Acute or chronic inflammation of the periosteum is called periostitis. The disease is accompanied by pain and swelling of the surrounding soft tissues. The following types of periostitis are distinguished:
- simple - the result of inflammation, injuries in the muscles, tissues above the bone, affects the tibia, olecranon;
- fibrous - appears due to irritation of the periosteum for a long time (necrosis, trophic ulcer, arthritis);
- purulent - develops when an exogenous infection occurs, affecting mainly tubular bones;
- ossifying – formed against the background of prolonged irritation of the periosteum (syphilis, rickets, tumor, arthritis) in typical places (between the bones of the wrist and tarsus, vertebrae);
- tuberculous - appears in childhood, in the area of the ribs and skull, characterized by the appearance of fistulas with purulent discharge;
- syphilitic – diagnosed with syphilis;
- serous albuminous - appears after injury, usually diagnosed on long tubular bones and ribs;
Treatment of periostitis
The form of periostitis influences the treatment tactics. In simple cases, rest, anti-inflammatory and painkillers are recommended. For purulent processes, antibiotics and analgesics are prescribed, and the abscess is opened and drained. In the chronic form, the underlying disease is treated, iontophoresis of dimexide and calcium chloride, and laser therapy are also prescribed. In some cases (with tuberculous and syphilitic periostitis with the formation of fistulas), surgery is indicated.
To treat the disease, you should contact a surgeon.
Types and stages of disease development
The classification of odontogenic periostitis depends on the phase of the disease and the nature of its course. In addition to examination and palpation, the dentist prescribes an X-ray examination. The resulting image allows you to assess the condition of the roots and periapical areas. The image does not show thickening of the periosteum in the first three days from the onset of the disease.
- Various types of periostitis are classified according to the international classification ICD 10 depending on the route of infection into the periosteal tissue:
- acute odontogenic periostitis of the jaws (cause - diseased tooth);
- hematogenous (infection enters through the blood);
- lymphogenous (spread through the lymph system);
- traumatic (for injuries of the periosteum).
According to the course and pathomorphology, the disease is divided into two forms: acute and chronic.
In the acute form, the symptoms are pronounced. There is swelling of half the face, he is tormented by severe throbbing pain, and pus forms. The acute serous form is characterized by such clinical manifestations as infiltration in the periosteum, serous exudate is formed in the lesion. In acute purulent periostitis of the jaw (popularly called gumboil), a limited subperiosteal focus of inflammation is formed, fistulous tracts are formed, and pus comes out through them. The course of purulent periostitis is much more severe, with bursting pain that increases when drinking hot foods. If a fistula tract does not form, the dentist cuts the periosteum to allow the pus to escape.
The course of the chronic process is sluggish, stages of exacerbation occur periodically. Young bone tissue begins to grow on the surface of the jaw. With the development of the ossifying form, ossification and hyperostosis occur quite quickly. There are two degrees of spread of this process: limited (covering one to three teeth) and diffuse purulent (almost the entire jaw is covered).
If the wisdom tooth erupts with difficulty, retromolar periostitis may develop in the lower jaw. The pus does not come out on its own due to anatomical features, which requires dissection.
Stages of the operation
When treating periostitis of the jaw, the surgeon must cleanse the cavity of pus so that the process does not spread deeper. To do this, he cuts the periosteum. The operation consists of several stages:
- Anesthesia . The affected area is numbed using modern drugs.
- Periostotomy . The surgeon makes a soft tissue incision along the fold between the gum and cheek, capturing the periosteum. This ensures the release of purulent exudate to improve the patient’s condition.
- Wound drainage . A rubber or gauze graduate is installed into the incision. This ensures the drainage of pus.
After opening the purulent lesion, the surgeon asks the patient to rinse his mouth with a disinfectant solution.
After this, chlorhexidine and similar solutions are used to wash the wound. Measures such as irrigation with dimexide with oxacillin and 15-minute applications of dimexide liniment are also effective.
After examining an x-ray of the tooth that caused periostitis, the doctor decides whether it can be preserved and treated in the future to eliminate the source of infection, or whether tooth extraction is necessary.
Historical reference
Tooth abscess, “tooth fire” - these are just some of the “folk” names for this disease that have come down to us from antiquity. In those days, a patient who came to a doctor with a gumboil, in the overwhelming majority of cases, left him... without a tooth, because the removal of the causative tooth seemed to be the only reliable “remedy” for all dental diseases. However, it is impossible not to mention the existing artifacts - the found skulls dating back to the time of the Old Kingdom, with traces of drilling in the jaw, in all likelihood to release pus - proving that even in those days attempts were made not to get rid of diseased teeth, but to treat them1.
But since medicine in those days was an “expensive pleasure,” people looked for ways to help themselves on their own, and traditional medicine always came to their aid. For example, in the treatment of gumboil, ground garlic was used as the most powerful natural antibiotic. Clove oil, peppermint oil and oregano oil, which have analgesic, bactericidal, and antiseptic properties, were widely used, as were warm salt water, apple cider vinegar, sesame seeds, herbal rinses, and even raw potatoes. Among the more “modern” folk remedies, rinsing with hydrogen peroxide and baking soda is known. Of course, all these “medicines” had extremely low effectiveness, in many cases they were simply useless, and in some cases they were dangerous, since they took up precious time, during which the active inflammatory process led to sepsis. And only at the end of the 19th and beginning of the 20th centuries, when medical science began to develop steadily and rapidly, did doctors have truly effective means of combating periostitis.
How is periostitis diagnosed?
For an accurate diagnosis, the doctor collects anamnesis, conducts an external and internal examination, prescribes an x-ray and examines the x-ray. Since the symptoms of some dental problems are identical, the surgeon must have a good understanding of their symptoms.
When conducting diagnostics, doctors look for similarities and differences between chronic periostitis of the jaw or acute and other diseases of the oral cavity. An x-ray helps differentiate the disease from others (apical periodontitis, phlegmon, abscess, inflammation of the salivary gland, osteomyelitis).
Apical periodontitis is characterized by the presence of a purulent focus located at the top of the root.
Cellulitis and abscess are manifested by external changes on the skin. An infiltrate appears on the affected area, the skin over it turns red and becomes shiny.
With sialadenitis, it is necessary to palpate the salivary gland to determine its density. Osteomyelitis is diagnosed by X-ray - in the early stage of the disease, it shows decaying bones, in the late stage - formed sequesters.
Surgical intervention
With serous inflammation, as a rule, conservative therapy is limited. Pulpitis or periodontitis is treated, the patient is prescribed a course of physiotherapeutic sessions (UHF), rinsing with disinfectants. This leads to resorption of the infiltrate.
The acute purulent form requires surgical intervention to open the subperiosteal or submucosal abscess.
The milk tooth that caused periostitis must be removed. Severely damaged permanent teeth are also removed. Teeth that are capable of performing their functions need to be treated.
Causes of the disease:
- consequences of other dental diseases, primarily periodontitis - inflamed tissues around the tooth secrete fluid that gets under the periosteum; complications after jaw injuries (fractures, bruises);
- inflammation of unerupted (impacted) teeth (pericoronitis); the infection has entered an epithelial new bone formation (cyst);
- purulent inflammation due to periodontal disease or osteomyelitis;
- consequences of statistical interventions in the treatment of periodontitis: a lot of filling material gets behind its root;
- root canals are poorly treated with disinfecting solutions;
- The filling was installed poorly.
Purulent periostitis is provoked by microflora with leukocytes, lactobacilli, numerous pathogenic bacteria - various types of cocci, bacilli.
Characteristic symptoms
Symptoms of acute periostitis of the jaw are determined by the form of the disease. The state of the patient’s immune system and the diseases he has are also influenced. But there are also characteristic signs that make it possible to make an accurate diagnosis.
The disease develops gradually. At first, the gums swell a little, and pressing on the tooth causes pain. Having discovered such signs, the patient should visit a doctor on the same day, otherwise the cheek may become swollen by the morning.
Signs of the form of the disease with serous infiltrate are:
- red color of the mucous membrane:
- the appearance of painful swelling in the fold between the gum and cheek;
- tolerable pain;
- temperature may rise to 37°C;
- facial asymmetry;
- submandibular and postauricular lymph nodes enlarge (lymphadenitis).
With a purulent infection, the condition becomes much worse:
- signs of intoxication and pain are observed;
- temperature (up to 38°C);
- the cheek becomes swollen;
- pain radiates along the trigeminal nerve;
- pulsation is felt in the swollen part;
- a fistula may occur;
- When you press in the area between the cheek and gum, you can feel the vibrations of the fluid.
What to do for prevention
The main preventive measure is to constantly monitor the condition of the oral cavity. Preventive measures include:
- daily hygiene of teeth and gums;
- visiting the dentist twice a year;
- use of professional hygiene procedures, removal of tartar;
- timely treatment of caries and other pathologies;
- If you have problem gums, you need to be systematically treated by a periodontist.
To prevent periosteal disease, doctors recommend having an x-ray every year.
Periostitis of the jaw often develops even in children.
If you notice swelling on the face of a child complaining of pain, immediately take him to the dental clinic. Self-medication is unacceptable! Taking some medications may disrupt the picture of the disease, which will complicate the diagnosis and may result in serious complications. Moscow metro station Zvezdnaya, Danube Avenue, 23
Physiotherapy
After surgery, the patient is recommended to undergo a course of physiotherapy to stop the inflammatory process, solux lamp, ultrasound. These are procedures such as: UHF, fluctuarization, microwave, laser, electrophoresis. Usually 5 to 7 sessions are prescribed.
Is it possible to do without it? Such a serious disease as periostitis of the jaw cannot be cured at home; qualified professional help is needed from a professional who will eliminate the source of infection. You can use folk remedies only in cases where the pain comes on suddenly, and you need to somehow improve the patient’s condition. But you need to visit a doctor as soon as possible. Before this, you can rinse your mouth with soda, salt, a decoction of herbs that have an anti-inflammatory effect, apply cold compresses to reduce swelling and relieve pain.
Causes and symptoms of periostitis
Symptoms of periostitis include swelling of the gums and face, suppuration, fever, and severe pain. The severity of dental flux manifestations depends on the form and severity of the disease. Swelling and asymmetry of facial contours depend on the location of the inflammation. With periostitis of the upper jaw, swelling of the upper lip, cheek and infraorbital area occurs. With periostitis of the lower jaw, swelling can be observed in the lower part of the face.
The causes of flux can be:
- failure to comply with hygiene rules;
- diseased or untreated teeth;
- consequences of complex tooth extraction;
- jaw injuries;
- infectious and inflammatory processes in the body;
- weakened immunity.
Price
Since periostitis and its complications can be life-threatening, in public medical institutions and in some commercial clinics assistance to patients with this diagnosis is provided free of charge under the compulsory medical insurance policy. But most private clinics are not included in the compulsory medical insurance program. In each specific case, periostitis requires a strictly individual approach, and the cost of treatment depends on the following factors and their combination: the diagnostic examination performed (OPTG, X-ray, in some cases - CT scan, examination); treatment algorithm (developed on the basis of the diagnosis, stage of the disease, characteristics of its course), methods, materials, drugs, tools and equipment used in treatment; additional physiotherapeutic procedures (if prescribed); consultations with narrow specialists (if necessary); qualification of the attending physician.
Periostitis is a dangerous infectious disease of the oral cavity. When its symptoms appear, it is extremely important to seek professional medical help as soon as possible, because periostitis of the jaw not only causes severe pain, but also poses a serious threat to the entire body, causing complications of varying severity, including blood poisoning. Timely, qualified treatment in a dental clinic is a guarantee of eliminating the existing pathology and, in many cases, saving the causative tooth.
According to antiplagiat.ru, the uniqueness of the text as of October 16, 2018 is 100%.
Key words, tags: tooth-preserving operations, bone grafting, orthopantomography, tooth extraction, dental cyst.
1 I. Zimin. "From the history of healing." 2 Great Medical Encyclopedia (Electronic reference book on human anatomy, www.spravochnik-anatomia.ru). 3 Shargorodsky A.G. Inflammatory diseases of the tissues of the maxillofacial area and neck. 2001. 4 https://mkb-10.com 5 “Surgical dentistry” edited by Robustova T.G. Fourth edition. Moscow "Medicine" 2010; https://rcmfs.ru/%D0%BF%D0%BE%D0%BB%D0%B8%D0%BA%D0%BB%D0%B8%D0%BD%D0%B8%D0%BA%D0 %B0/%D0%BB%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D0%B5%D0%BF%D0%B5%D1%80%D0%B8%D0% BE%D1%81%D1%82%D0%B8%D1%82%D0%B0.html