OSTEOMYELITIS

   Tuberculosis is a chronic infectious granulomatous disease 

caused by  Mycobacterium tuberculosis

1 which is an aerobic, 

slender,  non-motile, non-encapsulated, non-sporing, rod 

shaped organism ranging from 2 to 5 µm2

. The World 

Health Organization (WHO) estimates that worldwide 

there are approximately 20 million active cases, of them 

approximately 3 million people  die each year from 

tuberculosis, of which 80 % are in developing countries

3

.

            Tuberculous oral lesions are relatively rare occurrence. 

Oral manifestations occur in approximately 3% of cases 

involving long standing pulmonary and/ or systemic 

infection4

.Oral  clinical presentation may be as ulcers, 

erythematous patches, and indurated lesions with granular 

surface, nodules, and fissures or as jaw lesions. The most 

common sites involved are tongue, gingiva, tooth sockets 

and jaw involvement may present as osteomyelitis

5

.

               Two main types of tubercular infections of oral 

tissues are recognized – Primary and Secondary. Primary 

lesions develop when tuberculosis bacilli are directly 

inoculated into the oral tissues of a person who has not 

acquired immunity to the disease and in fact, any area that 

is vulnerable to direct inoculation of bacilli from 

exogenous source can be a potential site. These frequently 

involve gingiva, tooth extraction sockets and buccal folds. 

Secondary infection of oral tissues can result from either 

haematogenous or lymphatic spread or from 

autoinoculation by infected sputum and direct extensions 

from neighbouring structures. Intraoral sites frequentlyinvolved include the tongue, palate, lips, alveolar mucosa 

and jaw bones

2

.

           With myriad presentations and sometimes lack of 

specific systemic symptoms, oral tubercular lesions may 

present as puzzle for us and may escape our eyes. Hence, 

we document a case of primary tuberculous osteomyelitis 

of mandible  in an  old male individual who was initially 

suspected for  dental abscess with nonspecific chronic 

osteomyelitis and later proved as primary tubercular osteomylitis