Acute periostitis

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

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

[1], [2], [3], [4], [5]

Causes of acute periostitis

Inflammatory reaction can be caused by streptococcal, staphylococcal or other bacterial infection.

Factors that provoke the appearance of pathology, quite a lot. Sometimes periostitis appears as a consequence of an already existing inflammation, for example, periodontitis. In addition, the disease can occur with improper and complicated teething, with the development of inflammation of the unbroken tooth, with inaccuracies in treatment, excessive trauma and infection of the tooth. Often an infectious agent joins in the removal of teeth, unhindered falling into an insufficiently treated wound.

The disease is usually formed at the tooth root, extending to surrounding tissues, located, as a rule, below the focus of inflammation. Progression of periostitis is promoted by stressful situations, decreased immunity, prolonged exposure to cold on the body.

[6],

Symptoms of acute periostitis

At the initial stages of the development of pathology in the periosteum, swelling, blood rush and tissue stratification can be observed. Subsequently, the inflammatory process develops, localized cavities appear, filled with liquid contents. If at this time do not start treatment activities, after 5-6 days spontaneous dissection of the abscess into the oral cavity may occur.

What complaints can patients present in the acute form of periostitis?

• Severe unbearable pain directly in the damaged tooth or in the area (in the hole) of the tooth extraction. The pains not only do not subside, but become stronger, giving to the temporal part, the ears, the nape. After 2-3 days, the soreness gradually fades away, symptoms of intoxication come to replace them.
• General intoxication, accompanied by a state of malaise, fatigue, fever, pain in the head. Skin covers of grayish shade, there may be an increase in heart rate.
• Swelling of the facial area and oral cavity from the side of inflammation, violation of facial contours, an increase in submandibular lymph nodes.

A general blood test in this period may indicate signs of inflammation: leukocytosis appears and accelerated ESR.

Acute purulent periostitis

If the serous process develops unhindered, it passes into a purulent form - an acute purulent periostitis of the jaw is formed. The purulent discharge is accumulated under the periosteum, subnutrious abscesses are formed. The affected periosteum simply dies, and the purulent content penetrates into the tissues under the mucous membrane.

Such a complication is characterized by a strong, often throbbing soreness, and the application of warm compresses causes pain and the application of cold alleviates unpleasant sensations.

The gradual increase in the amount of accumulated pus causes an increase in painful symptoms. There may be a general increase in body temperature.

[7], [8], [9]

Acute odontogenic periostitis of the jaws

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

The patient tries not to close the jaw, any nipping of the causative tooth or touching his tongue causes severe pain. There are also general symptoms of intoxication damage to the body: 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, puffiness appears in the infraorbital zone, upper lip, nasolabial folds. The upper jaw is less infrequent than the lower one, usually the first large molars and the first small molars are affected.

[10]

Acute odontogenic periostitis

Acute periostitis of the jaw, which occurs due to dental and periodontal pathology, is called odontogenic. Often it is formed as a delineated inflammatory process of the periosteum of the alveolar process along the dentition. Often there are subperiosteal abscesses that do not extend beyond the alveolar process.

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

In the area of the infected tooth, there are pains that give off along the trigeminal nerve (in the temporal region, ears, occiput). Swelling, which is maximally expressed in the first day of the development of pathology, becomes slightly less, extending to the underlying tissue sites.

In the oral cavity, you can notice swelling of the gingival tissue, redness, the appearance of a dirty plaque on the mucosa. Often you can find an extremely painful dense infiltrate in place of the lesion.

Acute purulent odontogenic periostitis requires differentiation from other inflammatory pathologies of the jaw. It can be acute periodontitis, lymphadenitis, osteomyelitis, sialadenitis, phlegmon.

[11], [12]

Acute purulent periostitis in children

Acute serous periostitis in a child can manifest immediately after birth. The child becomes whiny, does not sleep well and eats, is restless. Mucous oral cavity has a visible puffiness and redness, when you feel the jaw, the child becomes painful.

With the subsequent progression of the disease, the serous process is transformed into a purulent process. This happens mostly in children over the age of three. Purulent inflammation manifests itself by a sharp temperature jump: the child's well-being, as a rule, is severe.

Diagnosing periostitis in childhood is difficult, which requires a great responsibility from the specialist. In addition, the child's acute purulent pathology can have many similar symptoms with an acute form of odontogenic osteomyelitis.

[13], [14]

Diagnosis of acute periostitis

Diagnosis of acute inflammation of the periosteum is based on clinical signs of the disease and the conduct of certain laboratory tests. In patients with various manifestations of periostitis in the blood, leukocytosis, expressed neutrophilia, ESR can remain unchanged or increase.

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

The method of thermography (thermal imaging) is the best method of diagnosis in inflammatory diseases of the maxillofacial zone. It allows to determine the exact location of the source by increasing the intensity and duration of infrared radiation. Temperatures in inflamed tissues are usually increased by 1-2 ° C. The use of the thermal imager (CEM®-thermo diagnostics) helps to accurately trace the boundaries of the pathological process, as well as assess the dynamics of recovery in the process of therapeutic measures.

The final diagnosis can be established only after complex diagnostics including external examination and a number of other studies, including laboratory ones.

[15], [16],

Treatment of acute periostitis

The best effect is observed in the complex treatment of the disease, namely a combination of surgery, medication and physiotherapy.

The use of an exceptionally conservative method of treatment is most often unreasonable, its use is possible only at the initial stage of pathology, with a small infiltrative lesion of the periosteum. At the same time, the dental cavity is opened, the removal of the affected tissues is made and the purulent contents are removed. Such manipulations, combined with antimicrobial therapy and UHF, may provoke regression of the inflammatory response.

However, it should be noted that patients rarely resort to the help of a specialist at the initial stages of pathology development. Usually this happens already in the presence of a purulent infiltrate, accompanied by unbearable pain, the patient can not cope with on his own.

Therefore, in most cases, the inflammatory focus is opened surgically, creating the possibility of purulent contents coming out. Before opening, local anesthesia is carried out with a solution of trimecaine or lidocaine if the patient does not have any allergies 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 a cut about two centimeters. In the wound, a drainage channel is inserted. At the same time, you can remove the infected tooth, if, in the opinion of a specialist, keep it meaningless. Remove the tooth if the degree of its destruction is too great, or if its root canals are impassable.

The tooth to be preserved is treated and a seal is placed. Some patients may undergo hemisection or resection of the apex of the roots.

Treatment of acute purulent periostitis is not always combined with the removal of the affected tooth, even if there is all the evidence for this. 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 non-saline solution of soda or potassium permanganate can be prescribed. As a drug treatment, sulfanilamide preparations (sulfadimethoxin, biseptol, bactrim), pyrazolone series preparations (analgin, butadione), antihistamines (diazolin, dimedrol), calcium-containing agents (calcium gluconate, calcemin), vitamin complexes are prescribed. In the presence of complications, antibiotic therapy may be prescribed.

Helps in the treatment and recovery period the application of physiotherapy procedures: solux, UHF, microwave, helium-neon irradiation. In cases of musculo-facial musculoskeletal disorders, therapeutic physical training and massage are shown.

Prevention of acute periostitis

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

• Regularly and correctly brush your teeth.
• Visit the dentist, both for the treatment of dental patients, and for preventive examination.
• With the slightest toothache or suspected caries development, consult a doctor.
• Do not subject your teeth to excessive injuries: do not gnaw nuts and other, too hard foods or objects.
• Introduce in the diet foods rich in calcium (milk, cheese, cottage cheese, beans, oatmeal) and vitamins (fruits, greens, vegetables, berries).

Prognosis of acute periostitis

Time spent therapeutic measures in acute periostitis ensure recovery within three to five days. On the contrary, the lack of adequate treatment threatens the development of osteomyelitis, abscessing of the process, the transition of the acute form of periostitis to chronic.

Thus, acute periostitis is a rather dangerous pathology. If this disease is suspected, you should immediately call a specialist dentist for qualified treatment.