Treatment of periostitis of the jaw. Symptoms of tooth periostitis with a photo, treatment of inflammation of the periosteum of the lower or upper jaw

The periosteum of the tooth resembles a dense film that almost completely covers its root. With the development of an inflammatory process in this area, they speak of periostitis. In the people, this disease is called "flux". Severe pain, swelling and hyperthermia are just some of the symptoms that characterize it. If you do not see a doctor in time or neglect treatment, you can lose a tooth.

What is periostitis?

The periosteum of the tooth is a vascular tissue consisting of many nerve fibers and cells. Together they form young bone. It is the main link for fastening the tooth with muscle tissue and ligaments. Due to such close proximity and a large number of vessels, any infection spreads freely in the periosteal elements, provoking an inflammatory process. Such a mechanism of development has periostitis.

The disease can occur at any age, but is rarely diagnosed in children and the elderly. The favorite place of localization of the pathological process is considered to be the teeth of the lower jaw. They are more likely to suffer from various dental ailments. However, periostitis is most dangerous for the teeth of the upper jaw. In addition to bone tissue and gum mucosa, the sinuses themselves may be affected.

Main reasons

There are many reasons for the development of periostitis. teeth in oral cavity are constantly at work. With improper care, they become a real target for various dental diseases.

The tooth most often occurs as a result of an infectious process. Food remains constantly accumulate in its cavity or in the gum area. Over time, they begin to rot. From the top of the tooth, pus forms a channel in the bone tissue, trying to break out. Breaking through all the obstacles, he stops under the periosteum.

Among other causes of periostitis, dentists distinguish:

• traumatic tissue surrounding it;
• running carious process;
• inflammation of the gum pocket;
• neglect;
• infection with the blood stream.

Reduced immunity, stress and frequent hypothermia also contribute to the development of pathology.

Symptoms of inflammation of the periosteum

The inflammatory process begins immediately after infection or traumatic damage to the gums. Within a few hours, severe swelling develops in this area. The gums increase in size, painful discomfort appears while eating.

Gradually, periostitis of the tooth spreads to neighboring soft tissues. As a result, the jaw, chin and lips swell slightly. Palpation may cause pain. In some people, the asymmetry of facial contours becomes clearly visible. The whole process is necessarily accompanied by hyperthermia. If you do not see a doctor at this stage, an abscess may develop in the affected area.

What other symptoms does tooth periostitis have? Outwardly, the affected area looks like a swollen mucous substance with a cloudy white coating. The tooth becomes excessively mobile. When the inflammatory process is accompanied by suppuration, it constantly tries to escape from the capsule. With a positive result, self-cleansing of the cavity occurs. However, without adequate treatment, cases of relapse are not excluded. Abscesses will reappear with some frequency.

Classification of periostitis

Any disease differs in forms corresponding to the clinical picture. Only a qualified specialist can determine the stage of the pathological process and its type. To do this, it is not enough for him to conduct a physical examination. Additionally, a snapshot of the affected area, a study of the patient's history may be required.

Periostitis of the tooth is usually classified into 2 types: acute and chronic. In the first case, the disease is characterized by the rapid formation of edema, multiple fistulas. Through the formed passages, an outflow of purulent secretion occurs. Chronic periostitis is characterized by a slow course, its symptoms appear several days or weeks after infection of the gums.

The acute form of the disease is divided into the following types:

• Serous periostitis. Accompanied by the formation of a small amount of serous exudate, infiltration of the periosteum.
• Purulent periostitis. It is characterized by the appearance of an abscess and the formation of fistulous passages through which pus is poured out. Otherwise, the serous discharge begins to accumulate, severe edema occurs.

The chronic form of the disease also has several stages of development:

• Simple periostitis. It is characterized by the formation of new bone tissue on the surface of the jaw. This process is considered reversible.
• Ossifying periostitis. Accompanied by ossification and hyperostosis. The disease progresses very quickly.

The chronic form of the disease also includes fibrous periostitis of the tooth. According to the degree of damage, it is limited and diffuse. In the first case, there is a fibrous thickening of the periosteum in the region of one tooth, and in the second - on the entire jaw.

Diagnostic methods

To make a correct diagnosis, the doctor needs not only to examine the patient's oral cavity, but also to conduct a comprehensive examination. The patient is prescribed to determine the boundaries of the focus of inflammation. In the purulent form of the disease, it is mandatory general analysis blood.

Other dental pathologies that need to be distinguished have a similar clinical picture. Otherwise, the prescribed treatment will be ineffective, and the periostitis of the tooth will pass into the chronic stage.

Differential diagnosis is carried out with the following diseases:

1. Acute periodontitis. It is characterized by the development of an inflammatory process at the root apex. Reaching the stage of exacerbation, purulent exudate breaks out, forming a fistulous passage.
2. lymphadenitis. These pathologies are accompanied by the appearance of dense formations. The skin above them is slightly hyperemic.
3. A purulent secret is secreted from the salivary ducts. Teeth and gums remain intact.
4. Acute osteomyelitis. With this disease, the temperature rises sharply, the patient feels chills throughout the body. There may be headaches.

Based on the results of a comprehensive diagnosis, the doctor prescribes therapy.

Drug treatment

Regardless of the form of the disease, therapy always begins with the appointment of medications. For example, with purulent periostitis, antibiotics are recommended. The following agents are characterized by the greatest efficiency: "Lincomycin", "Tsiprolet", "Amoxicillin". For topical application, various gels and ointments are used, also made on the basis of antibiotics (Levomekol, Metrogil-Denta). With a strong inflammatory process, it is better to drink tablets or capsules. Flux treatment with antibiotics is continued until the symptoms disappear completely.

Additionally, anti-inflammatory drugs are prescribed. Usually it is Nimesil or Diclofenac. These drugs not only relieve inflammation, but also relieve pain.

It must be understood that drug therapy is part of the whole course of treatment. Therefore, when the first symptoms of periostitis appear, you should consult a doctor. Uncontrolled and prolonged use of drugs can not only harm, but also aggravate the course of the disease.

Surgery

Treatment of flux with antibiotics is justified only at the initial stage of the development of the disease. If the patient ignored its first manifestations and did not consult a doctor, an abscess may appear. In this case, surgical intervention is indispensable. The operation is carried out in order to create conditions for the full outflow of purulent secretion, to eliminate the source of infection. It consists of the following steps:

1. First, the dentist examines the focus of inflammation, determines the course of treatment and selects the type of anesthesia. Usually a conductive or infiltration option is used.
2. After treatment of the oral cavity, the doctor makes an incision of about 2 cm. The depth of periodontal excision is reached by the jaw bone tissue.
3. The opened abscess is carefully cleaned, treated with a disinfectant solution.
4. The next step is the preparation of the dental crown.
5. Medicines are injected into the cleaned canals, the tooth itself is sealed.

In especially serious cases, tooth extraction is indicated.

Recovery after surgery

Periostitis of the tooth, the treatment of which was carried out in a timely manner, is practically not accompanied by complications. However, after surgery, it is important to follow certain rules. With their help, the rehabilitation process will go faster, and the risk of negative consequences will be equal to zero.

The recovery period includes rinsing the mouth with antiseptic solutions, the use of analgesics, and good hygiene. Since the likelihood of recurrence still exists, it is necessary to examine the cured teeth every day. Both the gums and the tissues around them can re-inflame.

Completely periostitis passes in 10 days. During this time, only food at room temperature is allowed. In this case, special attention should be paid to its consistency. Meat is recommended to grind into minced meat, and mash vegetables and fruits. After each meal, you need to rinse your mouth with antiseptics. You can buy them at every pharmacy.

How to remove flux at home?

Application folk remedies acceptable in the fight against disease. However, you must first consult a doctor and eliminate the cause of the abscess. Otherwise, such treatment will only ease the symptoms, but will not lead to a complete recovery.

How to remove flux at home? Among the variety of folk remedies, the following are especially effective:

• rinsing with a weak solution of soda;
• the use of infusions and decoctions based on anti-inflammatory medicinal plants(sage, chamomile, mint, calendula);
• applying ice to the affected area to reduce swelling.

It is important to understand that periostitis is an inflammatory process, so it is impossible to heat the gums and teeth. The same principle must be followed when using compresses and rinses. The temperature of the water in the infusions should not exceed 25 degrees.

Prevention measures

To prevent inflammation of the periosteum of the tooth, it is necessary to treat all foci of infection in a timely manner. This applies to minor caries and serious forms of periodontitis. Many chronic diseases are asymptomatic and can only be seen on x-rays. For the purpose of prevention, dentists recommend periodically undergoing examinations and professional teeth cleaning.

Periostitis is a serious pathology in which severe inflammation of the periosteum occurs. The disease is quite common and often diagnosed. With this disease, the patient does not feel pain, but suffers from heat and swelling, he develops purulent contents. Only a surgeon can help in this case.

The disease can develop at absolutely any age, but is rarely diagnosed among children and the elderly.

Distinguishing the disease from others is very simple: it is accompanied by severe swelling, which simply cannot be overlooked. As a rule, the pathological process is due to the influence of infection.

Periostitis of the upper jaw

When the roots become inflamed or the canals of the teeth are affected, the infectious process spreads to tissues and mucous membranes. As a result, pus is formed in large quantities that breaks through the bone. This is where swelling and pain occurs.

Periostitis of the upper jaw(photo above), is insidious in that the pathological process can spread to the sinuses. Most of the face will swell. Swelling occurs on the basis of the causative tooth. This can swell the lips, cheeks and other parts of the face.

However, this form of the disease is not common. As a rule, periostitis of the lower jaw is diagnosed (photo below). Most often, the last teeth are affected. They grow quite difficult and are subject to various pathologies. Often, patients remove eights.

Periostitis of the lower jaw

Etiology

As already mentioned, most often the disease is due to the presence of an infection. This occurs when the channels are damaged, when the nerves become inflamed, or when the treatment of these diseases is ineffective. Bacteria enter the oral cavity from food and through plaque.

The fault may also be insufficient oral hygiene, physical and mechanical injuries, blood diseases of an infectious nature, which can lead to adverse consequences.

Hence the infection of the lymphatic system.

Given the factors of occurrence, the disease is classified into:

• inflammatory form, which is a consequence of various various dental pathologies;
• traumatic, as a result of which a flux develops;
• toxic, in which an infection enters the oral cavity;
• specific, resulting from serious pathological processes in the body.

Varieties of pathology

Pathology varies based on symptoms and other criteria. Only a professional can correctly define the form of the disease. The tactics of treatment will depend on the stage of the pathology.

There are two forms pathological process: acute and chronic. The first is accompanied by severe swelling and the formation of pus.

In the chronic form, the course of the disease is somewhat sluggish, muffled, and develops for quite a long time.

If the disease proceeds in an acute form, it can be:

• serous, when an average volume of serous contents and infiltration is formed;
• acute, when an abscess and fistulous paths form, through which the purulent contents flow out. If there are no fistulous passages, then there is a lot of content and the patient develops severe edema.

In the chronic stage, the disease is also distinguished by category:

The fibrous form of the disease also has a chronic course. In this case, a fibrous thickening of the periosteum is formed. According to the stage of the lesion, the disease is classified into limited and diffuse. The first one affects one or more teeth, while the diffuse one affects the entire jaw.

Clinical picture

Each disease has its own symptoms. With the help of these signs, one disease can be easily distinguished from another. The course of the disease depends on the degree of damage and defensive forces body and general health. However, other common symptoms of periostitis of the upper and lower jaws are also characteristic.

If we talk about the serous form, then with it there is swelling of the mucous membranes, an increase in the lymph nodes. In the purulent form, patients feel worse in general health, which manifests itself as weakness, impaired rest and wakefulness, and headaches. Discomfort can be felt both in the area of ​​the pathological tooth and can be given to other parts of the face.

In a chronic course, a person feels periodic pain, a thickening of the alveolar part is observed, hyperemia and swelling of the mucosa occur.

Swelling is normal for this disease. It may disappear when fistulous passages form on the mucosa. In no case should you leave the disease unattended, otherwise everything can end badly.

How to distinguish from other pathologies

At the appointment, the doctor will ask the patient in detail about the symptoms of the pathology, prescribe an x-ray examination and laboratory tests. However, similar manifestations are often observed in other diseases that should be differentiated, otherwise the therapy will be ineffective.

Periodontitis

Similar diseases:

• with periodontitis, the root also becomes inflamed, over time, the pathological process progresses more and more. Purulent contents in the acute stage breaks out, creating a fistulous tract;
• diseases in which there are dense formations. Periostitis of the jaw is manifested by softening of the mucous membranes and swelling of the face without any special discharge on the skin;
• inflammatory process of the salivary glands. In this case, the infection comes from the salivary passages, and not from the diseased tooth;
• osteomyelitis is accompanied by general intoxication. Observed high performance temperature, fatigue, headaches, fever. This disease occurs as a result of untreated periostitis.

Complications of periostitis

Many people, due to some reasons and circumstances, delay their visit to the doctor for a long time. Even if severe pain begins to bother them, they get confused by all sorts of home methods to drown it out, but do not go to the doctor. The reasons for this behavior are absolutely unjustified: lack of finances, time, dislike for doctors. One way or another, contacting a dental clinic is the first thing on which your further tactics of behavior depend.

If you do not treat the disease in a timely manner, it will certainly move to another more severe stage, which will lead to irreparable complications. It is not difficult to treat the flux, but negligence in one's health can even lead to death.

The most common complications are the formation of abscesses and phlegmon. If the problem is ignored, the purulent contents will sooner or later break through its capsule to the surface.

In the absence of an appropriate course of therapy for phlegons, they increase in size, affect healthy bone and muscle tissue. The process proceeds with severe pain, fever, weakness, soreness when swallowing, speech and respiratory disorders.

If the disease is not treated in a timely manner, it will definitely go into a more severe stage.

Do not ignore such an infectious disease as periostitis. This pathology is very dangerous because the infection sooner or later penetrates the bloodstream, which causes general malaise and poisoning of the whole organism.

Features of therapy

Patients often ignore this problem, not understanding the seriousness of the situation. They explain their behavior by the fact that if there is no pain, then there is no need to contact a specialist. It is worth saying that this behavior is unacceptable for a sane person. The sooner you start treatment, the better the prognosis.

It's not wise to sit and wait that the pain will go away on its own. The disease does not go away on its own and it requires special attention. When the disease is diagnosed at an early stage, the patient is prescribed antibiotics to prevent the inflammatory process. A diseased tooth may be removed or treated if appropriate. After inspection x-ray the doctor will decide what to do in a particular case.

If swelling occurs, therapy is carried out in several steps. First of all, therapeutic measures should be aimed at removing the inflammatory process and swelling. The doctor makes a surgical opening, as a result of which pus comes to the surface. The person immediately feels better and his condition returns to normal.

The opening of the periostitis is performed in the place of the greatest swelling.

After this manipulation, drainage is installed in the wound, which does not allow the wound to heal. This is done in order to allow the pus to drain completely and to prevent relapse. Together with these measures, the patient is prescribed a course of antibiotics and after that a decision is made to remove or treat the tooth.

Non-traditional ways

It is not correct to treat this disease at home.

You can achieve a full recovery only in a hospital, but how can you help yourself when there is no way to get to a medical facility?

Folk remedies will help to slightly alleviate the symptoms of the disease until you get to the doctor. Rinse your mouth with an infusion of soda and salt or herbal decoctions. Suitable chamomile, sage, St. John's wort. Never try to take antibiotics on your own. Only a doctor prescribes such drugs, otherwise you will harm the whole body.

5.2. PERIOSTITIS

Periostitis - This disease is characterized by the spread of the inflammatory process to the periosteum of the alveolar process and the body of the jaw from an odontogenic or non-odontogenic focus.

Periostitis of the jaws occurs in 5.2-5.4% of patients treated in the clinic (Ya.M. Biberman, 1965; A.N. Fokina, D.S. Sagatbaev, 1967). Among patients with odontogenic inflammatory processes of the jaws, periostitis in 3.42% was treated on an outpatient basis and in 19.17% - in a hospital (Mauks, 1975). According to our data (A.A. Timofeev, 1983), in 20-23% of patients who were hospitalized with inflammatory diseases, periostitis was observed, mainly its acute form (in 94% of patients).

Periostitis was localized on one side of the jaw, often affecting it from the vestibular surface (in 93.4% of patients). In the region of the lower jaw, periostitis was observed in 58.9% of patients, the upper - in 41.1% (GA. Vasiliev, T.G. Robustova, 1981), and according to our data, in 61.3 and 38.7%, respectively (A.A. Timofeev, 1983).

♦ Acute periostitis

The occurrence of acute odontogenic periostitis is preceded by the following diseases: exacerbation of chronic periodontitis - in 73.3% of patients; alveolitis - in 18.3%; difficult eruption of the wisdom tooth - in 5.0%; festering odontogenic cysts of the jaws - in 1.7%, periodontitis - in 1.7% of patients. The disease often develops after a traumatic tooth extraction, with incomplete extraction, and less often after an atraumatically performed surgical intervention. The trauma associated with the extraction of a tooth can cause the activation of a dormant infection located in the periodontal gap, which leads to the spread of the inflammatory process under the periosteum.

Acute odontogenic periostitis is serous and purulent. Serous periostitis is considered as a reactive inflammatory process in the periosteum, which accompanies exacerbated chronic periodontitis. With purulent periostitis, exudate from the inflamed periodontium penetrates under the periosteum through the Volkmann and Havers canals, through the lymphatic vessels or through the previously formed uzura in the wall of the hole (GA. Vasiliev, 1972).

I believe that with such a mechanism for the spread of the infectious process, it is difficult to imagine acute odontogenic periostitis, complicated by abscesses and phlegmon, occurring without pronounced destruction of bone tissue. In an experiment conducted on animals and human corpses, which consists in introducing a methylene blue solution into the tooth socket, root canal or periodontal gap under pressure, A.I. Vasilenko (1966) noted its distribution along the medullary trabeculae to all sections of the lower jaw and surrounding soft tissues.

According to M.M. Solovyova and I. Khudoyarova (1979), the spread of the infectious process under the periosteum by the lymphogenous route during periostitis is less likely, since in these cases it is more likely to expect the retention of microbes, toxins and tissue decay products in the regional lymph nodes and the subsequent development of lymphadenitis and adenophlegmon. The authors believe that the formation of an abscess in the maxillary soft tissues is not associated with a breakthrough of pus under the periosteum, but with the formation of "own" pus in this place under the influence of microorganisms, bacterial toxins and tissue decay products.

In my opinion, the products of tissue decay of microorganisms, toxins, and sometimes the microbes themselves from odontogenic foci penetrate into the periosteum along the vessels that pass in the channels of the compact bone layer. The first penetration of these substances usually does not cause the development of an inflammatory process, but only forms a local tissue sensitization. The subsequent entry of microbes into the body, as well as a decrease in its reactivity, with an increase in allergization, with para-allergic reactions (hypothermia, overheating, physical overstrain, etc.) causes the development of an infectious-allergic inflammation with subsequent effusion of exudate under the jaw periosteum (A.A. Timofeev, 1982).

It has been established that non-pathogenic staphylococcus usually acts as the causative agent of the disease. Since the waste products of this microflora do not have a damaging effect, the author assigns a special role to the mechanisms of allergy in the occurrence of odontogenic periostitis.

When studying microbial sensitization of the patient's body to pathogens located in the focus of purulent inflammation of the jaw using intradermal tests and laboratory tests, we found that in patients with acute odontogenic periostitis, it occurs in response to the action of certain bacterial allergens. The sensitization of the body to the allergen of staphylococcus was 3 times higher than the norm, to the allergen of streptococcus - 2 times (A.A. Timofeev, 1982). In the occurrence of acute odontogenic periostitis of the jaws, the main predisposing factor is microbial sensitization to staphylococcus, the frequency and severity of which correlate with the severity and prevalence of the process. With uncomplicated acute odontogenic periostitis, it was registered by us in 22% of patients, and when its course was complicated by purulent processes in the maxillary soft tissues - in 46%.

Thus, the participation of allergy mechanisms explains the reasons for the development of odontogenic inflammation caused by non-pathogenic microflora, and the predominant damage to the perimaxillary soft tissues that occurs in certain forms of acute odontogenic inflammatory diseases (MM Solovyov, I. Khudoyarov, 1979).

CLINICAL PICTURE . Clinical manifestations during acute odontogenic periostitis of the jaws are diverse and largely depend on the general and local reactivity of the patient's body, the type of inflammatory reaction, the virulence of the microflora and the localization of the inflammatory process in the periodontium and the age of the patient. In most cases, it is possible to establish a connection between the occurrence of periostitis and previous paraallergic reactions: hypothermia, overheating, physical or emotional overstrain. In other patients, especially those with reduced body reactivity, the disease develops more slowly. Especially often this course of the process is observed in elderly and senile people, as well as in the presence of concomitant diseases, such as diabetes, circulatory disorders II-III degree, chronic diseases of the digestive system.

According to our research, the cause of acute periostitis of the lower jaw in 22.9% of patients is the focus of inflammation located in the tissues of the first large molars, in 17.8% - the third large molars, in 12.3% - the second small molars. The development of acute odontogenic periostitis of the upper jaw is due in 24.8% of patients to the presence of a focus of inflammation in the tissues of the first large molars, in 11.6% of the second large molars (A.A. Timofeev, 1982).

In acute periostitis, the inflammatory process develops vestibularly in 93.4% of patients and proceeds in an acute serous form in 41.7%, in an acute purulent form in 58.3%. With this form of acute odontogenic periostitis, detachment of the periosteum over 1 tooth is noted in 20% of patients, over 2 teeth - in 56%, over 3-4 teeth - in 24%.

Patients complain of pain in the tooth, aggravated by touching it with the tongue or an antagonist tooth, swelling of the face. The pain, which was previously localized in the area of ​​​​the causative tooth, during this period is characterized as pain in the jaw. In 8.9% of patients, its irradiation was noted along the branches of the trigeminal nerve to the region of the ear, temple, and eye. The general condition of patients worsens, weakness, headache, sleep disturbance, loss of appetite, chills, and malaise appear.

Paresthesia of the lower lip (Vincent's symptom) is noted in 11.7% of patients and is determined only in those in whom the inflammatory process is localized on the lower jaw in the region of large and small molars.

The body temperature in 92% of patients increases: in 20% - from 37 to 37.5 ° C, in 28% - from 37.6 to 38 ° C, in 44% - from 38, HS and above.

In acute odontogenic periostitis of the jaws, soft tissue edema appears, which can be expressed to one degree or another. The localization of the edema is usually quite typical and depends on the location of the causative tooth. At the beginning of the disease, soft tissue edema is most pronounced. According to V.G. Lukyanov (1972), the amount of edema depends on the structure of the vascular (venous) network of the periosteum. With a small-loop form of branching of the vessels of the lower jaw, soft tissue edema is not very pronounced, with the main one (the area of ​​the tubercle of the upper jaw, angle and branch of the lower jaw) it has a significant length. We observed pronounced soft tissue edema around the affected area in 67% of patients with acute odontogenic periostitis of the upper and lower jaws.

On palpation of the soft tissues at the location of the subperiosteal inflammatory focus, a dense, painful infiltrate was determined. In 82% of patients, regional lymph nodes were painful, enlarged, had a densely elastic consistency, but retained mobility. With the localization of the inflammatory process in the area of ​​large molars in 60% of patients with acute periostitis, inflammatory contracture muscles:I- when there is only a slight restriction of mouth opening;II- when the mouth opens 1 cm;III- when the jaws are tightly closed and independent opening of the mouth is impossible. In other cases, the restriction of mouth opening is associated with the fear of opening the mouth wide because of the pain that occurs.

When examining the oral cavity in the area of ​​the affected teeth, one can detect hyperemia and swelling of the mucous membrane of the transitional fold and the alveolar process of the jaw. As a result of examination of patients with acute odontogenic periostitis of the jaws, its serous form was revealed in 42%, and purulent in 58%. When the process passes into a purulent form, a roller-like protrusion is formed along the transitional fold - a subperiosteal abscess. If pus melts the periosteum and spreads under the mucous membrane, then subdes neva (submucosal) abscess.

The crown part of the causative tooth is partially or completely destroyed, the carious cavity and root canals are filled with putrefactive content. In the area of ​​the tooth that served as the source of infection, a deep periodontal pocket can be found. Sometimes this tooth is filled. Pain reaction to percussion of the causative tooth was noted in 85% of the examined, and neighboring teeth (one or two) - in 30%. The causative tooth becomes mobile in 37% of patients. In the event of acute periostitis as a result of alveolitis in 10% of patients, we observed (within 2-3 days) the release of purulent exudate from the hole of the extracted tooth. In 60% of patients with odontogenic periostitis, acute sinusitis was detected, which was a complication of the inflammatory process in the upper jaw when it was localized in the area of ​​large and small molars (A.A. Timofeev, 1982).

An X-ray examination of the jaws did not reveal any changes characteristic of acute periostitis; granulating or granulomatous periodontitis, periradicular cysts, semi-retained teeth, etc., were found prior to the process (Fig. 5.1.1-5.1.5).

Changes in the phagocytic activity of peripheral blood neutrophil granulocytes were not detected in patients (the exception was patients with concomitant diseases). The results of a blood test in the initial period of the development of the disease indicate an increase in the number of leukocytes (9-12 * 10 9 / l), and sometimes even higher. Only in some patients the number of leukocytes is within the normal range or leukopenia is observed. The increase in the number of leukocytes occurs due to segmented neutrophilic granulocytes (70-76%) and their stab forms (8-20%). The number of eosinophilic leukocytes can decrease to 1%, and lymphocytes - up to 10-15%. ESR increased to 19-28 mm/h, and sometimes more. In patients with acute odontogenic periostitis, an increase of 2-4 times (compared with healthy people) was found in the activity of alkaline and acid phosphatases of peripheral blood neutrophilic granulocytes. In most patients, no changes were found in urine tests, only in some individuals with high temperature body in the urine appeared protein (from traces to 0.33 g/l), sometimes leukocytes.

When studying the microbial sensitization of the body, its presence was established in 22% of patients with acute odontogenic periostitis and in 46% of patients with its complication by purulent processes in the maxillary soft tissues. The sensitization of the organism to the allergen of staphylococcus increased by 3 times, to the allergen of streptococcus - by 2 times. The presence of the fact of preliminary microbial sensitization later served as the basis for non-specific microbial hyposensitization in patients with this disease (A.A. Timofeev, 1982).

Features of the clinical course of acute odontogenic periostitis depending on the localization of the process . The clinical course of acute odontogenic periostitis depends on the location of the tooth, which was the cause of the development of the inflammatory process.

With the spread of the inflammatory process from the focus, located on the upper jaw from the vestibular side, in the region of the incisors, there is a significant swelling of the upper lip and wing of the nose, which can extend to the bottom of the lower nasal passage. In some cases, purulent exudate can penetrate under the periosteum of the anterior part of the bottom of the nasal cavity, especially with a low alveolar process, and form an abscess there. In the case when the inflammatory process begins from a focus located in the region of the central incisor, the edema can spread to the entire upper lip, and if in the region of the lateral incisor, it can capture the soft tissues of one half of the face. With the spread of purulent exudate from the lateral incisor towards the hard palate, in the region of its anterior section, a swelling of a hemispherical or oval shape that is painful when touched appears and a palatine abscess is formed.

In cases where the cause of the disease is an inflammatory process, located in the region of the upper canines, edema extends to the infraorbital and part of the buccal region, the corner of the mouth, the wing of the nose, the lower and even the upper eyelid. The focus of inflammation is always located on the vestibular surface of the alveolar process of the upper jaw.

If the source of infection is an inflammatory focus, located in the tissues of the small molars of the upper jaw, then collateral edema captures a significant area of ​​​​the face and is located somewhat to the side. It spreads to the infraorbital, buccal and zygomatic regions, often to the lower and upper eyelids. The nasolabial fold is smoothed out, and the corner of the mouth is lowered. Facial swelling may be absent when purulent exudate from the palatal roots of 414 teeth has spread to the palatal surface. In this case, a hemispherical protrusion is formed in the middle part of the hard palate - a palatine abscess. The constant contact of the palatine abscess with the tongue causes increased pain, so the patient's eating and speech are difficult.

Acute odontogenic periostitis, arising from a source of inflammation located in the region of the upper large molars, is characterized by swelling that captures the zygomatic, buccal and upper part of the parotid-masticatory regions. Swelling rarely spreads to the lower eyelid, and almost never spreads to the upper eyelid. The edema reaches the auricle. A few days after the development of the process, soft tissue edema begins to descend, which can create a false impression that the pathological focus comes from small and large molars of the lower jaw. With the spread of purulent exudate from the palatine root of 616 teeth towards the palate, there is no asymmetry of the face. Detachment of the dense periosteum in this area causes severe aching, and then throbbing pain in the palate. Due to the fact that the submucosal layer on the hard palate is absent, the edema is slightly pronounced. Spontaneous opening of the abscess usually occurs on the 7-10th day, which can lead to the development of cortical osteomyelitis.

For purulent periostitis, in which the inflammatory process spreads from tissues to the area of ​​the lower incisors, characteristic is the presence of edema of the lower lip, chin and chin area. At the same time, the chin-labial furrow is smoothed out. When the inflammatory process spreads to the periosteum from a focus located in the area lower canine and small molars, edema captures the lower or middle parts of the buccal region, the corner of the mouth and extends to the submandibular region. If the source of infection is a focus of inflammation located in large molars of the lower jaw, then collateral edema captures the lower and middle sections of the buccal region, the parotid-masticatory and submandibular regions. When the inflammatory process spreads to the periosteum in the region of the angle and branch of the lower jaw, the edema is not pronounced, but has a significant extent. Due to the fact that chewing muscles are located here, inflammatory contracture appears.

The study of lymph nodes in acute purulent periostitis, especially when the process is localized in the lower jaw, allows us to note that not single nodes are enlarged and painful, but their whole groups.

Anatomically, in the lower jaw, the inner bone wall is thinner than the outer one. Therefore, acute periostitis, the cause of which was a focus located in the region of the large molars of the lower teeth, can extend to the lingual surface of the alveolar process. In this case, there is hyperemia, swelling of the mucous membrane of the alveolar process and the sublingual region. The hyoid roller on the side of the lesion increases and bulges between the tongue and the lower jaw. The tongue is swollen, covered with plaque, teeth marks are visible on it, its movements are painful, it is raised and shifted to the healthy side. If the inflammatory process spreads from the lower wisdom teeth, then the infiltrate can be located in the region of the pterygo-mandibular fold and the anterior palatine arch, which causes severe pain when swallowing. In the case when inflammation captures the pterygoid muscles, inflammatory contracture occurs.

These are the main signs of the clinical manifestation of acute odontogenic periostitis. It should be emphasized that most of them are inherent in other acute inflammatory diseases of the jaws, so differential diagnosis is necessary.

Pathological changes in periostitis of the jaw characterized by the accumulation of purulent exudate between the bone and the periosteum. Dystrophic changes occur in the bone tissue: lacunar resorption of the bone substance, expansion of the Haversian canals and bone marrow spaces. As a result of these processes, a significant thinning occurs, and in some areas the disappearance of the cortical layer of the bone and adjacent bone trabeculae. At the same time, there is a penetration of purulent exudate from under the periosteum into the Haversian canals and its transition to the peripheral parts of the bone marrow spaces (GA. Vasiliev, 1973).

DIAGNOSTICS . Differences of acute (exacerbated chronic) periodontitis from acute odontogenic periostitis are determined by the fact that in the first case, the focus of inflammation is localized within one tooth, and in the second, the inflammatory process goes beyond it and spreads to the periosteum. The course of acute odontogenic periostitis is characterized by such signs as chills, asymmetry of the face, thickening of the alveolar process, mobility of the causative tooth, positive percussion and mobility of neighboring teeth, inflammatory contracture of the jaws (with the localization of the process in the region of large molars of the lower jaw). With the help of laboratory methods, it was proved that in patients with acute odontogenic periostitis, the activity of phosphatases of neutrophilic granulocytes in the early phase of inflammation was significantly increased (A.A. Timofeev, 1981).

In the clinical picture of acute odontogenic periostitis, uncomplicated and complicated by perimaxillary purulent processes, we did not find a significant difference in the incidence of clinical symptoms, which can be used to make a differential diagnosis of this disease and acute odontogenic osteomyelitis of the jaws in the early phase of inflammation. From the foregoing, it follows that their early diagnosis only for individual clinical symptoms is very difficult and is based on a combination of clinical data. (A.A. Timofeev, 1982).

Acute odontogenic periostitis should be differentiated from inflammatory diseases of the sublingual and submandibular glands and their ducts. It should be remembered that with periostitis, the salivary glands are never involved in the inflammatory process. When massaging the inflamed salivary glands and their ducts, muddy or purulent-streaked saliva is released from the mouths of the excretory ducts. With the help of X-ray examination of the soft tissues of the floor of the oral cavity, salivary stones can be detected (with calculous sialadenitis).

During the differential diagnosis of acute odontogenic periostitis and acute nonodontogenic lymphadenitis it is necessary to examine the alveolar process of the jaw. With lymphadenitis of non-odontogenic origin, there are no changes in the teeth and mucous membrane of the alveolar process of the jaw, which occur in acute periostitis.

TREATMENT . In acute serous odontogenic periostitis, the removal of the causative tooth leads to recovery. The subsidence of inflammatory phenomena is facilitated by the appointment of physiotherapeutic methods of treatment (UHF in an athermal dose, warming compresses, Dubrovin bandages, fluctuorization, helium-neon laser beams, etc.).

In acute purulent periostitis, the tooth that served as a source of infection is removed if it does not represent functional and cosmetic value. In other cases, it is preserved and after the inflammatory process subsides, it is subject to treatment. Simultaneously with the extraction of the tooth, an opening of the subperiosteal abscess is performed. The incision is made over three teeth, dissecting the mucous membrane and periosteum along the transitional fold to the bone. To prevent adhesion of the edges of the wound, it is drained. Drainage is left in the wound for 1-2 days. After opening the abscess on the hard palate, a small area of ​​soft tissues (triangular in shape) is excised. In this case, adhesion of the edges of the wound does not occur and reliable drainage of the abscess of the palate is ensured. In the case when the inflammatory focus is located on the lingual side of the lower jaw, the abscess is opened with a linear incision, which is performed above the transition point of the mucous membrane of the alveolar process to the sublingual region.

In the postoperative period, patients are prescribed medication: antibiotic therapy is prescribed only for weakened persons or with concomitant diseases (ampicillin or oxacillin sodium salt, oleandomycin phosphate or oletethrin, monomycin, kanamycin), sulfanilamide preparations - sulfadimethoxine, sulfapyridazine; painkillers (amidopyrine, analgin, phenacytin or paracetamol); sleeping pills.

Due to the fact that in patients with acute odontogenic periostitis of the jaws, the presence of preliminary microbial sensitization was revealed, which can be eliminated by conducting a course of nonspecific hyposensitizing therapy, we prescribed the following drugs to all of them: diphenhydramine, diazolin, suprastin, etc.

To remove pus released from the wound into the oral cavity and speedy resorption of the inflammatory infiltrate, oral rinses (40-42X) with a warm weak solution of potassium permanganate, 1-2% sodium bicarbonate solution or furacilin solution (1: 5000) 3-4 times were prescribed. times a day. For antiseptic rinses, you can use an infusion of chamomile flowers, calendula, sage leaves and other medicinal plants. I.G. Lukomsky (1955) believes that the movement of a warm mass of solution in the oral cavity (when rinsing) is an effective hydrothermotherapeutic procedure that helps to eliminate inflammation as soon as possible. The use of higher temperature solutions for these purposes causes stagnation in the focus of inflammation (Yu.I. Vernadsky et al., 1983).

Particular attention was paid to the treatment of regional lymphadenitis, since this complication can turn into an independent disease and thereby significantly prolong the period of disability for patients. On the 2nd - 3rd day, the patients were prescribed UHF therapy in an athermic dose, fluctuorization. For the treatment of lymphadenitis, you can also use warming half-alcohol compresses at night, electrophoresis with potassium iodide, magnetic applicators, helium-neon laser beams.

In order to prevent acute sinusitis, which can occur as a complication of odontogenic periostitis of premolars and molars of the upper jaw, it is necessary to prescribe daily use (for 5-6 days) of vasoconstrictive drugs (1-3% ephedrine solution, 0.1% solutions of naphthyzinum or sanorin , galazolin) and UHF or microwave on the area of ​​the maxillary sinus. To make sure that acute sinusitis has not taken on a chronic course, after 2 weeks, a control x-ray examination of the accessory cavities of the nose can be performed.

♦ Chronic periostitis

In adults, the disease develops rarely and, according to our data, occurs in 5.3-6% of patients with periostitis (VV Roginsky et al., 1983). There is a pathological process more often in young or childhood, localized more often on the lower jaw. (V.G. Lukyanov, 1972). Distinguish simple and ossifying chronic periostitis, as well as his refining form. At simple chronic periostitis newly formed osteoid tissue undergoes regression after treatment, with ossifying form - Ossification of the bone develops in the early stages of the disease and most often ends with hyperostosis. Rarefischy periostitis characterized by pronounced resorptive phenomena and restructuring of bone structures.

The cause of chronic periostitis of the jaws, as a rule, is its transition from the acute form of the disease. Preceded by chronic periodontitis and trauma. The disease can occur with suppuration of jaw cysts, inflammatory processes in the maxillary sinuses, as well as as a result of trauma caused by removable and non-removable dentures. The presence of a chronic inflammatory focus in the periodontium causes in some patients a sluggish localized inflammation of the periosteum with a predominance of the productive component (Ya.M. Biberman, A.G. Shargorodsky, 1985). Since chronic periostitis is not always preceded by an acute phase of the process, it should be attributed to primary chronic diseases. At post-mortem examination it can be seen that the affected area of ​​the periosteum is a spongy bone tissue, on the surface of which there is a thin cortical layer. The network of intertwining bone trabeculae has a different degree of maturity - from osteoid beams and primitive coarse fibrous trabeculae to mature lamellar bone tissue. Found in these layers bone is also at different stages of maturation (Ya.I. Gutner, N.I. Kushnir, 1970). Chronic proliferative inflammatory changes in the periosteum are difficult or not at all reversible.

Ignoring dental problems often leads to complications and the emergence of new dental diseases. Among these, a place of honor is occupied by periostitis of the jaw, better known to the people as a flux. Most of those who face this problem do not fully realize the seriousness of this disease. Lack of treatment is fraught with serious problems, so you should not delay a visit to the doctor.

Periostitis - what is it?

Despite the fact that the disease outwardly looks like an abscess of the gums, in fact it is an inflammation of the periosteum or periosteum. The disease affects a thin layer of connective tissue above the jaw bone. There are other varieties of the disease: periostitis tibia, calcaneus and other bones. If you do not start treatment on time, the layer of connective tissue gradually becomes thicker and begins to flake off, which causes even more problems.

The essence of the disease lies in the fact that serous fluid or pus begins to collect in the cavity between the jawbone and the periosteum. The onset of the disease is accompanied by symptoms such as severe pain, which first appear only when chewing food, gradually developing into continuous acute pain. As no inflammation goes away without an increase in temperature, so with acute maxillary periostitis, it can reach a subfebrile value.

Periosteal disease occurs in people of all ages, less often in young children. The first sign of flux is severe swelling of the cheeks. Many patients mistakenly believe that warming up a sore spot has a positive effect, but the inflammatory process is activated, the pain becomes unbearable and complications in treatment appear.

Varieties and symptoms of the disease

The classification of this disease is quite complicated. In dentistry, it is divided into several forms, depending on the following factors:

• from the form of the disease (acute and chronic);
• from the peculiarities of infection penetration into the periosteum (odontogenic, hematogenous, lymphogenous and traumatic);
• on the size of the affected area (limited and diffuse);
• from layers (retromolar, acicular, linear acute periostitis, lacy, fringed and others);
• from the ways of infection (toxic, traumatic, specific and inflammatory).

The classification of the disease does not end there, since some of these forms have their subspecies, for example, the acute form of periostitis is purulent or serous, depending on what fluid accumulates in the cavity between the jaw and the periosteum, and the chronic flux is divided into simple and ossifying. In the first case, the inflammatory process and changes occurring in the jaw bone tissue are reversible, and in the second case, hyperostosis occurs and ossification begins.

Linear odontogenic periostitis is a disease that begins as a result of neglected dental diseases (caries and others). With a lymphogenous disease, the infection affects not only the periosteum, but also the lymph nodes. Through the blood, the source of infection enters with a hematogenous form of acute periostitis. If the disease appeared as a result of trauma to the periosteum, then we are talking about a traumatic form of the disease.

When the disease affects the tissues in the area of ​​​​one or more teeth, then this disease has a limited form. Diffuse acute purulent periostitis affects the entire bone.

In the toxic form, the disease occurs by getting into the oral cavity of infection, and inflammation is the result of neglected dental diseases, which are accompanied by inflammatory processes. A specific form of the disease occurs against the background of pathological conditions of the oral cavity and teeth.

upper jaw

When inflammation occurs in the region of the upper jaw, the infection is activated in the anterior and chewing teeth. There is swelling and inflammation of the tissues of the upper lip, sometimes the nose, which can cause a lot of inconvenience and discomfort. Periostitis, formed on the jaw, is often accompanied by swelling of the eyelids, cheekbones and temples.

Purulent inflammation most often affects the palate, purulent masses penetrate through the mucous membranes into the shell, followed by its exfoliation. Often this process is accompanied by inflammation of the lymph nodes, and the outlines of the face in this case remain practically unchanged, and slight swelling can be observed. With an inflammatory process in the upper jaw, it is difficult for the patient to talk and eat due to severe pain and limited swelling opportunities.

Rarely, the place of suppuration spontaneously opens, bursts, after which the contents of the cavity flow out and there is significant relief and swelling disappears. With severe pain, you should not wait until everything breaks by itself, it is better to go to dentistry to open the abscess and clean the cavity where the pus was collected with special antiseptics.

With periostitis in the upper jaw, the maxillary sinuses, eye sockets and middle ear are highly vulnerable, which is fraught with complications in the ears, eyes and sinusitis. Purulent acute periostitis is much more difficult and entails serious problems than periostitis of the lower jaw.

Lower jaw

Periostitis of the lower jaw occurs against the background of a progressive purulent disease. In the lower jaw, pathological changes are possible not only in bone tissues, but also in soft ones. Often, untreated caries and neglected dental diseases are the cause of periostitis of the lower jaw. Odontogenic periostitis is a common form of inflammation, one of the symptoms of which is swelling, which can be seen in the photo below.

In the lower jaw, periostitis occurs more often than in the upper. First hallmark This type of disease is a dull growing pain, which at the beginning of the disease manifests itself during meals or when pressing on the tooth, and swelling of the lower jaw area. Over time, the pain intensifies, gives to the ear, to the temples, swelling increases.

Periostitis of the tooth is often found among children who have dental problems due to advanced caries or pulpitis. The infection spreads through the blood and lymph. Ignoring the problem leads to an aggravation of the situation and complications in the form of periostitis of the neck, eye sockets and other areas.

The inflammatory process in the periosteum can also occur due to a decrease in immunity and a weakening of the protective function of the body, as a result of which odontogenic acute periostitis of the jaw develops. This disease refers to recurrent, which, after another exacerbation and relapse, can develop into a chronic form. The disease may be the result of injury to this area, and the onset of aseptic (traumatic) inflammation of the jaw.

Other types of periostitis

The inflammatory process in the periosteum is possible not only on the jaw bones, but also on the heel, nasal, humerus, tibia, fibula. The symptoms of the disease may also vary. There are the following types of the disease:

• Simple (a consequence of inflammation of muscle tissue, periosteum). This form occurs on the tibia and olecranon.
• Purulent periostitis (a consequence of infection with a bacterial infection - staphylococci and / or streptococci). The cause of the purulent form of the disease may be a nearby focus of infection in the form of phlegmon, wounds, osteomyelitis and others. The affected area is tubular bones.
• Fibrous (a consequence of systematic irritation of the tissues of the periosteum with trophic ulcers, arthritis, necrosis and other diseases).
• Tuberculous periostitis (characterized by the appearance of fistulas, from which a purulent mass flows). Predominantly occurs on the ribs and/or in the area of ​​the skull.
• Ossifying is the most common type among all varieties of the disease. The cause of the occurrence is the same factor as in the fibrous form of the disease. The sites of damage are the bones of the wrist, vertebrae and bones of the tarsus. This type of disease is characterized by growth.
• Syphilitic (a type of disease caused by tertiary or congenital syphilis).
• Load (a consequence of strong loads on the ligaments and their sprains).
• Albuminous serous (or post-traumatic, which is the result of trauma in the area of ​​\u200b\u200bthe ribs and / or long tubular bones).
• Retromolar (a disease that occurs against the background of complications during the eruption of wisdom teeth).

Treatment of inflammation of the periosteum

Treatment of periostitis of the upper and lower jaws can be carried out depending on the situation, the size of the tumors, the severity and form of the disease by different methods. Often, dentists use several methods at the same time to speed up the treatment of acute purulent periostitis and increase its effectiveness. The method of treatment of periostitis of the jaw may be as follows:

• surgical (operational);
• therapeutic;
• medication;
• physiotherapy;
• unconventional.

During surgical intervention, the inflamed gum is opened and all contents are removed from the resulting cavity, as well as tissues affected by acute purulent periostitis. Then the dental canals are opened, which are thoroughly cleaned of pus, after which the dentist processes them. medicine and installs a temporary filling. A few days later, at the next visit to the doctor, the canals are sealed, and a permanent filling is placed on the tooth. To verify the effectiveness of the treatment, the patient is assigned a control x-ray.

The therapeutic method involves opening the tooth, cleaning it from serous fluid and filling the canals. This method is effective only in acute serous form of inflammation of the periosteum.

In many cases, there is no need for surgery. The doctor prescribes to the patient a set of medications that will help stop the growth of the flux, relieve inflammation and resist bacterial infection. Antibiotics, anti-inflammatory, analgesics, antihistamines are often prescribed. It is strongly not recommended to prescribe and take antibiotics on your own, this should be done by a doctor.

The physiotherapeutic method is most often used in cases of chronic and traumatic forms of periostitis of the tooth. The essence of the method is the impact on the tumor with such devices as a laser, UV lamp, electrophoresis and others.

Among folk methods Treatments use solutions and decoctions of herbs for rinsing. The most effective of them are soda-salt solution, as well as a decoction of chamomile flowers, calendula, sage and other herbs that have antiseptic, wound healing and anti-inflammatory properties. Warming up and compresses are strictly prohibited, as this will only aggravate the inflammatory process.

Complications of the disease

Untimely treatment of periostitis and a frivolous attitude to this problem can cause a number of complications and complicate the treatment process. If purulent periostitis is not treated, it can cost a life, at best, such a negligent attitude to health will lead to the fact that the acute form will smoothly turn into a chronic one. The most harmless form of this disease is acute serous, in contrast to purulent periostitis, which is a huge risk to human health and life.

In acute purulent periostitis, surgical intervention is indispensable, since not every flux can be opened without the help of a doctor. For example, if an abscess is located in the sky zone, then its independent opening is impossible, and the lack of timely treatment is fraught with necrosis of the palatine bone and osteomyelitis.

The sooner qualified assistance is provided to the patient, the greater the chances of a successful outcome and a quick cure. Do not delay with treatment, as the inflammatory process is rapidly spreading, and it becomes more difficult to cure it.

Prevention of periostitis

Prevent the appearance of periostitis of the jaw and possible complications in the form of sepsis, osteomyelitis and other serious diseases, compliance with preventive measures will help.

Be sure to take proper care of your mouth and teeth. This will make it possible to avoid a number of problems - caries, stomatitis, pulpitis and purulent maxillary periostitis.

1. To brush your teeth, you should use high-quality toothpaste, floss, brush, and also use toothpicks and chewing gums if it is not possible to brush your teeth after each meal. After brushing your teeth, it is advisable to thoroughly rinse your mouth with a special tool that removes what is left after brushing and fights pathogenic bacteria.
2. Fear of dentists can cause dental diseases, including acute periostitis. It is necessary to visit dentistry at least twice a year, since a regular examination by a doctor will help to identify the problem in time and eliminate it immediately, even if it is chronic periostitis of the tibia.
3. A balanced diet enriched with vitamins, useful and vital important trace elements- a guarantee of the health of the whole organism, including the dental part.

Periostitis is a dental pathology characterized by an inflammatory process in the tissues of the periosteum, which occurs in the lower or upper jaw. People of reproductive age are susceptible to the disease, but sometimes flux (aka periostitis) is diagnosed in elderly patients or children.

The disease proceeds quite severely and is accompanied by a pain syndrome of high intensity, which most patients cannot cope with on their own. To prevent complications (for example, sepsis), it is important to seek medical help at the first sign of periostitis.

Periostitis of the lower jaw

Periostitis is a complication that accompanies infectious diseases of the oral cavity. Poor personal hygiene, caries, poor oral care - all these factors contribute to the entry of bacteria into the dental canals and onto the tooth root. As the inflammatory process develops, purulent contents are formed, which penetrate into the surrounding tissues: the mucous membranes of the gums, bone tissue, etc.

It is easy to distinguish the flux from other dental diseases, since suppuration quickly increases in volume, breaks through, and a strong edema forms at the site of the lesion. The patient's temperature rises (sometimes to very high levels), symptoms of general intoxication appear.

Periostitis of the lower jaw in medical practice occurs several times more often than the defeat of the upper teeth. About half of all diagnosed cases of flux occur in the eighth teeth, as they are difficult to cut through, have anatomical structural features and are prone to infectious and inflammatory processes.

Periostitis is a complication that accompanies infectious diseases of the oral cavity.

Why does periostitis appear?

Dentists cite poor dental control and poor oral hygiene as the main cause of the disease. Most often, inflammation of the periosteum occurs as a result of untimely treatment of periodontitis and pulpitis, as well as in the presence of carious teeth (especially if the patient has been walking with bad teeth for several months or years). The ingress of food debris into periodontal pockets, the formation of plaque also create ideal conditions for the reproduction of pathogenic microorganisms and infection of tissues.

Other causes of periostitis include:

• injuries of the lower jaw;
• tonsillitis and other infectious diseases of the upper respiratory tract;
• furunculosis of the oral cavity;
• blood poisoning.

Sometimes bacteria and microbes enter the dental canals through infected lymph, but this situation is extremely rare.

Schematic representation of periostitis

Due to the occurrence of periostitis is divided into 4 types.

Inflammatory	The most common type of disease. Occurs as a result of complications with untimely or insufficient treatment of dental diseases (most often - pulpitis and periodontitis)
Specific	Inflammation develops under the influence of general intoxication in systemic diseases of the body (for example, infection with Koch's wand)
Traumatic	The surrounding tissues of the tooth root can be damaged as a result of mechanical impact, but such situations occur extremely rarely (no more than 5-7% of cases)
Toxic	The reason for this flux is the ingress of bacteria into the tissues of the periosteum during infectious diseases of the oral cavity or respiratory tract (stomatitis, tonsillitis, pharyngitis, etc.)

Types and stages

Flux can occur in an acute stage, in which the symptoms and signs of pathology are pronounced, and the course itself is characterized by increased soreness of tissues and the formation of edema, or a chronic form, which doctors call sluggish. Each of the forms of the disease differs in clinical symptoms and has features of the course that must be taken into account when determining methods of treatment and selecting drug therapy.

Forms of periostitis

Acute stage

The acute stage of periostitis has two forms: serous and purulent. In the serous form, the formation of serous contents occurs - a physiological fluid that resembles human blood serum. After some time, infiltration of the periosteum occurs - the bone tissue is saturated with serous fluid, becomes inflamed, and severe pain appears. In the case of attachment of the bacterial flora, inflammation develops, and the pathology passes into a purulent form.

Purulent periostitis can occur with the formation of fistulous passages through which pus enters the oral cavity. If this does not happen, pus accumulates in the tissues of the periosteum, and a volumetric edema forms at the site of the lesion, which is popularly called a flux.

Definition of acute purulent periostitis of the jaw

chronic stage

If the patient did not receive the necessary treatment at the acute stage of the pathology, the inflammation takes on a chronic form with sluggish symptoms and significant risks of complications. Chronic periostitis can be of several types. The classification of the disease is presented in the table below.

Most often in medical practice there is a limited periostitis of the lower jaw, when the lesion affects several teeth. In rare cases, the inflammatory process can cover the entire jaw - then they say that we are talking about diffuse periostitis.

Chronic periostitis. Description

Symptoms and signs

Clinical symptoms differ depending on the form, stage of the disease, localization of the lesion, the state of the immune system and other factors. One of the first signs of inflammation of the periosteum is swelling of the gums, which quickly spreads to the surrounding tissues. The pain may be moderate, but with pressure on the site of the lesion, the patient experiences intense pain, which is poorly relieved by drugs.

Other signs of acute periostitis include:

• throbbing pain inside the damaged tooth;
• asymmetry of the face, which is the result of profuse edema;
• redness of the gums;
• swelling of the area around the affected tooth;
• temperature rise to 38-38.5 degrees.

Important! Pain always appears on the side in which the inflammatory process is localized. Sometimes the pain syndrome can be moderate, but as the disease develops, the patient experiences severe pain that can spread to the area of ​​the temples, neck and eye sockets.

Symptoms of acute periostitis of the jaw

Chronic periostitis has the same symptoms, but their severity is sharply reduced due to the lack of an immune response. The temperature at this stage rarely rises and usually stays within subfebrile values.

Diagnosis of pathology

In order to correctly determine the cause of the pain, you need to contact a specialist. To begin with, you can go to a dentist-therapist, who will give a referral for an x-ray and, based on its results, redirect you to a specialized specialist. If the pain is accompanied by the outflow of pus, the formation of edema or fever, you can immediately contact a dental surgeon or maxillofacial surgeon (these specialists are available in district hospitals).

To clarify the diagnosis, the patient must undergo X-ray or tomography of the lower jaw.

Differential diagnosis of periostitis

Important! Self-treatment of periostitis is unacceptable, since there is a high probability of confusing the pathology with other dental diseases that have similar symptoms (periodontitis, phlegmon, lymphadenitis, etc.). The correct diagnosis can only be made by an experienced specialist after taking an anamnesis and examining an x-ray.

X-ray of periostitis of the lower jaw

Periostitis in childhood

In childhood, the disease is rarely diagnosed, but sometimes mandibular periostitis can even affect milk teeth. In children, the most common acute form occurs, which is extremely painful and is characterized by rapid development. Several factors contribute to this:

• insufficient activity of the immune system (finally, the child's immunity is formed by the age of 6-7 years);
• anatomical features of the structure of the teeth;
• increased supply of bone structures with blood in childhood;
• increased hydrophilicity (the ability to absorb and retain liquids) of connective tissue and mucous membranes;
• incomplete formation of the protective function of the lymphatic system.

Acute periostitis of the lower jaw in children

Purulent periostitis in the acute stage, diagnosed in a child, requires surgical treatment using surgical methods. After removal of pathological tissues and drainage of purulent contents, children are prescribed conservative treatment:

• a diet that excludes the intake of lumpy foods that require thorough chewing (mashed and ground cereals, mashed potatoes, soups);
• rinsing with decoctions or infusions of calendula, string, chamomile to prevent inflammatory reactions, disinfection of the oral cavity (children who cannot rinse their mouths on their own can be treated with a napkin soaked in a medicinal solution);
• bed rest;
• increase in the amount of fluid consumed;
• physiotherapy treatment (UHF, laser therapy).

Important! Antibiotics for children are prescribed only in complicated cases. It is impossible to give a child antibacterial drugs without a doctor's prescription - preventive antibiotic treatment should be carried out according to strict medical indications.

Treatment of mandibular periostitis in adult patients

Treatment of pathology in patients over 18 years of age is carried out in three stages, each of which has its own characteristics.

Video - Treatment of periostitis, causes and symptoms

First stage: operation

Acute purulent periostitis is a direct indication for surgical intervention. Manipulations are performed under local anesthesia. General anesthesia is used in exceptional cases, for example, when the patient is very afraid and nervous. With a special scalpel, the surgeon dissects the tissues of the periosteum, cuts the abscess and drains the wound. During the operation, free outflow of pus is ensured.

The order of the operation for periostitis

Stage two: drug therapy

At this stage, the patient is prescribed the following types of treatment:

• the imposition of sterile dressings soaked in a disinfectant solution or medicinal ointments;
• taking antibiotics to prevent complications and relapses;
• washing the wound surface with antiseptic compounds.

Third stage: physiotherapy

To eliminate the pain syndrome after surgery and accelerate the regeneration (healing) of tissues, the patient is prescribed physiotherapy. Depending on the degree of the initial lesion, the depth of the incision, the postoperative condition of the patient, the doctor may prescribe the following procedures:

• laser treatment;
• current treatment, etc.

Further treatment after surgery for periostitis of the jaw

When does recovery come?

A significant improvement and elimination of the symptoms of the disease occurs already 2-3 days after the surgical treatment. We can talk about complete recovery on the 7-10th day - it is at this time that the patient stops taking antibacterial drugs.

Despite the elimination of symptoms, the patient is prescribed a sparing regimen and a special diet for 3-5 days to prevent complications and accelerate the regeneration of periosteal tissues.

Is it possible to do without surgery?

Conservative therapy of mandibular periostitis is possible only at an early stage of formation (serous form). In this case, the doctor removes pus from the dental canals, followed by the installation of a drain to drain the exudate. Great importance has the correct filling and follow-up, so patients with periostitis are registered with the district dentist for six months.

Consequences of periostitis

Prevention measures

Improper treatment or untimely seeking medical help can lead to severe complications - sepsis, osteomyelitis, etc. To prevent this from happening, it is important to follow preventive measures aimed at preventing periostitis and other dental pathologies.

1. Teeth should be brushed after every meal. If this is not possible, you should at least remove large pieces of food by rinsing or flossing.
2. To brush your teeth, you need to use a quality toothpaste that suits the specific type of teeth. It is best to choose a hygiene product, taking into account the recommendations of the attending dentist.
3. Preventive examination should be carried out at least once every 6 months. This will help to identify existing problems in time and take measures to eliminate them.
4. The diet should include a sufficient amount of protein foods and foods containing calcium.
5. Malocclusion should be corrected as early as possible. While wearing braces, your teeth require increased care and meticulous hygiene.

The main preventive measure is the timely treatment of any dental pathologies, injuries and infectious lesions of the teeth and gums. Some endure discomfort to the last, as they are afraid of the dentist. It is not right. Now all hospitals and clinics use modern anesthetic drugs that allow you to completely remove any pain during treatment, so you should not put off going to the dentist, especially if the tooth starts to hurt or there is increased bleeding.

Periostitis of the upper and lower jaw refers to common purulent-inflammatory diseases of the maxillofacial region. Its symptoms are obvious, and the treatment has a favorable outcome.

Inflammation of the periosteum, manifested by a change in the shape of the face and severe pain, is commonly called a flux. Although there is no such term among official medical diagnoses.

A large number of people, especially those who inattentively monitor the condition of their teeth, have encountered periostitis at least once in their lives. The patient's condition is weakened due to severe pain that occurs in response to the formation of purulent exudate. A dentist will help you deal with the problem.

Description of periostitis of the upper and lower jaw

Periostitis is an inflammatory lesion of the periosteum, it is a thin connective tissue lining the surface of the bone. In this case, it thickens and peels off. Purulent or serous fluid accumulates in the space between the bone and the periosteum. The disease is characterized by severe, sometimes unbearable, pain, deterioration of health, fever to subfebrile values.

Periostitis of the jaw affects people of all ages, but occurs much less frequently in children. This is due to the fact that it is a consequence of periodontitis, which was not cured in a timely manner. Infection from the cavity of the tooth through the hole at the top of the root penetrates into periodontal tissues, from where inflammation spreads to the periosteum.

But the very first and noticeable manifestation is swelling of the cheek. Depending on whether inflammation develops in the upper or lower jaw, the localization of edema is different.

With periostitis in the upper jaw, edema can be located:

1. vestibular.
2. From the side of the sky.
3. Diffuse bilateral inflammation.

At the same time, the area from the wing of the nose, the lower edge of the orbit and directly the cheek swells on the face. The danger of maxillary periostitis is associated with the likelihood of inflammation moving into the sinuses of the bone.

Periostitis of the lower jaw is more common. The configuration of the face changes due to the localization of swelling in the area of ​​the jaw angle, or in the submandibular space.

Causes

The most common type of periostitis is inflammation arising from the affected teeth, which is called odontogenic. healthy tooth cannot cause swelling of the periosteum. In order to start the purulent-inflammatory process, the presence of microorganisms is necessary.

If the tooth and gums around it are completely healthy, then the bacteria do not penetrate inside. With poor-quality treatment of the tooth cavity, the presence of periodontal pockets, complicated caries, involvement of the periosteum in the process may occur.

The etiology and pathogenesis of the disease are well studied and confirmed by clinical practice, so the treatment of periostitis does not cause difficulties.

Why does periostitis of the jaw occur:

• complicated caries is a source of spread of pathogenic microbes. Through the microtubules, they penetrate into the tooth, from where they spread through the apical opening to the periradicular tissues;
• chronic apical periodontitis is a common cause of periostitis formation. The long-existing pathogenic microflora in the canal system gradually moves deeper, in the absence of proper treatment, it initially affects the soft tissues, and later the periosteum;
• staphylococcus is a permanent inhabitant of the oral cavity. When immunity is weakened, its population increases and becomes the cause of inflammation of the periosteum.

In addition to inflammation of the periosteum, which develops from the teeth, there are other causes. However, their prevalence is much lower:

• traumatic damage to the organs of the oral cavity;
• spread of the source of infection through the blood vessels;
• lymphogenous lesion of the periosteum;
• periostitis that occurs with tuberculosis;
• some systemic diseases can give complications to the periosteum of the jaw.

Video: details about periostitis of the jaw from the dentist.

Kinds

Odontogenic periostitis of the jaw, like any other disease, has its own classification according to the time and nature of the course. Only a dentist can make an accurate diagnosis; to determine it accurately, the doctor prescribes an x-ray of the problem area, according to which the doctor can assess the condition of the roots of the teeth and the periapical region. Thickening of the periosteum in the first three days is not displayed on the picture.

According to the type of course of the process, periostitis is subdivided:

1. Acute - has a pronounced symptomatology. Swelling of half of the face, severe throbbing pains, pus formation.
2. Chronic - sluggish, with recurrent exacerbations.

By the type of exudate, acute periostitis happens:

1. Serous - more often develops against the background of apical periodontitis, while infiltration of the periosteum and its thickening occur.
2. Purulent - it is more difficult, the patient is disturbed by arching pains, aggravated by hot. In some cases, pus finds its way out on its own through the formation of a fistulous tract. If this does not happen, then the increasing pulsation of pain makes you turn to the dentist. He will make a dissection of the periosteum and give an outflow to the contents.

Often, retromolar periostitis develops on the lower jaw, which occurs due to the complex eruption of the wisdom tooth. It is difficult for purulent exudate to come out on its own, as this is due to the anatomical features of this area.

Symptoms

Signs vary depending on the form of the course of the disease. The nature of the development of the disease is affected by the state of the immune system, as well as the presence of general ailments. There are general symptoms that make it possible to distinguish periostitis of the jaw from other purulent-inflammatory processes in the jaws.

It develops gradually. Initially, there is a slight swelling of the gums and pain when pressing on the tooth. If during the first day you do not contact a dentist-surgeon, then the next morning there is a chance to wake up with a swollen cheek.

Manifestations of periostitis with serous infiltrate:

• the mucous membrane of the gum becomes red;
• a swelling occurs along the transitional fold from the gum to the cheek, which is painful when touched;
• moderate pain;
• body temperature can rise up to 37 °C;
• there is asymmetry of the face due to infiltration of soft tissues;
• lymph nodes located under the jaw or behind the ears grow in size.

When a purulent infection joins, the course of the disease becomes more severe, and the patient's condition worsens:

• the general condition of the body worsens, symptoms of intoxication appear;
• body temperature rises to 38 ° C;
• swelling of half of the face;
• irradiation of pain along the branch of the trigeminal nerve;
• pulsation in the area of ​​edema;
• a fistulous passage may occur;
• when pressing on the swollen transitional fold, there is a fluctuation - the phenomenon of fluctuations in the liquid.

Photo

Diagnostics

To establish the correct diagnosis, the dental surgeon carefully collects an anamnesis, conducts an intraoral and external examination, and also gets acquainted with the results of radiography. A number of other dental diseases have a similar clinical picture, so it is important for a dentist to be well versed in the symptoms and clinical picture of various diseases.

Conducting differential diagnosis is based on the search for similarities and distinguishing features between other purulent-inflammatory diseases of the oral cavity.

• apical periodontitis in the acute stage - a purulent focus is located at the top of the root. External changes do not occur, but on the x-ray, a rounded rarefaction of the bone tissue is determined. It has clear contours, or it can be a blurry configuration. When eating and closing the jaws, there is a sensation as if the tooth had elongated and interfered with the closing of the mouth. This causes pain when pressed. The resulting fistula allows pus to flow out;
• phlegmon and abscess are serious diseases that greatly affect well-being. common cause is a bad tooth. Phlegmon is a diffuse inflammation, an abscess is with a limited process. The diseased area is infiltrated, while the skin above it changes color to red, there is a shine. With periostitis, external changes on the skin are not observed;
• sialadenitis is an inflammation of the salivary gland. On palpation of the gland, its density is determined, and in the oral cavity at the location of the duct there is inflammation, and the secretion of saliva is difficult due to compression of the excretory tubule by edematous soft tissues;
• osteomyelitis is an inflammatory disease of the bone. When examining the radiograph, the main distinguishing features in the form of bone destruction are revealed. At later stages sequesters are formed.

Periostitis or inflammation of the periosteum is a dangerous complication in various dental diseases. Pathological changes affect the deep layers of soft tissues in the mouth and the jawbone area.

Inflammation of the periosteum of the upper jaw often affects vast areas, purulent masses infect tissues with millions of pathogenic microorganisms. Untimely treatment provokes suppuration of soft tissues, damage to the temples, eyes, and the development of lymphadenitis. In the absence of competent therapy, periostitis significantly impairs the quality of life of the patient.

• general information
• Causes
• Forms of periostitis
• Types and classification
• Diagnostics
• Methods and rules of treatment
• Preventive advice

general information

Briefly about periostitis:

• a complication occurs against the background of pathological processes in the dental and gingival tissue;
• purulent masses are formed in the roots of problem teeth;
• gradually inflammation affects the pulp, affects the outer and inner layers of the periosteum;
• if a purulent focus occurs in the gum, soft tissues are necessarily involved in the pathological process;
• inflammation in the upper jaw often develops hidden, noticeable only at a late stage. A large volume of purulent masses requires an exit, a fistula appears, a flux develops;
• in severe cases, periostitis is complicated by phlegmon, abscess, and blood poisoning is possible. Proximity to the brain, maxillary sinuses provokes serious damage to important organs, there is a threat to the patient's life.

Causes

The main provoking factors:

• deep, neglected caries, pulpitis;
• inflammatory processes in the gum tissue;
• penetration of infectious agents in fractures of the jaw or purulent wounds in the face;
• infectious diseases of the nasopharynx (angina, tonsillitis). The infection penetrates through the blood and lymph flow;
• periodontitis;
• alveolitis or other complications after extraction (removal) of problematic units.

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The rules for taking antibiotics for stomatitis for adults and children are described on this page.

The risk of an active inflammatory process increases in the following cases:

• hypothermia;
• exhaustion, general weakness;
• reduced immunity;
• dental treatment during acute infectious diseases;
• frequent stress;
• respiratory infections.

Forms of periostitis

Classification depends on the severity of the disease:

• simple form. Pathogenic organisms are absent, redness, swelling develops as a complication of fractures or severe bruises of the jawbone;
• fibrous form. Fibrous tissue grows, thickening of the layers of the periosteum appears;
• ossifying form. Tissue proliferation is also noted, a chronic inflammatory process is formed;
• purulent form. The larger the volume of exudate, the more serious the danger to the body. With an abundance of carious cavities, the infection from the root of the tooth quickly spreads to neighboring areas. Acute course of purulent periostitis is characteristic.

Types and classification

The basis of the classification is the way in which the infectious agents entered the periosteum. Most often, a variety caused by dental diseases is diagnosed. The risk of infection increases with a large number of teeth affected by caries.

Periostitis is of several types:

• hematogenous (transmission of bacteria through the blood);
• odontogenic (dental disease);
• post-traumatic (inflammation due to mechanical damage to the periosteum);
• lymphogenous (pathogenic microorganisms penetrate into the tissues of the periosteum with lymph flow).

Another classification takes into account the symptoms, the nature of the course, the area of ​​​​distribution:

• acute purulent (limited and diffuse) periostitis;
• acute serous periostitis;
• chronic periostitis.

Characteristic features of the disease

Pay attention to the symptoms and course of the disease:

• periostitis often occurs in an acute form;
• inflammation of the periosteum often affects the area of ​​\u200b\u200bthe eyelids, eyes, swelling extends to the temples, cheekbones, cheeks;
• when the parotid region is affected, the salivary glands located just below the ear and at the edge of the auricle sometimes become inflamed;
• the gum turns red, touching the affected area causes pain;
• with an inflammatory process in the molars and premolars, the lip, bottom, wings of the nose swell;
• swelling of the eyelids leads to a noticeable narrowing of the palpebral fissure;
• in some patients, palatal localization of the pathological process was noted. Acute purulent inflammation is often provoked by carious cavities in the incisors, roots of premolars and molars;
• purulent masses penetrate into soft tissues, provoke detachment of the gums;
• with a palatine abscess, swelling of the lymph nodes in the submandibular region is noticeable;
• swelling of the palate passes to the zone of the tongue, pharynx, affects the mucous membrane. With exfoliation of tissues, an increase in the volume of exudate, food intake turns into torture;
• when purulent masses break through a thin film, exudate is poured into the oral cavity. The condition improves somewhat, but the infection with saliva penetrates the digestive system. Swallowing pus does not bode well;
• with severe swelling, surgical treatment of inflammation of the periosteum in the area of ​​\u200b\u200bthe upper jaw is required.

Diagnostics

If you notice certain signs, hurry to the dentist or jaw surgeon. Remember: the abundance of purulent masses poisons the body, in advanced cases of phlegmon, an abscess is life-threatening.

The acute process is easier to recognize, the symptoms of the chronic form are often blurred. X-ray gives an accurate picture. Additionally, a blood test is needed, a test for sensitivity to antibiotics, if an infectious form of periostitis is established.

When diagnosing, the doctor differentiates periostitis with other pathologies that have similar symptoms:

• lymphadenitis;
• phlegmon;
• abscesses;
• acute periodontitis;
• acute osteomyelitis;
• acute sialadenitis.

Methods and rules of treatment

The first stage is the establishment of the cause that provoked the pathological process. The doctor will study the nature of the course of the disease, determine which form is revealed: acute or chronic. After analyzing the collected data and x-ray, the treatment of inflammation of the periosteum that affected the upper jaw begins.

Stages of therapy:

• gum resection, removal of purulent / serous masses, installation of drainage for the outflow of exudate;
• antibiotic therapy to combat the identified pathogen;
• rinsing the mouth with Chlorhexidine, Furacilin, Miramistin; (Read the instructions for using Chlorhexidine here; Furacilina - here; Miramistin - on this page);
• in severe forms of the disease, it is impossible to do without the removal of a diseased tooth. The focus of inflammation will continue to cause complications;
• with timely treatment, a positive result is noticeable after 5-7 days;
• problematic tooth extraction required condition for the successful treatment of the chronic form;
• after the removal of a tooth affected by caries, the doctor will prescribe antibiotics, therapeutic rinses;
• iontophoresis with potassium iodide, paraffin baths are effective procedures that remove growths of fibrous tissue, accelerating regeneration processes. Physiotherapy methods increase local immunity, reduce inflammation.

Important! Never choose antibiotics on your own. Not all drugs have a detrimental effect on a certain type of pathogen. At best, the drug will be ineffective, at worst, the bacteria will develop "immunity", you will have to select a stronger antibiotic.

Folk remedies and recipes: is there any benefit

Dentists, jaw surgeons remind:

• never replace the medical treatment of an inflamed periosteum with home methods;
• late visit to the doctor in some cases causes severe complications;
• remember: not far from the upper jaw are the maxillary sinuses, eyes, channels leading to the meninges. Penetration of pus into sensitive cells sometimes causes death;
• rinsing with decoctions of herbs, the use of home solutions for irrigating the oral cavity is just an addition to the main treatment;
• rinsing, as the only method of combating inflammation of the periosteum, translates the disease into a chronic form. Relapses for many years are provided.

find out effective methods treatment of trigeminal neuralgia with folk remedies.

The causes and methods of treating pain on the side of the tongue are written on this page.

For medicinal decoctions and home antiseptic solutions, use:

• chamomile;
• sage;
• calendula;
• soda;
• propolis tincture;
• sea ​​salt + iodine;
• potassium permanganate.

Remember! Therapeutic rinses are prescribed by a doctor. Be sure to consult about home formulations.

Complications or what threatens the lack of treatment

With an untimely visit to the doctor, the pathological process affects the deep layers of tissues:

• blood circulation, lymph circulation is disturbed;
• the inner layer of the periosteum is destroyed;
• lymphocytes accumulate in the cavity formed after tissue exfoliation;
• serous masses appear, exudate is formed;
• gradually, under the influence of pus, are violated metabolic processes in the periosteum, irreversible changes develop;
• in some areas, the cortical layer of bone tissue dissolves. The consequences are severe: pus enters the bone marrow, and the hard tissue is gradually destroyed.

Take note:

• in patients with reduced immunity, the reaction to the inflammatory process is weak;
• symptoms are mild, soreness, swelling is practically absent;
• pus gradually comes out, periostitis takes a chronic form;
• with a sluggish process, the problem can be eliminated quickly enough;
• with the growth of the fibrous layer, hyperostosis develops, the treatment is longer, more complicated. Often, the help of a jaw surgeon is required.

Recall the factors that cause inflammation of the periosteum. One of the main reasons is untreated dental diseases. Contact your dentist promptly for filling carious cavities, and the risk of pathological changes in the tissues of the periosteum will be minimal.

Compliance with simple rules will prevent inflammatory processes in the periosteum:

• treatment of infectious diseases of the throat, nose, oral cavity;
• strengthening immunity, taking multivitamins, mineral complexes;
• proper nutrition, rejection of foods that scratch the mucous membrane, gums, destroying teeth. Crackers, lollipops, chips are not recommended. Harm to dental and gum tissue is caused by sweet soda, chocolate, muffins, seeds;
• regular cleaning of teeth and gums from accumulated deposits. In addition to toothpaste with mineral elements, herbal extracts, use dental floss, rinse, oral irrigator; (Read more about dental floss here; about the irrigator - here; about mouthwash is written on this page);
• constant monitoring of the condition of the teeth, mucous membranes, gums;
• rejection of dubious methods of treatment for inflammation of the gums, damage to the tissues of the periosteum;
• preventive examinations at the dentist at least once every six months;
• visiting a doctor at the first signs of dental diseases.

Inflammation of the periosteum in the region of the upper jaw has characteristic symptoms. Even with mild symptoms, regular visits to the dentist will prevent severe complications in the development of periostitis. If you are terrified of going to the dentist, learn useful information about sedation - a modern technique that removes the panic fear of dental treatment.

You can learn more about sedation in dentistry from this article.

- an infectious-inflammatory process with the localization of the focus in the periosteum of the alveolar process or the body of the jaw. Periostitis of the jaw is accompanied by the formation of a subperiosteal abscess; swelling of the maxillary soft tissues; pain radiating to the ear, temple, eye; deterioration in general well-being (weakness, elevated temperature body, headache, sleep disturbance). The diagnosis of periostitis of the jaw is established on the basis of examination and palpation data, confirmed radiologically. Treatment of periostitis of the jaw includes opening and drainage of the subperiosteal abscess, removal of the tooth-source of infection, physiotherapy, mouth rinses, and antibiotic therapy.

General information

Periostitis of the jaw - inflammation of the periosteum (periosteum) of the alveolar arch, less often - the body of the upper or lower jaw of an infectious or traumatic genesis. In surgical dentistry, jaw periostitis is diagnosed in 5.4% of patients with inflammatory diseases of the maxillofacial region; at the same time, in 95% of cases, periosteal inflammation proceeds in an acute form and only in 5% - in a chronic one. Approximately 1.5-2 times more often periostitis is localized in the lower jaw. The course of periostitis of the jaws is characterized by the peculiarity of the local and general clinical picture, the reversibility of the inflammatory process in timely treatment and a high risk of severe purulent complications with a progressive variant of development.

Classification

Depending on the way the infection enters the periosteum, the following forms of jaw periostitis are distinguished: odontogenic (due to dental disease), hematogenous (due to the spread of infection through the bloodstream), lymphogenous (due to the spread of infection through the lymphatic tract), traumatic (due to damage to the periosteum). Taking into account the clinical course and pathomorphological picture of inflammation, periostitis of the jaw can be acute (serous or purulent) and chronic (simple or ossifying).

Acute serous periostitis of the jaw is accompanied by infiltration of the periosteum and the accumulation of a moderate amount of serous exudate in the inflammatory focus. Acute purulent periostitis of the jaw (flux) proceeds with the formation of a limited subperiosteal abscess, the formation of fistulas through which pus flows out.

Chronic periostitis of the jaw is characterized by a sluggish infectious and inflammatory process in the periosteum, accompanied by the formation of young bone tissue on the surface of the jaw bones. If with simple periostitis of the jaw, the process of new bone tissue formation is reversible, then with ossifying, ossification and hyperostosis progress rapidly. According to the degree of distribution, limited (in the area of ​​\u200b\u200b1 or several teeth) and diffuse (covering almost the entire jaw) purulent periostitis are distinguished.

Causes of periostitis of the jaw

Most often, periostitis of the jaw has an odontogenic origin and occurs against the background of a previous dental disease. In 73% of cases, the cause of periostitis of the jaw is chronic periodontitis; in 18% - alveolitis; in 5% - inflammation of semi-impacted and impacted wisdom teeth; in about 4% - periodontitis and festering cyst of the jaw. In these cases, the inflammatory exudate moves from the periodontium under the periosteum along the bone tubules of the spongy and compact layer of the jawbone.

Hematogenous and lymphogenous periostitis of the jaws usually develops after suffering a sore throat, tonsillitis, otitis, influenza, SARS, scarlet fever, measles. This route of infection most often occurs in children. Traumatic periostitis of the jaw may be the result of the removal of a complex tooth, surgical intervention, trauma to the teeth, open fractures of the jaw, infected wounds soft tissues of the face, etc.

In most patients, there is a connection between periostitis of the jaws and previous hypothermia or overheating, emotional or physical overstrain. In the study of inflammatory exudate with purulent periostitis of the jaw, a mixed anaerobic (75%) and aerobic (25%) microflora is found, represented by streptococci, staphylococci, gram-positive and gram-negative rods, putrefactive bacteria.

Symptoms of periostitis of the jaw

The course of periostitis of the jaw depends on the form and location of inflammation, the reactivity of the patient's body. Acute serous periostitis of the jaw is characterized mainly by local manifestations: swelling of the soft tissues, hyperemia of the mucosa in the region of the transitional fold, regional lymphadenitis. The oral cavity usually has a "causative" tooth with pulpitis or periodontitis, and the periosteal inflammation is reactive.

Acute purulent periostitis can be an independent pathology or serve as a leading symptom of jaw osteomyelitis. This clinical form is accompanied by a deterioration in general well-being: weakness, subfebrile condition, chills, headache, sleep disturbance and appetite. Patients note a sharp local pain in the jaw area with irradiation to the ear, temple, eye socket, neck; soreness when opening the mouth, limited movement of the jaw, pathological mobility of the diseased tooth.

On examination, swelling of the cheek is revealed, a change in the configuration of the face due to swelling of the soft tissues of the perimaxillary region. Puffiness with purulent periostitis of the jaw has a characteristic localization: for example, if the region of the upper incisors is affected, swelling of the upper lip occurs; with damage to the upper canines and premolars - buccal, zygomatic, infraorbital regions; upper molars - parotid-chewing area. With periostitis of the lower jaw, the edema extends to the lower lip and chin.

With periostitis of the jaw, changes are also found in the oral cavity, including hyperemia of the mucous membrane, the presence of a dense, painful infiltrate or roller-like swelling with a focus of fluctuation - a subperiosteal abscess. Later, as the purulent melting of the periosteum, the exudate penetrates under the mucous membrane of the gums, forming a submucosal (subgingival) abscess, from where the pus can periodically pour out through the fistulous opening into the oral cavity, bringing temporary relief.

Chronic periostitis of the jaw occurs with periodic pain in the area of ​​the causative tooth, thickening of the jaw, a slight change in the contour of the face, an increase in the submandibular lymph nodes, swelling and hyperemia with a cyanotic tinge of the mucous membrane from the oral cavity.

Diagnosis of periostitis of the jaw

During a dental examination, characteristic clinical signs of periostitis of the jaw (hyperemia, infiltration, fluctuation, etc.) are revealed. With an odontogenic infection in the oral cavity, there is usually a severely destroyed crown part of the tooth that served as the source of infection, with a carious cavity and root canals filled with tissue decay products. When percussion of the tooth, a pain reaction is noted.

With the help of radiography in acute periostitis of the jaws, no changes in the bone tissue are detected, however, granulomatous or granulating periodontitis, odontogenic cysts, impacted teeth, etc. can be detected. In chronic periostitis of the jaws, newly formed bone tissue is determined radiographically. Acute purulent periostitis of the jaw should be distinguished from acute periodontitis, osteomyelitis, sialadenitis, abscess, neck phlegmon, sepsis), which pose a threat to the patient's life. Acute serous periostitis of the jaw proceeds most favorably; purulent periostitis requires active surgical tactics.

Prevention of periostitis of the jaw consists in the timely treatment of odontogenic foci (caries, pulpitis, periodontitis), professional oral hygiene, sanitation of chronic purulent foci.