Odontogenic periostitis

The term "odontogenic periostitis" refers to a purulent inflammatory process in the jaw periosteum, which is commonly referred to as gumboil. Gumboil is a very painful condition that cannot be cured at home, so a visit to the dentist is a must for a speedy recovery.

Odontogenic periostitis often occurs as a result of untreated or insufficiently treated dental caries, with the pathological process spreading to the periosteum of the alveolar process of the tooth. The disease can occur with injuries and wounds to the jaws.

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Causes of odontogenic periostitis

Rarely, the cause of inflammation in the periosteum of the jaw is the penetration of infection through the blood or lymphatic system. The pathological process can also be provoked by such unfavorable factors as hypothermia, stress and overwork.

It has been recently established that odontogenic periostitis is caused by non-pathogenic strains of staphylococcus. If there is an infectious focus in the periodontium, pathogenic microorganisms from it can enter the periosteum through the osteon channels. The disease can also be caused by mixed pathogens: streptococci, gram-positive and -negative bacilli, and sometimes putrefactive bacteria.

Young and middle-aged people are most susceptible to the disease.

• Perhaps the most common cause of periostitis is a tooth damaged by caries. A purulent process develops, and the purulent contents, trying to find a way out, break through the bone tissue from the upper part of the root, stopping at the periosteum of one of the jaws. "Periosteum" in Latin sounds like "periosteum", which explains the name of the disease - periostitis (an inflammatory process in the periosteum).
• The next cause of inflammation may be mechanical damage (tooth breakage) due to biting hard foods, such as nuts, or the presence of gum pockets in which an inflammatory reaction develops due to the ingress of food particles.
• Causes that accelerate the development of periostitis may include damage to the mucous tissues in the mouth, respiratory infections (laryngitis, pharyngitis), tonsillitis, and the penetration of pathogenic flora into the dental tissue.
• A dental cyst can also lead to the appearance of an inflammatory reaction in the periosteum.
• Periostitis often occurs as a result of ignoring progressive caries, with the process starting.
• The disease may appear if the tooth was not treated properly or was treated incorrectly.
• Periostitis can develop if the patient had a temporary filling (with arsenic) installed, which was not subsequently replaced with a permanent filling.

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Symptoms of odontogenic periostitis

The onset of the disease often resembles an exacerbation of chronic periodontitis. The patient complains of painful sensations in the tooth, which become stronger when trying to chew with it. Then the gum edema appears, the transitional fold is smoothed out. Gradually, the localization and nature of the pain change. The patient notes that the pain has moved to the gum, it has become constant, pulsating with irradiation to the ear and eye socket. The patient's appearance is characteristic: the face is asymmetrical due to collateral tissue edema. Above the edema, the skin is of normal color, it can be taken in a fold.

When examining the oral cavity, a carious tooth is usually found, which served as a gateway for the infection to enter. It happens that the tooth is healthy, but upon careful examination, marginal periodontitis or periodontosis, or inflammation of the gum above the tooth that has not yet erupted, can be detected. Further examination can reveal tooth mobility, and pain upon percussion. An infiltrate is found in the gum, the mucous membrane is inflamed and hyperemic. The infiltrate spreads beyond the projection zone of the diseased tooth on the jaw, while the vestibule of the oral cavity is smoothed out, and when an abscess forms, a protrusion appears. If fluctuation appears in the center of the protrusion, this indicates an abscess that has already formed. Often, this process is not limited to local phenomena: the patient has a fever, general malaise, headaches, and body aches.

Odontogenic periostitis can be distinguished from other diseases by the following characteristic symptoms:

• one of the first signs is pain in the tooth or jaw - sharp, uncontrollable, which does not go away even after taking painkillers. The pain intensifies when trying to chew food, or when biting down on the sore tooth;
• then there is an accumulation of purulent discharge in the affected area, resulting in severe swelling in the gum area, and not only the area of inflammation swells, but also part of the cheek;
• if the process develops in the lower jaw area, the chin area may also swell. Enlarged submandibular lymph nodes become especially noticeable;
• if inflammation develops in the maxillary region, the eyelids, upper lip, and periorbital area may swell;
• As the infection progresses, the body temperature may rise to approximately +38°C. Along with the temperature, a feeling of weakness, fatigue, and possible headaches appear.

Clinical symptoms are most noticeable in patients aged 30-40. It is noted that in children and the elderly, the signs of the disease may be expressed to a lesser extent.

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 disease begins rapidly and proceeds acutely with 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 may begin with a feeling of increasing weakness. The child complains of an incomprehensible pain, either in the ear or at the temple, while the pain is pulsating and increasing. Most often, the development of periostitis coincides with the moment of teething. The temperature can rise to +38°C.

The question arises: what should and should not parents do if their child develops gumboil?

In no case is it recommended to apply warming compresses and heating pads to the swollen area, since under the influence of heat pathogenic microbes will multiply and spread better. Moreover, you should not give the child hot drinks, and the baby should sleep only with the healthy cheek to the pillow.

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

Calm the child down, explain to him that a visit to the doctor is necessary. It is important that the child is not scared and understands that they want to help him.

Acute odontogenic periostitis

Acute odontogenic periostitis is an acute inflammation in the periosteum, which is essentially a complication of caries and periodontal tissue diseases and occurs rapidly and limitedly in the periosteum of the alveolar processes of two or three teeth. The patient's condition with odontogenic periostitis worsens literally every hour: toothache intensifies, it is of an increasing and pulsating nature, gradually becomes unbearable, fever, fatigue, weakness, pain in the head appear, sleep is disturbed, appetite disappears. The amount of swelling is associated with the structure of the vessels located in the periosteum. The patient needs urgent medical care.

The acute inflammatory process usually passes quickly with timely treatment, but can be complicated by fibrous growths, calcium salt deposits, as well as tissue bone neoplasms or ossifying periostitis.

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

If treatment is not started in a timely manner, the risk of further spread of purulent discharge in the spaces between muscle tissue to the face and neck increases, which in some cases can even cause death.

If the disease process is slow, and the symptoms increase gradually and are expressed insignificantly, then in such cases we can talk about the chronic course of the disease. In this case, the swelling of the tissues is small: however, there is a gradual pathological change in the jaw bone, which thickens and hardens.

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 most often affected. The disease is provoked mainly by mixed bacterial flora - this is staphylococcal infection, streptococcal infection, gram (+) and gram (-) rods, occasionally - putrefactive microorganisms.

Acute odontogenic periostitis of the jaws may be a consequence of difficult teething, purulent process of radicular cyst, inflammation of unerupted or not fully erupted teeth. Pathology may also occur after complex or incorrect tooth extraction, accompanied by injuries to the gums and periosteum.

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Acute purulent odontogenic periostitis

Acute purulent periostitis is manifested by intense pulsating pain, which sometimes reaches the temple, eye and ear. When interacting with heat, the pain intensifies, cold has a calming effect. Edema appears, body temperature rises, the mucous membrane above the affected area is hyperemic. With the accumulation of pus, all signs of inflammation increase. In addition to tooth damage, injuries and fractures can also be the cause of the disease.

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Odontogenic periostitis of the jaw

When an infection from the dead pulp of a tooth gets into the periosteum, odontogenic periostitis of the jaw can develop. The lower jaw is affected most often. The cause of periostitis on the lower jaw can be inflammatory processes in the first large molars and wisdom teeth, on the upper jaw the pathological process can begin with the first small and large molars. It is characterized by acute pulsating pain in the tooth affected by caries, which becomes stronger when biting and percussion, swelling, an increase in body temperature to subfebrile numbers, regional lymphadenitis is possible.

Diagnosis of odontogenic periostitis

The diagnosis is made on the basis of examination, patient complaints, and X-ray examination. X-ray examination of the periosteum, especially in the initial stages of the disease, can reveal an additional shadow.

It is important to diagnose odontogenic periostitis in time and distinguish it from some similar diseases, such as:

• periodontitis – inflammation of the periodontium (tissue that surrounds the tooth root). With this disease, the tumor does not progress as much as with periostitis – the entire process is localized only in the area of the affected tooth;
• odontogenic osteomyelitis is a purulent inflammation of the jaw bone. With this disease, general discomfort is felt much more: fever, deterioration of health, signs of intoxication. With osteomyelitis, not only the affected teeth hurt, but also those located nearby, and areas in the chin and lower lip may also go numb;
• an abscess or phlegmon (abscess, boil) is a strictly localized infectious focus;
• purulent lesion of the lymph nodes - lymphadenitis or adenophlegmon;
• purulent lesion of the salivary gland.

If the doctor suspects periostitis first of all, he will definitely ask the patient about his main complaints, conduct an examination of the oral cavity, and then prescribe certain laboratory tests. As a rule, the complex of such tests is limited to radiography.

The disease should be differentiated from acute periodontitis, abscess, phlegmon, osteomyelitis. Odontogenic periostitis differs from other pathological processes in that the center of its inflammation is located above the alveolar process, and other symptoms of bone damage are not observed. In the acute period, especially in children, leukocytosis may be observed in the clinical blood test, the number of rods may increase, and ESR may increase.

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Treatment of odontogenic periostitis

Treatment procedures for odontogenic periostitis can correspond to two methods:

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

Drug treatment consists of the following stages:

• elimination of swelling and relief of the inflammatory process. For this purpose, the doctor prescribes antibiotics (amoxiclav, ampiox, lincomycin, doxycycline, tsifran, etc.) or other antimicrobial agents, such as sulfanilamide drugs;
• impact on the underlying cause of odontogenic periostitis (treatment of caries, treatment or extraction of a tooth, etc.);
• support of immunity and bone health (use of strengthening and immunostimulating therapy, taking calcium supplements, vitamins, and immunomodulators).

Surgery is prescribed when conservative treatment is ineffective, or in case of purulent periostitis. What does such an operation consist of:

• the patient is given local anesthesia;
• the resulting abscess is opened (an incision is made in the gum through which the purulent contents are removed, then drainage is installed to ensure the outflow of purulent discharge);
• a control radiograph is performed to clarify the cause of the formation of periostitis;
• They prescribe restorative drug treatment, or remove the damaged tooth if further treatment is not possible.

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

In the initial stages of the disease, as well as during the recovery stage after surgery, traditional healing methods can also be used.

• Infusion of St. John's wort, sage and oak bark can be used as a mixture or on its own. Infuse for at least 30 minutes, strain and rinse the mouth immediately after eating (use only a warm solution, not hot).
• Honey – natural honey can be applied to the swollen gum area after each meal and at night.
• Chamomile tea is taken internally and also used to rinse the mouth after meals.

If the wound bleeds after opening the abscess, it is recommended to rinse the gums with infusions of chamomile, calendula, plantain, mint, and yarrow.

Folk recipes can be used as a supplement to medical and surgical treatment, but not instead of them. Otherwise, this may 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 physiotherapeutic 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 decayed tissues of the root canals of the tooth and allowing the exudate to drain. Antibacterial drugs and UHF are used locally. This can reverse the process. But in the early stages, people rarely turn to specialists, they usually come when acute odontogenic periostitis "torments" them for some time and the main method of treatment can only be surgical treatment, which consists in opening the inflammation site. The operation is most often performed under local anesthesia, which uses a two-percent solution of lidocaine or a one-two percent solution of trimecaine. Moreover, the anesthetic solution is injected into healthy tissues located on the border area with the infiltrate. Sometimes, according to indications, the patient is provided assistance under general anesthesia. After the anesthetic takes effect, the surgical field is treated with antiseptics and a cut of one and a half to two centimeters is made, the periosteum and the mucous membrane above it are cut down to the bone. In order for the purulent discharge to drain freely, the resulting cavity is drained by inserting a thin drain into it for several days. Simultaneously with this procedure, the diseased tooth is removed if there is no point in keeping it any longer. In order for the infiltrate to dissolve faster, rinses with a warm solution of sodium hydrogen carbonate and potassium permanganate are prescribed. UHF and microwave, low-power helium-neon laser work very well. Ointment dressings with Levomekol, Levosin and Metrogil-Denta, lotions with dimexide 1:5 are used locally.

Non-steroidal anti-inflammatory drugs have proven themselves to be effective: lornoxicam, 8 mg per day.

Immediately after surgery, sulfonamides are prescribed (sulfadimezine 1-2 grams per day, sulfadimethoxine 2 g per day), painkillers: analgin 50% - 2.0 ml; antihistamines: suprastin 75 mg per day in four doses, diphenhydramine 1% - 1 ml; calcium preparations: calcium chloride 10% - 10 ml in 0.9% saline strictly intravenously, calcium gluconate 1-3 grams per day orally or intravenously slowly; vitamins: B1, B12, B6 1 ml every other day, ascorbic acid 500 mg per day, vitamins A (100 thousand IU) and E (0.2-0.4 g per day); Antibiotics that have tropism to bone tissue - lycomycin hydrochloride 0.6 g per day every twelve hours - for extensive surgical interventions, as well as general exhaustion and a weak immune system. If the jaws are clenched or the facial muscles are impaired, a special course of therapeutic exercise is indicated.

Prevention of odontogenic periostitis

Prevention of odontogenic periostitis means timely treatment of teeth, periodontitis, pulpitis. It is necessary to fight any sources of infection existing in the body, maintain oral hygiene, and visit the dentist every six months. Proper nutrition is also important: you need to eat as many vegetables and fruits as possible, especially apples and carrots. Strengthening the immune system plays an important role, but excessive hypothermia should still be avoided, as well as stress, which weakens the body's resistance.

Experts have identified a number of simple and well-known rules, following which one can prevent the occurrence of odontogenic periostitis.

• It is necessary to brush your teeth regularly, paying attention to all interdental spaces and hard-to-reach places. Remember that periostitis most often occurs when the carious process is advanced. When choosing a toothpaste, pay attention to fluoride-containing products, and choose a soft brush so that it cannot damage the mucous tissues.
• After brushing your teeth, it is advisable to use special dental rinses.
• Pay attention to the condition of your gums: if they bleed, you should definitely see a dentist.
• Visit your dentist at least once every six months. If you make such visits regular, you won't have to worry about hidden carious processes and the development of periostitis.
• Consult your doctor: you may need to remove dental plaque, which accumulates various microbes. In addition, tartar can periodically injure the gum line, which will eventually lead to inflammation.
• Pay attention to your diet: exclude from your menu products that promote the destruction of tooth enamel - these are sweets, acids, hard products. Eat more plant foods and dairy products.

Prognosis of odontogenic periostitis

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

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

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

What conclusions can be drawn from the above:

• timely and competent therapy in all cases results in the complete elimination of the pathological process;
• If odontogenic periostitis is not treated, the disease may worsen, with the involvement of bone tissue and soft tissues of the oral cavity in the process.