Culture and sensitivity of the wound site determines the choice of antibiotic. Repeated culture and sensitivity testing is often carried out in OM since the treatment is prolonged and antibiotic resistance may occur, when a change in the drug may be required.

Pathologic fracture of the mandible is a possible complication of OM where the bone has been weakened significantly.

A systematic review reported that there is some evidence that rinsing with chlorhexidine (0.12% or 0.2%) or placing chlorhexidine gel (0.2%) in the sockets of extracted teeth reduces the frequency of dry socket. Another systematic review concluded that there is evidence that prophylactic antibiotics reduce the risk of dry socket (and infection and pain) following third molar extractions of wisdom teeth, however their use is associated with an increase in mild and transient adverse effects. The authors questioned whether treating 12 patients with antibiotics to prevent one infection would do more harm overall than good, in view of the potential side effects and also of antibiotic resistance. Nevertheless, there is evidence that in individuals who are at clear risk may benefit from antibiotics. There is also evidence that antifibrinolytic agents applied to the socket after the extraction may reduce the risk of dry socket.

Some dentists and oral surgeons routinely debride the bony walls of the socket to encourage hemorrhage (bleeding) in the belief that this reduces the incidence of dry socket, but there is no evidence to support this practice. It has been suggested that dental extractions in females taking oral contraceptives be scheduled on days without estrogen supplementation (typically days 23–28 of the menstrual cycle). It has also been suggested that teeth to be extracted be scaled prior to the procedure.

Prevention of alveolar osteitis can be exacted by following post-operative instructions, including:

1. Taking any recommended medications

2. Avoiding intake of hot fluids for one to two days. Hot fluids raise the local blood flow and thus interfere with organization of the clot. Therefore, cold fluids and foods are encouraged, which facilitate clot formation and prevent its disintegration.

3. Avoiding smoking. It reduces the blood supply, leading to tissue ischemia, reduced tissue perfusion and eventually higher incidence of painful socket.

4. Avoiding drinking through a straw or spitting forcefully as this creates a negative pressure within the oral cavity leading to an increased chance of blood clot instability.

Treatment is usually symptomatic, (i.e., analgesic medications) and also the removal of debris from the socket by irrigation with saline or local anesthetic. Medicated dressings are also commonly placed in the socket; although these will act as a foreign body and prolong healing, they are usually needed due to the severe pain. Hence, the dressings are usually stopped once the pain is lessened. Examples of medicated dressings include antibacterials, topical anesthetics and obtundants, or combinations of all three, e.g., zinc oxide and eugenol impregnated cotton pellets, alvogyl (eugenol, iodoform and butamen), dentalone, bismuth subnitrate and iodoform paste (BIPP) on ribbon gauze and metronidazole and lidocaine ointment. A systematic review of the efficacy of treatments for dry socket concluded that there was not enough evidence to discern the effectiveness of any treatments. People who develop a dry socket typically seek medical/dental advice several times after the dental extraction, where the old dressing is removed, the socket irrigated and a new dressing placed. Curettage of the socket increases the pain and has been discouraged by some.

The process is usually asymptomatic and benign, in which case the tooth does not require endodontic treatment.

The offending tooth should be tested for vitality of the pulp, if inflamed or necrotic, then endodontic treatment is required, while hopeless teeth should be extracted.

The first three cases of bisphosphonate-associated osteonecrosis of the jaw were spontaneously reported to the FDA by an oral surgeon in 2002, with the toxicity being described as a potentially late toxicity of chemotherapy. In 2003 and 2004, three oral surgeons independently reported to the FDA information on 104 cancer patients with bisphosphonate-associated osteonecrosis of the jaw seen in their referral practices in California, Florida, and New York. These case series were published as peer-reviewed articles — two in the "Journal of Oral and Maxillofacial Surgery" and one in the "Journal of Clinical Oncology". Subsequently, numerous instances of persons with this ADR were reported to the manufacturers and to the FDA. By December 2006, 3607 cases of people with this ADR had been reported to the FDA and 2227 cases had been reported to the manufacturer of intravenous bisphosphonates.

The International Myeloma Foundation's web-based survey included 1203 respondents, 904 patients with myeloma and 299 with breast cancer and an estimate that after 36 months, osteonecrosis of the jaw had been diagnosed in 10% of 211 patients on zoledronate and 4% of 413 on pamidronate. A population based study in Germany identified more than 300 cases of osteonecrosis of the jaw, 97% occurring in cancer patients (on high-dose intravenous bisphosphonates) and 3 cases in 780,000 patients with osteoporosis for an incidence of 0.00038%. Time to event ranged from 23–39 months and 42–46 months with high dose intravenous and oral bisphosphonates. A prospective, population based study by Mavrokokki "et al.". estimated an incidence of osteonecrosis of the jaw of 1.15% for intravenous bisphosphonates and 0.04% for oral bisphosphonates. Most cases (73%) were precipitated by dental extractions. In contrast, safety studies sponsored by the manufacturer reported bisphosphonate-associated osteonecrosis of the jaw rates that were much lower.

Although the majority of cases of ONJ have occurred in cancer patients receiving high dose intravenous bisphosphonates, almost 800 cases have been reported in oral bisphosphonate users for osteoporosis or Pagets disease. In terms of severity most cases of ONJ in oral bisphosphonate users are stage 1–2 and tend to progress to resolution with conservative measures such as oral chlorhexidine rinses.

Owing to prolonged embedding of bisphosphonate drugs in the bone tissues, the risk for BRONJ is high even after stopping the administration of the medication for several years.

This form of therapy has been shown to prevent loss of bone mineral density (BMD) as a result of a reduction in bone turnover. However, bone health entails quite a bit more than just BMD. There are many other factors to consider.

In healthy bone tissue there is a homeostasis between bone resorption and bone apposition. Diseased or damaged bone is resorbed through the osteoclasts mediated process while osteoblasts form new bone to replace it, thus maintaining healthy bone density. This process is commonly called remodelling.

However, osteoporosis is essentially the result of a lack of new bone formation in combination with bone resorption in reactive hyperemia, related to various causes and contributing factors, and bisphosphonates do not address these factors at all.

In 2011, a proposal incorporating both the reduced bone turnover and the infectious elements of previous theories has been put forward. It cites the impaired functionality of affected macrophages as the dominant factor in the development of ONJ.

In a systematic review of cases of bisphosphonate-associated ONJ up to 2006, it was concluded that the mandible is more commonly affected than the maxilla (2:1 ratio), and 60% of cases are preceded by a dental surgical procedure. According to Woo, Hellstein and Kalmar, oversuppression of bone turnover is probably the primary mechanism for the development of this form of ONJ, although there may be contributing co-morbid factors (as discussed elsewhere in this article). It is recommended that all sites of potential jaw infection should be eliminated before bisphosphonate therapy is initiated in these patients to reduce the necessity of subsequent dentoalveolar surgery. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate (Fosamax), for osteoporosis is uncertain and warrants careful monitoring. Patients taking dexamethasone and other glucocorticoids are at increased risk.

Matrix metalloproteinase 2 may be a candidate gene for bisphosphonate-associated osteonecrosis of the jaw, since it is the only gene known to be associated with bone abnormalities and atrial fibrillation, both of which are side effects of bisphosphonates.

The prognosis is excellent, as no treatment is usually required.

If the offending tooth is extracted, the area of condensing osteitis may remain in the jaws indefinitely, which is termed osteosclerosis or bone scar.

The treatment should be tailored to the cause involved and the severity of the disease process. With oral osteoporosis the emphasis should be on good nutrient absorption and metabolic wastes elimination through a healthy gastro-intestinal function, effective hepatic metabolism of toxicants such as exogenous estrogens, endogenous acetaldehyde and heavy metals, a balanced diet, healthy lifestyle, assessment of factors related to potential coagulopathies, and treatment of periodontal diseases and other oral and dental infections.

In cases of advanced oral ischaemic osteoporosis and/or ONJ that are not bisphosphonates related, clinical evidence has shown that surgically removing the damaged marrow, usually by curettage and decortication, will eliminate the problem (and the pain) in 74% of patients with jaw involvement. Repeat surgeries, usually smaller procedures than the first, may be required. Almost a third of jawbone patients will need surgery in one or more other parts of the jaws because the disease so frequently present multiple lesions, i.e., multiple sites in the same or similar bones, with normal marrow in between. In the hip, at least half of all patients will get the disease in the opposite hip over time; this pattern occurs in the jaws as well. Recently, it has been found that some osteonecrosis patients respond to anticoagulation therapies alone. The earlier the diagnosis the better the prognosis. Research is ongoing on other non-surgical therapeutic modalities that could alone or in combination with surgery further improve the prognosis and reduce the morbidity of ONJ. A greater emphasis on minimizing or correcting known causes is necessary while further research is conducted on chronic ischaemic bone diseases such as oral osteoporosis and ONJ.

In patients with bisphosphonates-associated ONJ, the response to surgical treatment is usually poor. Conservative debridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses, and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this form of ONJ. Although an effective treatment for bisphosphonate-associated bone lesions has not yet been established, and this is unlikely to occur until this form of ONJ is better understood, there have been clinical reports of some improvement after 6 months or more of complete cessation of bisphosphonate therapy.

Osteomyelitis often requires prolonged antibiotic therapy for weeks or months. A PICC line or central venous catheter can be placed for long-term intravenous medication administration. It may require surgical debridement in severe cases, or even amputation.

Initial first-line antibiotic choice is determined by the patient's history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities. Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes. Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization can be done. Hyperbaric oxygen therapy has been shown to be a useful to the treatment of osteomyelitis.

Prior to the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean. In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting titled "The Gross Clinic".

There is tentative evidence that bioactive glass may also be useful in long bone infections. Support from randomized controlled trials, however, is not available as of 2015.

Idiopathic osteosclerosis is a condition which may be found around the roots of a tooth. It is usually painless and found during routine radiographs. It appears as a radiopaque (light area) around a tooth, usually a premolar or molar. There is no sign of inflammation of the tooth.

Mainly surgical approach has to be taken.

If cavity is small then surgical evacuation & curettage is performed under antibiotic cover.

If cavity is large then after evacuation, packing with cancellous bone chips

Condensing osteitis, sclerosing osteomyelitis, cementoblastoma, hypercementosis, Exostoses (tori).

Condensing osteitis may resemble idiopathic osteosclerosis, however, associated teeth are always nonvital in condensing osteitis.

Many impacted wisdom teeth are extracted prior to the age of 25, when full eruption can be reasonably expected and before symptoms or disease have begun. This has led to a treatment controversy generally referred to as the extraction of asymptomatic, disease-free wisdom teeth.

In 2000, the first National Institute of Clinical Excellence (NICE) of the United Kingdom set guidelines to limit the removal of asymptomatic disease-free third molars citing the number of pathology free impacted teeth being removed and the potential cost savings to the public purse. Advocates of the policy point out that the impacted wisdom teeth can be monitored and avoidance of surgery also means avoidance of the recovery, risks, complications and costs associated with it. Following implementation of the NICE guidelines the UK saw a decrease in the number of impacted third molar operations between 2000 and 2006 and a rise in the average age at extraction from 25 to 31 years. American Public Health Association has adopted a similar policy against removal of third molars before any problems have occurred.

Those who argue against a blanket moratorium on the extraction of asymptomatic, disease-free wisdom teeth point out that wisdom teeth commonly develop periodontal disease or cavities which may eventually damage the second molars and that there are costs associated with monitoring wisdom teeth. They also point to the fact that there is an increase in the rate of post-operative periodontal disease on the second molar, difficulty of surgery and post-operative recovery time with age. The UK has also seen an increase in the rate of dental caries on the lower second molars increasing from 4–5% prior to the NICE guideline to 19% after its adoption.

Although most studies arrive at the conclusion of negative long-term outcomes e.g. increased pocketing & attachment loss after surgery, it is clear that early removal (before 25 years old), good post-operative hygiene & plaque control, and lack of pre-existing periodontal pathology before surgery are the most crucial factors that minimise the probability of adverse post-surgical outcomes.

The Cochrane review of surgical removal versus retention of asymptomatic disease-free impacted wisdom teeth suggests that the presence of asymptomatic impacted wisdom teeth may be associated with increased risk of periodontal disease affecting adjacent 2nd molar (measured by distal probing depth > 4 mm on that tooth) in the long term, however it is of very low quality evidence and high risk of bias. Another study which was at high risk of bias, found no evidence to suggest that removal of asymptomatic disease-free impacted wisdom teeth has an effect on crowding in the dental arch. There is also insufficient evidence to highlight a difference in risk of decay with or without impacted wisdom tooth.

One trial in adolescents who had orthodontic treatment comparing the removal of impacted mandibular wisdom teeth with retention was identified. It only examined the effect on late lower incisor crowding and was rated 'highly biased' by the authors. The authors concluded that there is not enough evidence to support either the routine removal or retention of asymptomatic impacted wisdom teeth. Another randomised controlled trial done in the UK has suggested that it is not reasonable to remove asymptomatic disease-free impacted wisdom tooth merely to prevent incisor crowding as there is not strong enough evidence to show this association.

Due to the lack of sufficient evidence to determine whether such teeth should be removed or not, the patient's preference and values should be taken into account with clinical expertise exercised and careful consideration of risks & benefits to determine treatment. If it is decided to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals is advisable to prevent undesirable outcomes (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection).

Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children while the feet, spine, and hips are most commonly involved in adults.

The cause is usually a bacterial infection and rarely a fungal infection. It may occur via spread from the blood or from surrounding tissue. Risks for developing osteomyelitis include diabetes, intravenous drug use, prior removal of the spleen, and trauma to the area. Diagnosis is typically suspected based on symptoms. This is then supported by blood tests, medical imaging, or bone biopsy.

Treatment often involves both antimicrobials and surgery. In those with poor blood flow, amputation may be required. With treatment outcomes are often generally good when the condition has only been present a short time. About 2.4 per 100,000 people are affected a year. The young and old are more commonly affected. Males are more commonly affected than females. The condition was described at least as early as the 300s BC by Hippocrates. Before the availability of antibiotics the risk of death was significant.

Osteitis is inflammation of bone. More specifically, it can refer to one of the following conditions:

- Osteomyelitis, or "infectious osteitis", mainly "bacterial osteitis")

- Alveolar osteitis or "dry socket"

- Condensing osteitis (or Osteitis condensans)

- Osteitis deformans (or Paget's disease of bone)

- Osteitis fibrosa cystica (or Osteitis fibrosa, or Von Recklinghausen's disease of bone)

- Osteitis pubis

- Radiation osteitis

- Osteitis condensans ilii

- Panosteitis, a long bone condition in large breed dogs

- In horses, pedal osteitis is frequently confused with laminitis.

Most patients will experience pain and swelling (worst on the first post-operative day) then return to work after 2 to 3 days with the rate of discomfort decreased to about 25% by post-operative day 7 unless affected by dry socket: a disorder of wound healing that prolongs post-operative pain. It can be 4 to 6 weeks before patients are fully recovered with a full range of jaw movements. A Cochrane investigation found that the use of antibiotics either just before or just after surgery reduced the risk of infection, pain and dry socket after wisdom teeth are removed by oral surgeons, but that using antibiotics also causes more side effects for these patients. Twelve patients needed to receive antibiotics to prevent 1 infection and for every 21 people who received antibiotics, an adverse event was likely. The conclusion of the review was that antibiotics given to healthy people to prevent infections may cause more harm than benefit to both the individual patients and the population as a whole. Another Cochrane Investigation has found post-operative pain is effectively managed with either ibuprofen, or ibuprofen in combination with acetaminophen.

Long-term complications can include periodontal complications such as bone loss on the second molar following wisdom teeth removal. Bone loss as a complication after wisdom teeth removal is uncommon in the young but present in 43% of those of 25 years of age or older. Initiation or worsening of temporomandibular joint problems is uncommon and unpredictable. Injury to the inferior alveolar nerve resulting in numbness or partial numbness of the lower lip and chin has reported rates that vary widely from 0.04% to 5%. The largest study is from a survey of 535 oral and maxillofacial surgeons in California, where a rate of 1:2,500 was reported. The large variation in report rates is attributed to variations in technique, the patient pool and surgeon experience. Other complications that are uncommon have been reported including persistent sinus communication, damage to adjacent teeth, lingual nerve injury, displaced teeth, osteomyelitis and jaw fracture. Alveolar osteitis, post-operative infection, excessive bleeding may also be expected.

A sequestrum (plural: sequestra) is a piece of dead bone that has become separated during the process of necrosis from normal or sound bone.

It is a complication (sequela) of osteomyelitis. The pathological process is as follows:

- infection in the bone leads to an increase in intramedullary pressure due to inflammatory exudates

- the periosteum becomes stripped from the osteum, leading to vascular thrombosis

- bone necrosis follows due to lack of blood supply

- sequestra are formed

The sequestra are surrounded by sclerotic bone which is relatively avascular (without a blood supply). Within the bone itself, the haversian canals become blocked with scar tissue, and the bone becomes surrounded by thickened periosteum.

Due to the avascular nature of this bone, antibiotics which travel to sites of infection via the bloodstream poorly penetrate these tissues, hence the difficulty in treating chronic osteomyelitis.

At the same time as this, new bone is forming (known as involucrum). Openings in this involucrum allow debris and exudates (including pus) to pass from the sequestrum via sinus tracts to the skin.

Rarely, a sequestrum may turn out to be an osteoid osteoma, a rare tumor of the bone.

Crowding of the teeth is treated with orthodontics, often with tooth extraction, clear aligners, or dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth. However, most problems are very minor and do not require treatment.

Simple (Unicameral) Bone Cyst

Some unicameral bone cysts may spontaneously resolve without medical intervention. Specific treatments are determined based on size of the cyst, strength of the bone, medical history, extent of the disease, activity level, symptoms an individual is experiencing, and tolerance for specific medications, procedures, or therapies. The types of methods used to treat this type of cyst are curettage and bone grafting, aspiration, steroid injections, and bone marrow injections. Watchful waiting and activity modifications are the most common nonsurgical treatments that will help resolve and help prevent unicameral bone cysts from occurring and reoccurring.

Aneurysmal Bone Cyst

The aneurysmal bone cyst can be treated with a variety of different methods. These methods include open curettage and bone grafting with or without adjuvant therapy, cryotheraphy, sclerotherapy, ethibloc injections, radionuclide ablation, and selective arterial embolization. En-block resection and reconstruction with strut grafting are the most common treatments and procedures that prevent recurrences of this type of cyst.

Traumatic Bone Cyst

The traumatic bone cyst treatment consists of surgical exploration, curettage of the osseous socket and bony walls, subsequent filling with blood, and intralesional steroid injections. Young athletes can reduce their risk of traumatic bone cyst by wearing protective mouth wear or protective head gear.

Unerupted microdonts may require surgical removal to prevent the formation of cysts. Erupted microdonts, peg laterals especially, may cause cosmetic concern. Such teeth may be restored to resemble normal sized teeth, typically with composite build ups or crowns. Orthodontics may be required in severe cases to close gaps between the teeth.

A Brodie abscess is a subacute osteomyelitis, which may persist for years before converting to a frank osteomyelitis. Classically, this may present after conversion as a draining abscess extending from the tibia out through the shin. Occasionally acute osteomyelitis may be contained to a localized area and walled off by fibrous and granulation tissue. This is termed Brodie's abscess.

Most frequent causative organism is Staphylococcus aureus.

Traumatic bone cyst, also called a simple bone cyst, is a condition of the jaws. It is more likely to affect men and is more likely to occur in people in their first and second decades. There is no known cause though it is sometimes related to trauma. It appears on radiographs as a well-circumscribed radiolucency (dark area), and it commonly scallops between the roots of teeth. When the lesion is surgically opened, an empty cavity is found.

One study showed female predominance.

The prognosis depends upon the type, size and location of a cyst. Most cysts are entirely benign, and some may require no treatment. Rarely, some cystic lesions represent locally aggressive tumors that may cause destruction of surrounding bone if left untreated. This type of cyst are usually removed with a margin of healthy bone to prevent recurrence of new cysts. If a cyst expands to a very large size, the mandible may be weakened such that a pathologic fracture occurs.

Teeth affected by macrodontia are either contoured, aligned or extracted. Contouring involves shaving the tooth down to change shape and size. However, the result is minimal change as this could be dangerous for the dentin and dental pulp. Aligning involves the use of braces to straighten, align, and make space for larger teeth to grow. When extracted, they are replaced with an implant or bridge. This is done in cases in which the patient suffers from pain that cannot be treated by other methods.

Radicular cysts are by far the most common cyst occurring in the jaws.