Jaws periosteum

The inflammatory process, localized in the periosteum, or in the common folate, has the medical name periostitis of the jaw.

Depending on the severity of the course, the disease is divided into the following forms:

• simple - the inflammation is caused by a bruise / fracture of the jaw bones, proceeds with pronounced edema and hyperemia without revealing pathogenic microorganisms;
• ossifying - inflammation of a chronic nature with the characteristic growth of the layers of the periosteum, often covering the soft tissues of the oral cavity;
• fibrous - a characteristic thickening of the layers of the periosteum occurs with a significant formation of fibrous tissue;
• Purulent - due to infectious processes in the teeth an abscess is formed, the disease proceeds in an acute form.

The disease is not self-contained and is a complication due to various dental problems. Clinical practice indicates frequent cases of upper jaw pathology that develops concealed, thereby representing the maximum threat to the patient. Often, the disease is accompanied by a strong pain syndrome and temperature, so do not take self-medication, and if you have anxious symptoms, seek medical help immediately.

ICD-10 code

The international classification of diseases under the K10 coding includes a section of dentistry "other diseases of the jaw", in which periostitis of the jaw refers to inflammatory pathologies with the index K10.22, and chronic periostitis of the jaw - K10.23.

Causes of periostitis of the jaw

Pathology develops in view of various factors. Being the most frequent complication of caries, this disease is dangerous by the blurring of the symptoms and the hidden course. The initial formation of pus is observed in the roots of the teeth, then the focus of the disease extends to the pulp, the outer and inner layers of the pile. Soft tissues are easily involved in the process, if suppuration occurs in the gum area.

The following causes of the disease are distinguished:

• dental diseases are the main cause of infection;
• Inflammation of the teeth without proper and timely therapy;
• penetration of microorganisms from the bloodstream or lymphatic channel, due to infectious diseases (eg, tonsillitis, tonsillitis, etc.);
• spread of infection in the presence of purulent wounds of the face or jaw fractures.

Periodontitis can also serve as a source of inflammation, however, as well as complications resulting from tooth extraction, especially against respiratory diseases or under hypothermia. Very rarely diagnosed allergic and rheumatic form.

Increase the risk of developing the disease stress conditions, a sharp drop in immunity, dental interventions in the period of acute infectious conditions.

[1], [2]

Symptoms of periostitis of the jaw

The disease begins with the swelling of the tissues surrounding the tooth, puffiness gradually increases, with palpation, there is a significant pain syndrome. The appearance of febrile temperature is associated with the achievement of edema of critical dimensions. In the pathological focus is often involved the entire jaw, the zone of temples and eyes.

The following symptoms of the disease are distinguished:

• swelling and redness of the gum area;
• the temperature of the thermometer reaches an index of 38 ° C;
• in the area of the tooth there is a noisy, pulsating type of pain syndrome;
• the pain covers that jaw where the focus of inflammation is;
• tenderness can be moderate, but the pain becomes unbearable with the slightest impact on the affected tooth;
• asymmetry of the face caused by unilateral puffiness is observed;
• lymphadenitis of the regional species.

The symptomatology of the disease differs depending on the etiology, pathogenesis, the location of the foci of suppuration and the duration of manifestation of clinical factors. Sluggish development is most often caused by a fall in the defenses of the body, as a result of which the immune system does not give a vivid answer.

Periostitis of the jaws in children

The child's body has a number of features, not an exception is the anatomy of the structure of the tissues of the maxillofacial zone. The immune system ripens only to seven years, the bone tissue is characterized by good blood supply, soft tissues are characterized by a high degree of hydrophilicity (this property causes a strong puffiness), the barrier function of the lymphatic system is not fully formed. All of the above factors cause instantaneous inflammation of the periosteum with hematogenous and lymphogenic pathways, which entails serious complications and form primary chronic lesions.

Distinguish acute (serous and purulent form) and chronic (simple and hyperplastic stage) odontogenic periostitis of the jaw in children. Acute flow is an independent disease or develops against pulpitis, festering cysts of tooth roots, periodontitis, osteomyelitis. Inflammation of the periosteum of the acute course especially with suppuration is subject to surgical intervention followed by conservative therapy. If necessary, the affected dairy and root teeth are removed. In especially severe cases, dentists recommend taking antibiotics. After surgical manipulation, babies are prescribed a gentle diet, bed rest, copious drinking and mouth rinsing with decoctions of chamomile, St. John's wort or sage. Eliminate swelling, relieve inflammation, relieve pain and normalize the functions of the tissues help physiotherapeutic procedures: UHF, microwave, course of laser therapy, treatment with fluctuating current.

Chronic periostitis of the jaw in children is diagnosed at an older age. Clinically, the disease manifests itself as a characteristic, painless thickening of the jaw. In this case, determine the fate of an infected tooth with a mandatory intake of antibiotics. It is often appointed electrophoresis (potassium iodide, lidase), ultrasound and laser therapy. Children with a chronic form of pathology are under dispensary supervision up to the normalization of clinical and radiological indices.

Acute periostitis of the jaw

Inflammation of the acute type of periosteum in most cases is diagnosed on the jaw from below. Acute periostitis of the jaw was called the odontogenic process, limited by periodontium and caused by the penetration of pathogens into the gum tissue. Acute current causes:

• caries without proper and timely therapy - the disease begins to be hidden from the slow accumulation of pus in the root area. Overgrowth in the active stage is due to any slight irritation of the tooth, which is characterized by inflammation of the jawbones. From the enclosed space, pus, tearing tissue, spreads over the periosteum;
• periodontitis of the neglected type serves as a trigger factor for the development of the acute form of the disease;
• this form of the disease is caused by non-pathogenic staphylococcus present in the oral cavity, which differentiates with a transferred viral disease, a significant decrease in immunity, and the like.

The acute process is divided into: serous, purulent and purulent diffuse purulent. Serious form during the period of onset (the first or second day of inflammation) is characterized by moderate soreness and marked swelling of the soft tissues of the jaw area.

[3], [4], [5]

Acute odontogenic periostitis of the jaws

Purulent infection of the body of the jaw or periosteum of the alveolar process with localization of the primary inflammation focus in the periodontal tissues. This phenomenon often occurs on the jaw from below and is called acute odontogenic periostitis of the jaws. The cause of the pathology is the complication of dental problems (difficulty erupting, trauma in the process of removal, etc.) and a mixed type of flora - strepto-, staphylococcus, gram-positive and gram-negative organisms, putrefactive bacteria.

In the periosteum, the puffiness zone is formed, the tissue structures from the bone are detached. Under the microscope, areas of leukocyte infiltration with changes in blood vessels are revealed. This form of the disease is characterized by a severe clinical course: pulsating pain syndrome, temperature up to 38º C, leukocytosis and lymphadenitis of regional type. Diagnosis of the acute stage of pathology is difficult because x-rays do not determine changes in bone tissue.

With the timely access to a specialist, the correct differentiation of pathology and proper treatment, a quick recovery ensues. In the case of disease progression, an abscess, acute osteomyelitis of the jaw, soft tissue phlegmon can not be ruled out.

[6], [7]

Chronic periostitis of the jaw

Patients with pathology of the periosteum most often turn to a specialist at the stage of the disease, since this form of the disease is marked by a severe, hard-to-treat pain syndrome. In turn, this fact reduces the risk of relapse and minimizes the incidence of chronic course.

Chronic periostitis of the jaw is common in the immunodeficiency of the first / second stage. Chronic form of pathology is often diagnosed in children and adolescents. Incomplete or spontaneous emptying of the purulent discharge in the acute stage leads to a cylindrical densification on the gum, where the purulent exudate constantly accumulates. And the appearance of a chronic form of the disease is possible in the absence of an acute phase.

Chronic disease lasts from a couple months to several years with regular alternations of the stage of remission and deterioration. The cinical picture is inherent:

• inflammation of submandibular lymph nodes and absence of soreness in palpation;
• The face oval is characterized by minor changes;
• in the jawbone region there is a painless densification;
• puffiness and hyperemia of the skin in the affected area.

Diagnosis pathology helps radiography and careful collection of anamnesis.

[8], [9]

Purulent periostitis of the jaw

The accumulation of pus in the periosteum area occurs as a result of previous infectious diseases. In clinical practice, purulent contents are often emptied through the dental canal, provided it is emptied, through the pocket of the gum or fistula. If there is no outlet for pus, the infection from the periodontal passes to the periosteum. Purulent exudate can spread to several nearby teeth.

Isolate a limited and diffuse purulent periostitis of the jaw. Limited form is inherent inflammation of the plate of the alveoli, in the case of diffuse flow pathological focus extends to the entire body of the jaw, including the base.

Limited periostitis is distinguished by a strong pain syndrome, which covers the entire jaw with irradiation into the ears, eyes and temporal region. For this reason, patients complain of a broken, weak condition with constant insomnia, terrible headaches and loss of appetite. Pus can pour itself into the oral cavity, which will bring long-awaited relief.

In the inflammatory process, the tongue, the submaxillary zone, the cheek, the upper palate and tonsils are often involved. Such a spread of purulent exudate complicates speech and masticatory functions. Pain is characterized as an intense, pulsating species that reach its peak during the meal and during the conversation.

Acute purulent periostitis of the jaw

This form of the disease is characterized by an inflammatory process in the periosteum or alveolar process (jaw zone, the place of attachment of the roots of the teeth). Acute inflammation with the formation of pus is more often differentiated on the jaw from below, mainly on large multi-rooted teeth. In the second place in clinical practice - wisdom teeth and small molars (premolars), and the share of canines and incisors account for the smallest percentage of inflammation. Periostitis of the jaw from above is formed when the foci of infection spread from the central teeth (molars and premolars).

Analysis of purulent contents indicates the presence of mixed flora with the presence of strepto-, staphylococci, putrefactive microorganisms, gram-negative and gram-positive bacteria. Therefore, we can make an unambiguous conclusion that the cause of acute purulent inflammation lies in the defeat of pathogenic microflora.

Predisposing factors to the onset of the disease are:

• periodontal disease;
• the formation of pus in the radicular cysts;
• problems associated with teething;
• benign tumors (odontomas);
• injury to the tooth / jaw when removed.

Acute purulent periostitis of the jaw is characterized by an increase in regional lymph nodes.

[10], [11]

Periostitis of the upper jaw

Disease-causing microflora in molars and premolars causes periostitis of the upper jaw. In the inflammatory process, the upper lip, wings and bottom of the nose are involved, which is manifested by pronounced puffiness. Often swollen eyelids, because of what there is a sharp narrowing of the eye gap. When the premolars are affected, swelling spreads to the cheeks, cheekbones, parotid and temporal region.

Purulent inflammation of the acute nature of the upper jaw can have a palatal localization resulting from the spread of infection from the incisors, roots of molars and premolars (the roots of these teeth are closest to the sky). Pus can penetrate the mucosa, causing softening and delamination of the tissues. Cases of a palatine abscess are diagnosed by an increase in submandibular lymph nodes and the presence of a characteristic palatal swelling of the oval or hemispherical shape. Changes in the outline of the face, as a rule, are not detected. The growth of a purulent focus causes smoothing of the transverse folds in the upper sky. For the abscess, the growth of the tumor site on the mucous membrane, the area of the tongue and pharynx is typical, which provokes the painful syndrome when swallowing. Unpleasant sensations accrue as the purulent contents increase and the soft tissue exfoliates, turning food and communication into real torture. Spontaneous outflow of pus in the oral cavity facilitates the patient's condition. If an autopsy of the abscess does not occur, acute periostitis of the upper jaw requires urgent surgical intervention.

Periostitis of the lower jaw

In medical practice this form of the disease of the following species is most often diagnosed:

• odontogenic in chronic form - occurs in patients who have a primary or secondary stage of immunodeficiency, with relapses of acute periodontitis;
• aseptic inflammation of the periosteum - a consequence of a lower jaw injury, the tissues of which are less protected from external influence;
• acute purulent process - affects the zone of large multi-rooted teeth on average or young age, often formed after neglected periodontitis, as well as against the background of a viral infection.

Inflammation in the incisors of the lower jaw causes swelling of the lower lip, chin and chin. Affected premolars and fangs lead to swelling of the corners of the mouth, as well as the lower zone of the cheek. In the pathology of painters edema is located at the bottom of the cheek, in the parotid-chewing and submandibular region. If the infection penetrates the periosteum, it manifests itself in the inflammation of the masticatory and pterygoid muscles.

Acute purulent periostitis of the lower jaw

Purulent inflammation of the acute periosteum is accompanied by a strong, throbbing pain, a sharp deterioration in the general condition, an increase in temperature, a lack of appetite. Such a pathology is revealed mainly on the lower jaw.

As clinical practice shows, this form of pathology is formed as a result of:

• the spread of pathogenic microflora (often of a mixed type) from a diseased tooth of the lower jaw;
• complications of periodontitis of acute or chronic course, including marginal;
• problems associated with teething;
• pus formation in radicular cysts;
• periodontal lesions;
• as a negative consequence of conservative therapy;
• injuries;
• unsuccessful tooth extraction or activation of pathogens after surgery.

Periostitis of the jaws of the acute course with the formation of purulent exudate leads to the appearance of inflammatory puffiness of the soft tissues, the location of which depends on the affected tooth. Tumescence is found on the lower lip, in the zone of the chin, lower cheeks, corners of the mouth. Acute purulent process takes place against the background of regional lymphadenitis. Hyperemic area and swelling of the mucosa of the alveolar process spread to adjacent teeth, a thickened fold is formed, which is easily palpated. The diffuse calciferous region is painful, purulent exudate appears through it. When the sublingual zone is involved in the inflammatory process, the patient complains of soreness during swallowing and limited speech function.

[12], [13]

Diagnosis of periostitis of the jaw

An exact diagnosis can be made by a dentist, which should be consulted when there is an alarming symptom. Classification of the disease is carried out on the basis of a careful collection of anamnesis, clarification of the features of the pathology, the initial examination. If necessary, radiography and laboratory tests are prescribed.

Diagnosis involves the exclusion of similar clinical features:

• acute periodontitis, in which the focus of inflammation is concentrated around the affected tooth (with periostitis, the swelling covers several teeth);
• acute sialoadenitis (pathology of the salivary glands) - the source of pus is the salivary ducts, not the teeth;
• other inflammatory processes - phlegmon, lymphadenitis, abscesses, which are dense neoplasms with the characteristic tension and reddening of the skin. Periostitis of the jaw, on the contrary, entails the softening of tissues with a characteristic swelling of the skin without hyperemia;
• osteomyelitis in acute form - is characterized by general intoxication of the body, including fever, chills, headache, fever, weakness. An important difference is that the alveolar process thickens from two sides, and not from one.

[14], [15]

Treatment of periostitis of the jaw

Therapy of acute suppurative inflammation of the periosteum is a combination of surgical and conservative methods, the purpose of which is the mandatory dissection of suppuration with rapid stabilization of the patient's condition.

Treatment at the beginning of its formation (serous stage) can do without a cut. In this case, the cleansing of the dental canals from purulent exudate. It may be necessary to drain in the cavity of the tooth for spontaneous outflow of purulent contents or removal of the affected tooth. Dental manipulations are performed using an anesthetic of the conductor and infiltration type.

Local anesthesia is important for conditions requiring the dissection of the periosteum. And the medicinal substance is injected into the mucosa along the line of the prospective incision, but not into the zone of suppuration. After opening the abscess, the patient rinses the mouth with a solution of sodium hydrogen carbonate or manganese and the wound surface is treated with chlorhexidine or gramicidin. The decision to remove the tooth is taken by the doctor, based on its functional and aesthetic characteristics. Removal facilitates the expiration of pus and significantly reduces pain syndrome. Treatment with preservation of the affected tooth requires careful processing of the cavity cleared of pus and qualitative sealing.

In cases of acute inflammatory process with removal of pus on the second day, physiotherapeutic procedures are appropriate: light-thermal treatment, laser therapy, warm mouth rinsing with special antiseptics, UHF, sea buckthorn / dogrose / camphor in the form of bandages, and fluxing.

Antibiotics for periostitis of the jaw

Medicinal preparations are divided into groups:

• Nitrofurans - furazolidone, furadonin;
• antihistamines - diazolin, suprastin, dimedrol;
• sulfonamides - norsulfazole, sulfadimethoxin;
• substances with calcium;
• vitamins and multivitamins.

In recent years, antibiotic (lincomycin, macrolide group, as well as preparations based on metronidazole) of a wide spectrum of action have replaced the sulfonamides. Antibiotics are prescribed to suppress pathogenic microflora, preventing the spread of infection to neighboring tissues. Reception of antibiotics is possible in agreement with the attending physician, after revealing the causative agent of pathology. Dosage, duration of treatment is selected individually based on the patient's age, severity and features of the inflammatory process.

It should be remembered that the periostitis of the jaw lends itself to complex therapies, the main of which is surgical intervention. Only antibacterial treatment in most cases does not bring the desired result.

[16]

Treatment of periostitis of the lower jaw

Treatment at the beginning of the formation is reduced to the opening of the suppuration of the tooth region, if necessary, the affected tooth is to be removed. To suppress inflammatory phenomena and prevent relapses, subsequent therapy includes taking antibiotics, vitamins, and treating the wound surface with anesthetics.

Acute inflammation in the periosteum of the lower jaw is subject to mandatory surgical intervention. The operation is performed under local anesthesia with free outflow of purulent exudate. In the arsenal of surgeons have their own special techniques: the use of a sickle-shaped scalpel with the dissection of the perioste along the inner surface of the jaw branch. The abscess of the subperiosteal region is cut vestibularly to the bone along the 2nd and 3rd molars, then the digester moves to the corner of the lower jaw, avoiding the masticatory muscle. The wound is drained, the result of which is checked the next day.

The next stage will be drug treatment, including washing the wound with antiseptics, taking antibiotics, bandages with special ointments (vaseline, camphor / sea-buckthorn oil, etc.). Good results are provided by the physiotherapeutic effect - microwave, laser treatment, fluctuorization and other methods. The final recovery is, as a rule, already on the second-third day after the operation.

Treatment of periostitis of the upper jaw

Operative treatment is carried out in the molar zone along the transitional fold, when using a raspberry / gouged probe, the incision is conducted along the upper hillock, moving backward. Excision in inflammation, covered the lingual surface, do in the place of greatest accumulation and bulging pus. Abscess of the upper sky after dissection requires drainage of the wound with fine rubber (often using glove latex) for the purpose of complete outflow of purulent exudate. Maximize purulent content in this case allows triangular excision of the soft tissue of the mucous membrane.

After the incision is made, the patient needs to rinse the oral cavity with a solution of potassium permanganate or sodium hydrogencarbonate, followed by treatment of the foci of infection with an antiseptic. Irrigation can be shown by distilled water with oxacillin and dimexide, as well as applications using the latter substance.

If the effect of surgical treatment is not observed on the following day, this serves as the basis for placing the patient in a hospital.

Prevention of periostitis of the jaw

Without competent and timely treatment, periostitis of the jaws is dangerous consequences in the form of pus spread to nearby soft tissues and bone structures, osteomyelitis, infection of blood (sepsis). Inflammatory disease is characterized by rapid flow and a severe clinical picture. This is why prevention plays an important role in dental practice, including:

• regular and thorough care of the oral cavity;
• obligatory cleaning of teeth twice a day with paste or tooth powder;
• the use of floss, balsam-rinse, special means (for example, if there are problems with bleeding gums, etc.);
• visit the dentist at least every six months, as well as compliance with all medical recommendations;
• timely curing of any dental problems (caries, trauma, etc.);
• correction of bite and curvature of teeth;
• compliance with hygiene rules during wearing bracket systems, removable plates;
• avoid self-medication, which can exacerbate the problem and lead to irreparable consequences.

Prognosis of periostitis of the jaw

Duration and effectiveness of therapy, absence of complications and relapses of inflammation of the periosteum largely depend on the timely treatment of the patient for qualified care, as well as the correctness of the prescribed treatment.

It can be confidently asserted that the prognosis of the periostitis of the jaw is favorable at the initial stage of development, and a noticeable relief comes already on the fifth day after dental intervention.

Periostitis of the jaws with the formation of a palatine abscess, which is not opened by itself, threatens with necrosis of the bony parts of the jaw or the appearance of osteomyelitis. It should be remembered that mistakes in treatment can lead to overgrowth of inflammation in a chronic form, the formation of an abscess and phlegmon.