Acute periostitis

The acute form of inflammation localized in the periosteum is called acute periostitis.

According to the international classification of diseases, acute periostitis ICD 10 is defined under the designation K10.2 - inflammatory jaw diseases, or K10.9 - unspecified jaw diseases.

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Causes of acute periostitis

The inflammatory reaction may be caused by a streptococcal, staphylococcal, or other bacterial infection.

There are quite a few factors that provoke the appearance of pathology. Sometimes periostitis appears as a consequence of an existing inflammation, for example, periodontitis. In addition, the disease can manifest itself with incorrect and complicated eruption of a tooth, with the development of inflammation of an unerupted tooth, with errors in treatment, excessive trauma and infection of the tooth. Often, the infectious agent joins during tooth extraction, freely getting into an insufficiently treated wound.

The disease usually forms at the tooth root, spreading to surrounding tissues, usually located below the inflammation site. Stressful situations, decreased immunity, and prolonged exposure to cold on the body contribute to the progression of periostitis.

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Symptoms of acute periostitis

At the initial stages of pathology development in the periosteum area, swelling, blood flow and tissue stratification can be observed. Subsequently, an inflammatory process develops, localized cavities filled with liquid contents appear. If treatment is not started at this time, spontaneous opening of the abscess into the oral cavity may occur in 5-6 days.

What complaints can patients present with acute periostitis?

• Severe unbearable pain directly in the damaged tooth or in the area (in the socket) of the tooth extraction. The pain not only does not subside, but also becomes stronger, radiating to the temporal part, ears, and the back of the head. After 2-3 days, the painful sensations gradually fade away, and are replaced by symptoms of intoxication.
• General intoxication, accompanied by a state of malaise, fatigue, increased body temperature, headache. Skin of a grayish tint, possible increased heart rate.
• Swelling of the facial area and oral cavity on the side of inflammation, disturbance of facial contours, enlargement of the submandibular lymph nodes.

A general blood test during this period may indicate signs of inflammation: leukocytosis and an accelerated ESR appear.

Acute purulent periostitis

If the serous process develops unhindered, it turns into a purulent form - acute purulent periostitis of the jaw is formed. Purulent discharge accumulates under the periosteum, subperiosteal abscesses are formed. The affected periosteum simply dies, and the purulent contents penetrate into the tissues under the mucous membrane.

This complication is characterized by severe, often pulsating pain, with the application of warm compresses causing increased pain, while the application of cold alleviates the discomfort.

A gradual increase in the amount of accumulated pus causes an increase in painful symptoms. A general increase in body temperature may be observed.

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Acute odontogenic periostitis of the jaws

• Acute purulent periostitis of the lower jaw: with periostitis affecting the lower jaw, tissue swelling on the face is localized to a greater extent in the lower part and under the lower jaw. In the area of close contact of facial tissues and the inflammatory focus, an infiltrative lesion of soft tissues is formed, characterized by reddening of the skin, enlargement and soreness of the nearest lymph nodes.

The patient tries not to close his jaws, any biting of the causative tooth or touching it with the tongue causes severe pain. General symptoms of intoxication damage to the body are also evident: body temperature up to 38°C, dizziness, loss of appetite, weakness.

• Acute purulent periostitis of the upper jaw: when the process spreads to the upper jaw, swelling appears in the infraorbital area, upper lip, nasolabial folds. The upper jaw is affected less often than the lower jaw, usually the first large molars and first small molars are affected.

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Acute odontogenic periostitis

Acute periostitis of the jaw, which occurs as a result of dental and periodontal pathology, is called odontogenic. It often develops as a delineated inflammatory process of the periosteum of the alveolar process along the dental row. Subperiosteal abscesses often appear, not extending beyond the alveolar process.

The onset of the disease is rapid, the symptoms intensify as the inflammatory process grows and spreads. The general condition gradually becomes worse, weakness, excessive fatigue, headaches appear.

In the area of the infected tooth, pain is observed, radiating along the trigeminal nerve (to the temporal region, ears, back of the head). Swelling, most pronounced in the first day of the development of the pathology, becomes slightly less, spreading to the underlying tissue areas.

In the oral cavity, you can notice swelling of the gum tissue, redness, and the appearance of dirty plaque on the mucous membrane. Often, you can feel an extremely painful dense infiltrate at the site of the lesion.

Acute purulent odontogenic periostitis requires differentiation from other inflammatory pathologies of the jaw. This may be acute periodontitis, lymphadenitis, osteomyelitis, sialoadenitis, phlegmon.

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Acute purulent periostitis in children

Acute serous periostitis in a child may manifest itself immediately after birth. The child becomes whiny, sleeps and eats poorly, and is restless. The mucous membranes of the oral cavity are visibly swollen and reddened, and the child's jaw becomes painful when palpated.

With subsequent progression of the disease, the serous process transforms into a purulent one. This happens mainly in children over three years of age. Purulent inflammation is manifested by a sharp jump in temperature: the child's health is usually severe.

It is quite difficult to diagnose periostitis in childhood, which requires a great deal of responsibility from the specialist. In addition, acute purulent pathology in a child can have many similar symptoms to the acute form of odontogenic osteomyelitis.

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Diagnosis of acute periostitis

Diagnosis of acute periostitis is based on clinical signs of the disease and certain laboratory tests. In patients with various manifestations of periostitis, leukocytosis and pronounced neutrophilia are detected in the blood, ESR may remain unchanged or increase.

There are usually no characteristic deviations in the urine analysis. The X-ray is also uninformative in this case, since it indicates moderate signs of pathology only a few days after the onset of the disease.

Thermography (thermal imaging) is the best diagnostic method for inflammatory diseases of the maxillofacial area. It allows for the precise localization of the lesion by increasing the intensity and duration of infrared radiation. Temperature readings in inflamed tissues are usually increased by 1-2°C. The use of a thermal imager (CEM®-thermo diagnostics) helps to accurately trace the boundaries of the pathological process, as well as to evaluate the dynamics of recovery during therapeutic measures.

A final diagnosis can only be established after a comprehensive diagnosis, including an external examination and a number of other studies, including laboratory ones.

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Treatment of acute periostitis

The best effect is observed with complex treatment of the disease, namely a combination of surgical intervention, medication and physiotherapy.

The use of exclusively conservative treatment is most often inappropriate, its use is possible only at the initial stage of pathology, with minor infiltrative damage to the periosteum. In this case, the dental cavity is opened, the affected tissues are removed and the purulent contents are discharged. Such manipulations, combined with antimicrobial therapy and the use of UHF, can provoke regression of the inflammatory reaction.

However, it should be noted that patients very rarely resort to the help of a specialist at the initial stages of the pathology development. Usually this happens already in the presence of a purulent infiltrate, accompanied by unbearable pain, which the patient can no longer cope with on his own.

Therefore, in most cases, the inflammatory focus is opened surgically, creating the possibility of the release of purulent contents. Before the opening, local anesthesia is administered with a solution of trimecaine or lidocaine, if the patient is not allergic to such drugs. Anesthetics are used in the form of injections directly at the borders of the infiltrate. The mucous tissue is dissected to the maximum depth (to the bone), making an incision of about two centimeters. A drainage channel is inserted into the wound. At the same time, the infected tooth can be removed if, in the opinion of the specialist, it is pointless to save it. The tooth is removed if the degree of its destruction is too great, or if its root canals are impassable.

The tooth to be saved is treated and filled. In some patients, a hemisection or root apex resection may be performed.

Treatment of acute purulent periostitis is not always combined with the removal of the affected tooth, even if there are all indications for it. Sometimes the patient's condition is so unsatisfactory that the removal is performed only after 2-3 days, after the elimination of the bright symptoms of the inflammatory reaction.

After opening the infiltrate, for faster healing, several times a day, rinsing the mouth with a weak and not hot solution of soda or potassium permanganate may be prescribed. As a drug treatment, sulfanilamide drugs (sulfadimethoxine, biseptol, bactrim), pyrazolone drugs (analgin, butadion), antihistamines (diazolin, diphenhydramine), calcium-containing agents (calcium gluconate, calcemin), vitamin complexes are prescribed. In the presence of complications, antibiotic therapy may be prescribed.

Physiotherapy procedures help in the treatment and recovery period: sollux, UHF, microwave, helium-neon irradiation. In case of disorders of muscular-facial innervation, therapeutic physical training and massage are indicated.

Prevention of acute periostitis

Preventive measures are aimed at maintaining the health of teeth and oral cavity. What is needed for this?

• Brush your teeth regularly and properly.
• Visit the dentist both for treatment of diseased teeth and for preventive examination.
• At the slightest toothache or suspicion of developing caries, consult a doctor.
• Avoid exposing your teeth to unnecessary trauma: do not chew nuts or other very hard foods or objects.
• Introduce foods rich in calcium (milk, cheese, cottage cheese, beans, oatmeal) and vitamins (fruits, greens, vegetables, berries) into your diet.

Prognosis of acute periostitis

Timely therapeutic measures for acute periostitis ensure recovery within three to five days. On the contrary, the lack of adequate treatment threatens the development of osteomyelitis, abscess formation, and the transition of acute periostitis to chronic.

Thus, acute periostitis is a rather dangerous pathology. If you suspect this disease, you should immediately contact a dental specialist for qualified treatment.