelitis of the mandible.

The medical care of patients with diffuse sclerosing osteomyelitis (DSO) of the mandible has been unsatisfactory. The main reasons for this have been insufficient knowledge of the disease and its natural history, difficulties in establishing the correct diagnosis, and the unknown etiology. The clinical features and natural history of the disease were studied by means of repeated radiographic and scintigraphic recordings. The biopsy technique was improved by using a slowly rotating coarse trepan bur. Histological and enzyme histochemical investigations were performed for determination of the histopathological diagnosis. Orthopantomograms in combination with intraoral views and 99mTc-scintigraphy were used for the radiographic diagnosis and follow-up studies. Bacteriological and serological investigations were performed in attempt to clarify the obscure etiology. The occurrence in the patients' sera of antibodies to antigens prepared from cultured bacteria was studied. ASTA, IgM, IgG, and IgA were determined and lymphocyte stimulation tests were performed. The investigations made it possible to distinguish DSO as a separate entity with rather characteristic clinical, histological and radiographic features. The histological diagnosis was facilitated by an improved biopsy technique and enzyme histochemical recordings. Different rather unspecific tissue reactions were together found to form a pattern which was strongly indicative of DSO. The radiographic and scintigraphic investigations gave valuable findings which increased the diagnostic accuracy and improved the prognostic and therapeutic judgements. The bacteriological and serological investigations indicated that propionibacterium acnes and peptostreptococcus intermedius were of etiological importance but could not explain the chronicity of the disease. The results of the different investigations gave a better understanding of DSO and made it possible to provide more appropriate care for patients in different stages of the disease. Long-term antibiotic therapy was found to have a positive influence on the course of the disease in its early stages, while cortisone therapy, and sometimes decortication, were found to be more effective in chronic stages.