Osteomyelitis is a spreading infection of the bone marrow space. It can start as an acute apical periodontitis following death of a pulp (good old-fashioned toothache) and due to virulent organisms or reduced resistance by the patient spread to the nearby bone marrow. Since it is acute (sudden onset), after a couple of weeks the changes are predominantly ill-defined bone destruction such as shown in the periapical radiographs here: OSTEOMYELITIS images.

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