Tooth Germ Osteomyelitis Involving the Left Mandibular Premolar Region in a Child: A Rare Case Report

Abstract

Background: Tooth germ osteomyelitis is a rare inflammatory condition involving the developing tooth follicle and surrounding alveolar bone in paediatric patients. Due to its uncommon occurrence and nonspecific clinical presentation, the condition is often overlooked, leading to delayed diagnosis and management. If not identified early, the infection may compromise the developing permanent dentition and result in disturbances in mandibular growth. Case Presentation: A 7-year-old child presented with swelling and discomfort in the left mandibular posterior region. Clinical examination revealed localised intraoral swelling and tenderness in the mandibular left premolar region, associated with mild facial asymmetry. Radiographic evaluation using Cone Beam Computed Tomography (CBCT) revealed an ill-defined radiolucent lesion associated with the developing premolar tooth germ, suggestive of inflammatory bone destruction. Based on the clinical and radiographic findings, a provisional diagnosis of tooth germ osteomyelitis was established. Management and Intervention: The patient underwent surgical exploration and debridement of the infected bone along with removal of necrotic tissue under appropriate antibiotic coverage. Care was taken to preserve surrounding anatomical structures and minimise damage to the developing dentition. Postoperative management included systemic antibiotics, analgesics, and regular clinical and radiographic follow-up. Outcome: The postoperative course was uneventful, with gradual resolution of swelling and pain. Follow-up radiographic evaluation demonstrated progressive bone healing without evidence of recurrence or persistent infection. Mandibular growth and development of adjacent teeth were preserved. Conclusion: Tooth germ osteomyelitis is a rare but potentially serious paediatric condition. Early diagnosis with the aid of advanced imaging such as CBCT, appropriate surgical intervention, and close follow-up are essential to prevent damage to developing tooth germs and ensure normal mandibular growth. Increased clinical awareness is crucial for the timely management of this uncommon entity. Highlight: This case highlights the importance of early CBCT-based diagnosis and prompt surgical intervention in managing tooth germ osteomyelitis to prevent damage to developing permanent dentition and mandibular growth.