Non-surgical treatment of adults with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible

• Published in: Journal of cranio-maxillo-facial surgery 2019-12, Vol.47 (12), p.1922-1928
• Main Authors: van de Meent, Marieke M., Wetselaar-Glas, Miranda J.M., Fiocco, Marta, Appelman-Dijkstra, Natasha M., van Merkesteyn, J.P. Richard
• Format: Article
• Language: English
• Subjects: Adult; Bisphosphonates; Bone Density Conservation Agents - therapeutic use; Child; Chronic Disease; Chronic tendoperiostitis; Conservative Treatment - methods; Dentistry; Diffuse sclerosing osteomyelitis; Diphosphonates - therapeutic use; Female; Humans; Male; Mandible - pathology; Mandibular Diseases - complications; Mandibular Diseases - therapy; Middle Aged; Non-surgical therapy; Occlusal Splints; Osteomyelitis - complications; Osteomyelitis - therapy; Pain; Pain - drug therapy; Pain - etiology; Periostitis - complications; Periostitis - therapy; Treatment Outcome; Young Adult
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2019.11.020

Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients. We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation. Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy. In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.