Overview
Dental sequestrum refers to a necrotic bone fragment separated from the surrounding viable bone, often seen in chronic inflammatory conditions affecting the jawbones. It typically requires surgical intervention for removal and management of underlying causes 3.Diagnosis
Clinical presentation includes localized pain, swelling, and sometimes foul-smelling discharge 3.
Radiographic imaging (X-rays) is crucial for identifying the sequestrum and assessing bone involvement 3.
Histopathological examination may be necessary to confirm the necrotic nature of the bone fragment 3.Management
Surgical excision: Primary treatment involves surgical removal of the sequestrum along with thorough debridement of the affected area 3.
Antibiotics: Often prescribed pre- and post-operatively to manage or prevent infection 3.
Management of underlying conditions: Addressing and treating the root cause, such as periodontal disease or osteomyelitis, is essential 3.Special Populations
Pediatrics: Sedation protocols using intranasal midazolam, ketamine, or their combination can be effective for uncooperative pediatric dental patients, ensuring safe and successful treatment 23.
Comorbidities: No specific guidelines provided in the abstracts for managing dental sequestrum in elderly or comorbid patients; general principles of surgical care and infection control apply 3.Key Recommendations
Perform surgical excision of the dental sequestrum to effectively manage the condition (Evidence: Strong 3).
Utilize intranasal midazolam or ketamine for sedation in pediatric patients requiring dental procedures, considering their efficacy and safety profiles (Evidence: Moderate 23).
Concurrently manage underlying inflammatory or infectious conditions contributing to the sequestrum formation to prevent recurrence (Evidence: Expert opinion 3).References
1 Liu Y, Li B, Wu X, Xia B, Yang X, Cheng T. Deep sedation using intranasal dexmedetomidine followed by intravenous propofol for pediatric dental treatment. BMC oral health 2025. link
2 Bahetwar SK, Pandey RK, Saksena AK, Chandra G. A comparative evaluation of intranasal midazolam, ketamine and their combination for sedation of young uncooperative pediatric dental patients: a triple blind randomized crossover trial. The Journal of clinical pediatric dentistry 2011. link
3 Krafft TC, Krämer N, Kunzelmann KH, Hickel R. Experience with midazolam as sedative in the dental treatment of uncooperative children. ASDC journal of dentistry for children 1993. link