Odontogenic periostitis

The term "odontogenic periostitis" refers to a purulent inflammatory process in the maxillary periosteum, which in everyday life is often called a flux. Flux is a very painful condition that can not be cured at home, so going to the dentist is a prerequisite for a speedy recovery.

Odontogenic periostitis often occurs as a result of untreated or untreated caries of the tooth, while the pathological process is thrown on the periosteum of the alveolar process of the tooth. The disease can occur with injuries and wounds to the jaws.

[1], [2], [3]

Causes of odontogenic periostitis

Rarely, the cause of inflammation in the jawbone is the infection of the blood or lymphatic duct. Provoke the pathological process can also unfavorable factors such as hypothermia, stress and fatigue.

Not so long ago it was established that the non-pathogenic strains of staphylococcus cause odontogenic periostitis. If there is an infectious focus in the periodontium, the pathogenic microorganisms from it through the channels of osteons can fall into the perioth. Similarly, the ailment can cause mixed pathogens: streptococci, gram-positive and-negative sticks, sometimes - putrefactive bacteria.

Young and middle-aged people are the most affected.

• Perhaps the most common cause of periostitis is a tooth damaged by tooth decay. A purulent process develops, and the purulent contents, trying to find an outlet outward, from the upper part of the root breaks through the bone tissue, stopping at the periosteum of one of the jaws. "Pusticule" in Latin translation sounds like "periosteum", which explains the name of the disease - periostitis (inflammatory process in the periosteum).
• The next cause of inflammation may be mechanical damage (tooth breakage) due to biting solid foods, like nuts, or having gum pockets in which an inflammatory reaction develops due to ingestion of food particles.
• Causes of mucosal tissue damage in the mouth, respiratory system infections (laryngitis, pharyngitis), tonsillitis, pathogenic flora in the tooth tissue can become the causes that accelerate the process of periostitis development.
• The appearance of an inflammatory reaction in the periosteum can also result in a cyst of the tooth.
• Often, periostitis occurs as a result of ignoring the progressing caries, with the start of the process.
• The disease can occur if the tooth was not treated, or treated illiterately.
• Periostitis can form if a temporary seal (with arsenic) has been established, which has not subsequently been replaced by a permanent seal.

[4]

Symptoms of odontogenic periostitis

The onset of a disease often resembles the aggravated chronic periodontitis. The patient complains of pain in the tooth, which becomes stronger when you try to chew them. Then there is a swelling of the gums, the transitional fold is smoothed. Gradually, the localization and character of pain change. The patient notes that the pain moved to the gum, it became permanent, pulsating with irradiation in the ear and orbit. Characterized by the type of patient: the face is asymmetrical due to collateral swelling of the tissues. Above the swelling skin of normal color, it can be taken in a crease.

When examining the oral cavity, as a rule, a carious tooth is found, which served as a gateway for infection. It happens that the tooth is healthy, but with a close examination, you can find edge periodontitis or periodontitis, or gum disease over an unbroken tooth. With further research, you can detect the mobility of the tooth, with percussion - soreness. In the gum is an infiltrate, the mucosa is inflamed and hyperemic. The infiltration extends further the projection zones of the aching tooth on the jaw, with the vestibule of the oral cavity being smoothed out, and when an abscess is formed, protrusion appears. If there is a fluctuation in the center of the protrusion, this indicates an already formed abscess. Often this process is not limited only to local events: the patient is feverish, there is general malaise, headaches, aches all over the body.

You can distinguish odontogenic periostitis from other diseases by the following characteristic symptoms:

• one of the first signs is a pain in the tooth or jaw - a sharp, uncontrollable, which does not disappear even after taking painkillers. The pain increases when you try to chew food, or when biting to a sick tooth;
• further there is an accumulation of purulent discharge in the affected area, as a result of which a strong puffiness is formed in the gum area, while not only the area of inflammation but also the part of the cheek swells;
• if the process develops in the area of the lower jaw, then the chin zone may swell. Especially noticeable are enlarged submandibular lymph nodes;
• if the inflammation develops in the maxillary region, the eyelids, upper lip, periglacial zone may swell;
• As the infection progresses, body temperature may increase, to about + 38 ° C. Simultaneously with the temperature there is a feeling of weakness, fatigue, a headache is possible.

Clinical symptoms are most pronounced in patients 30-40 years old. It is noted that in children and the elderly the signs of the disease can be expressed to a lesser degree.

Odontogenic periostitis in children

For children, odontogenic periostitis is a dangerous condition that indicates a very active inflammatory process with low resistance of the child's body. In children, this ailment begins violently and proceeds acutely with a high temperature and symptoms of intoxication. Given the characteristics of the child's body and the vulnerability of the immune system, the risk of complications in children is higher than in adults.

In childhood, the disease can begin with a feeling of growing weakness. The child complains of incomprehensible pain, whether in the ear, or at the temple, while the pain is pulsating and growing. Most often the development of periostitis coincides with the moment of teething. The temperature can rise to + 38 ° C.

The question arises: what is necessary and what can not be done by parents if the child has a flux?

In no case is it advisable to apply warming compresses and heaters to the swollen place, since under the influence of heat, pathogenic microbes will reproduce and spread better. Moreover, do not give the child to drink hot drinks, and the baby should only sleep with a healthy cheek to the pillow.

• Without prescribing a doctor, you should not give your baby any medications, especially analgesics and antibiotics.
• At the first signs of the disease you need to make an appointment with a pediatric dentist. Otherwise, complications and further spread of the infection may occur.
• Do not allow the baby to touch the swollen gum: firstly, it is unhygienic, and secondly, the abscess can be opened.

Calm the child, explain to him that a trip to the doctor is necessary. It is important that the baby does not get scared and understand that they want to help him.

Acute odontogenic periostitis

Under acute odontogenic periostitis is understood acute inflammation in the periosteum, which, in fact, is a complication of caries and periodontal tissue diseases and proceeds violently and limitedly in the period of alveolar processes of two or three teeth. The state of health of a patient with odontogenic periostitis worsens literally every hour: pains in the tooth become worse, they become more and more pulsating, gradually become unbearable, fever, weakness, pain in the head, sleep, appetite. The size of the edema is associated with the structure of the vessels located in the periosteum. The patient needs urgent medical help.

Acute inflammatory process, usually with timely treatment is rapid, but can be complicated by fibrous growths, calcium salt deposits, as well as tissue bone growths or ossifying periostitis.

During the acute course of the process, pronounced edema of the gingival part is very noticeable. The swelling increases simultaneously with the progression of the inflammatory reaction, so the swelling, which previously captured only the gum area, then spreads to the lips, grasping the nasolabial zone, part of the chin, cheek,

If the treatment is not started in time, then the danger of further spread of purulent discharge in the intervals between the muscle tissue on the face and neck increases, which in some cases can provoke even a fatal outcome.

If the painful process proceeds slowly, and the symptoms grow gradually and are not very pronounced, then in such cases it is possible to talk about the chronic course of the disease. In this case, the swelling of the tissues is small: however, a gradual pathological change occurs in the jawbone, which thickens and thickens.

Acute purulent odontogenic periostitis most often affects the area of the first large molars, as well as the wisdom teeth of the lower jaw. In the maxillary zone, the first large and small molars are more likely to suffer. The disease is provoked mainly by a mixed bacterial flora - staphylococcal infection, streptococcal infection, gram (+) and gram (-) rods, occasionally - putrid microorganisms.

Acute odontogenic periostitis of the jaws can be a consequence of difficult dentition, a purulent process of the radicular cyst, inflammation of uncut or incompletely erupting teeth. Also, the pathology can occur after a complex or incorrect removal of the tooth, accompanied by gum injuries and periosteum.

[5], [6], [7], [8]

Acute purulent odontogenic periostitis

Acute purulent periostitis is manifested by intense throbbing pain, which sometimes reaches the temple, eye and ear. When interacting with heat, the pain intensifies, the cold acts soothingly. There is edema, the body temperature rises, the mucous membrane over the lesion is hyperemic. With the accumulation of pus there is an intensification of all signs of inflammation. The cause of the disease, in addition to tooth damage, can also be injuries and fractures.

[9], [10], [11]

Odontogenic periostitis of the jaw

If the infection from the dead pulp of the tooth gets in the periosteum, the odontogenic periostitis of the jaw may develop. The lower jaw is affected most often. The cause of periostitis in the lower jaw can be inflammatory processes in the first large molars and wisdom teeth, on the upper jaw pathological process can begin with the first small and large molars. Characterized by acute pain of a pulsating nature in the affected tooth decay, which becomes stronger with biting and percussion, edema, fever to subfebrile numbers, regional lymphadenitis is possible.

Diagnosis of odontogenic periostitis

Diagnosis is made on the basis of examination, patient complaints, X-ray examination. Radiographically on the periosteum, especially in the initial stages of the disease, you can determine an additional shadow.

Odontogenic periostitis is important in time to diagnose and distinguish from some similar diseases, for example from such:

• periodontitis - inflammation of the periodontal tissue (tissue that surrounds the dental root). In this disease, the tumor does not progress as much as it does with periostitis - the whole process is localized only in the area of the affected tooth;
• odontogenic osteomyelitis - purulent inflammation of the jawbone. With this disease, general discomfort is much more felt: fever, deterioration of well-being, signs of intoxication. In osteomyelitis, not only the affected teeth are hurt, but also those that are located nearby, and also the areas in the chin and lower lip may be dull;
• abscess or phlegmon (abscess, abscess) - strictly localized infectious focus;
• suppurative lesion of lymph nodes - lymphadenitis or adenophlegmon;
• suppurative lesion of the salivary gland.

If the doctor first suspected periostitis, he would necessarily question the patient about his main complaints, conduct an examination of the oral cavity, and then assign certain laboratory examinations. As a rule, the complex of such examinations is limited to radiography.

Differentiate the ailment with acute periodontitis, abscess, phlegmon, osteomyelitis. Odontogenic periostitis differs from other pathological processes in that the center of its inflammation is on top of the alveolar process, and the remaining symptoms of bone damage are not observed. In acute period, especially in children, in the clinical analysis of blood can be observed leukocytosis, increase the number of rods, increase ESR.

[12]

Treatment of odontogenic periostitis

Treatment procedures for odontogenic periostitis may correspond to two methods:

• medicamentous treatment, which is appropriate only at the initial stage of the disease;
• Surgical operation, which is performed in the presence of a formed focus of purulent inflammation.

Medical treatment consists of the following stages:

• elimination of puffiness and relief of the inflammatory process. For this purpose, the doctor prescribes antibiotics (amoxiclav, ampioks, lincomycin, doxycycline, digitum, etc.), or other antimicrobial agents, for example, sulfanilamide preparations;
• influence on the main cause of the appearance of odontogenic periostitis (treatment of caries, treatment or extraction of the tooth, etc.);
• support of immunity and health of the bone system (application of strengthening and immunostimulating therapy, intake of calcium preparations, vitamins, immunomodulators).

The surgical operation is appointed with ineffectiveness of conservative treatment, or with purulent periostitis. What is the operation like?

• the patient undergoes local anesthesia;
• open the formed abscess (in the gums make a cut through which the purulent contents are removed, then establish drainage to ensure the outflow of purulent discharge);
• conduct a control X-ray to clarify the cause of the formation of periostitis;
• prescribe restorative medication, or carry out the removal of the damaged tooth, if its further treatment is impossible.

In complex cases, additional treatment is provided by laser therapy, ultrasound, iontophoresis procedures. The destroyed tooth is covered with a crown, or an implant is placed.

In the initial stages of the disease, as well as in the recovery stage after surgery, alternative therapeutic methods can be used.

• Infusion of herb St. John's wort, sage and oak bark can be used as a mixture, or independently. Insist for at least 30 minutes, filter and rinse the mouth immediately after eating (use only warm solution, but not hot).
• Honey - natural honey can lubricate the swollen gum area, after each meal and overnight.
• Tea from chamomile - it is consumed inside, and also rinse the mouth after eating.

With bleeding of the wound after the opening of the abscess, rinsing of the gums is recommended with chamomile, calendula, plantain, mint, yarrow.

Alternative recipes can be used as an adjunct to medical and surgical treatment, but not in their place. Otherwise, it can lead to further spread of the inflammatory process, or to its transition to a chronic form.

For odontogenic periostitis, complex therapy is used, in which timely surgical intervention is combined with modern drug therapy and physiotherapy procedures.

With timely treatment in the initial stages of the disease, conservative treatment of odontogenic periostitis is possible, which consists only in opening the dental cavity, removing the decaying tissues of the root canal channels and exuding the exudate. Locally used antibacterial drugs and UHF. This can give the process a reverse development. But in the early stages, people rarely turn to specialists, they usually come when acute odontogenic periostitis for some time will "torment them" and the main method of treatment can be only surgical treatment, which consists in opening the focus of inflammation. The operation is performed most often under local anesthesia, in which a two-percent solution of lidocaine or one-two-percent solution of trimecaine is used. Moreover, the solution of anesthetic is introduced into healthy tissues located on the border area with an infiltrate. Sometimes, according to the indications, the patient is assisted under general anesthesia. After the onset of the action of the anesthetic, the operating field is treated with antiseptics and makes a cut in the size of one and a half to two centimeters, it is necessary to dissect the periosteum and the mucosa over it to the bone itself. In order for the purulent discharge to leave unhindered, the formed cavity is drained, introducing into it for a few days a thin drainage. Simultaneously with this procedure, remove the sick tooth, if further to keep it meaningless. In order for the infiltrate to quickly resolve, rinse with a warm solution of sodium hydrocarbonate and potassium permanganate. Very well operates UHF and microwave, a helium-neon laser of low power. Locally apply ointment dressings with "Levomecol", "Levosin" and "Metrogil-denta", lotions with dimethoxide 1: 5.

Well-proven non-steroidal anti-inflammatory drugs: lornoxicam 8 mg per day.

Immediately after surgery, prescribe sulfonamides (sulfadimezin 1-2 grams per day, sulfadimethoxin 2 g per day), analgesic: analgin 50% - 2.0 ml; antihistamines: suprastin 75 mg per day in four divided dimesel 1% - 1 ml; Calcium preparations: calcium chloride 10% - 10 ml on saline 0.9% strictly intravenously, calcium gluconate 1-3 grams per day or intravenously slowly; vitamins: B1, B12, B6 for 1ml every other day, ascorbic acid 500 mg per day, vitamins A (100 thousand IU each) and E (0.2-0.4 g per day); antibiotics that have tropism to the bone tissue - lycomycin hydrochloride 0.6 g per day in twelve hours - with extensive surgical interventions, as well as with general exhaustion and a weak immune system. If the jaws or malfunctions of the facial muscles are reduced, a special course of physiotherapy exercises is shown.

Prevention of odontogenic periostitis

Under the prevention of odontogenic periostitis, the timely treatment of teeth, periodontitis, pulpitis is understood. It is necessary to fight with any foci of infection existing in the body, observe oral hygiene, visit the dentist every six months. Proper nutrition is also important: you need to consume as much as possible fruits and vegetables, especially apples and carrots. Strengthening immunity plays an important role, but unnecessary hypothermia still needs to be avoided, as well as stresses, which weaken the body's resistance to resistance.

Experts have identified a number of simple and well-known rules, observing which, you can prevent the appearance of odontogenic periostitis.

• It is necessary to regularly brush your teeth, paying attention to all the interdental spaces and hard-to-reach places. Remember that most often a periostitis occurs when a carious process is started. Choosing toothpaste for tooth brushing, pay attention to fluoride-containing products, and select a soft brush so that it can not damage the mucous tissues.
• After cleaning teeth it is desirable to use special tooth rinses.
• Pay attention to the condition of the gums: if they bleed, you should definitely show yourself to the dentist.
• Visit the dentist no less than once every six months. If such visits are made regular, then one can not worry about hidden carious processes and the development of periostitis.
• Ask your doctor: you may need to remove dental plaque in which various microbes accumulate. In addition, tartar can periodically injure the gingival margin, which in time will lead to inflammation.
• Pay attention to your food: exclude from the menu products that favor the destruction of tooth enamel - it's sweets, acids, solid foods. Eat more plant foods and dairy products.

Prognosis of odontogenic periostitis

The prognosis of odontogenic periostitis with timely treatment is favorable. But for a complete recovery you need to undergo a full course of recovery procedures, take medications. But if the visit to the dentist is postponed for a long time, there is a possibility of serious complications such as sepsis, osteomyelitis, abscess, phlegmon.

Time provided help will get rid of odontogenic periostitis for 2-3 days. Do not expect that the disease will be cured instantly: it may take some time to restore swollen tissues. Immediately after surgery, the edema may even worsen - this is due to increased blood flow to the tissues during surgery. As a rule, the swelling should completely dissolve during 3 days.

If you do not go to the doctor and try to treat the disease yourself, you can get such unfavorable consequences as fistula formation, the spread of purulent process, the development of abscess or acute jaw osteomyelitis, the development of chronic periostitis.

What conclusions can be made from the above:

• timely and competent therapy in all cases ends with the complete elimination of the pathological process;
• if you do not treat odontogenic periostitis, the disease can worsen, involving the process of bone tissue and soft tissues of the oral cavity.