Periostitis is an inflammation of a thin but dense connective tissue covering the bone (periosteum). First, the inflammatory process develops in the outer and inner layers of the periosteum, and then spreads to all layers.
Periostitis - especially in the later stages - is a disease that requires emergency dental surgery, and in some cases, the maxillofacial surgeon. If puncture is not performed in time and pus is not evacuated, the inflammatory process, penetrating into the general blood stream, can lead to sepsis (general blood infection) and to death. These are the realities that we neglect.
The periosteum of the upper and lower jaws is also called periosteal inflammation, this is one of the most widespread complications that occur when caries treatment is started. Disease is dangerous in that the inflammation develops asymptomatically and covers first the inner and then the outer layer of the periosteum.
What is a periostitis?
Periostitis of the lower and upper jaw is an inflammatory-infectious process that takes place in the body of the jaw or periosteum of the alveolar process.
The causes of periostitis of the jaw are as follows:
- Untreated caries in time. The insidiousness of periostitis lies in the fact that the process first goes unnoticed, the purulent exudate accumulates around the dental root gradually. With the most insignificant effect, the focus of inflammation is activated, and the inflammatory process passes to the bone. An acute purulent periostitis develops.
- Presence of non-pathogenic staphylococcus in the oral cavity. If a patient has recently suffered an acute viral respiratory infection, his body may still be weak enough to resist the activation of staphylococcal bacteria. As a result, staphylococcus causes a hyperergic inflammatory process, rapidly penetrating from the periodontal region to the periosteal region.
- Acute purulent periostitis often develops withbadly neglected periodontitis.
Depending on the possible type of penetration of infection in the periosteum, there are the following forms of the disease:
- Odontogenic(the process associated with tooth disease);
- Hematogenous(the process associated with the spread of infection through the bloodstream);
- Lymphogenous(the process associated with the spread of infection through lymphatic connections);
- Traumatic(due to mechanical damage to the periosteum).
In most cases, periostitis of the jaw arises as a complication of periodontitis, or as a complication after removal of the tooth, especially if it was preceded by hypothermia, influenza, angina, etc.
Symptoms of periostitis
The first sign of the disease is a slight swelling of the gum (see Fig. a photo). Further, there is an increase in swelling, and along with this, the pain sensation increases. The next stage, which accompanies acute periostitis, is an abscess (a purulent inflammation of the tissues), which is the main cause of facial edema.
Acute periostitis develops rapidly, accompanied by the following symptoms:
- gum abscess;
- pain in the area of the inflamed periosteum;
- redness of the inflamed gingiva;
- swelling of the facial tissues, most often the cheeks on the side of the location of the flux;
- general malaise of the body;
- headache;
- an increase in the cervical and submandibular lymph nodes;
- subfebrile body temperature;
- lack of appetite.
In some cases, the periostitis of the jaw is accompanied by the appearance of a fistulous course through which pus comes out. Periostitis in such a manifestation is dangerous because pain subsides, and this can cause the patient to ignore the approach to the doctor. Which, in turn, leads to the development of chronic periostitis. In time, the non-stopped infection spreads to neighboring tissues and is subsequently expressed as osteomyelitis or ulcers.
Chronic periostitis
Most often it develops in the periosteum of the lower jaw and is characterized by local inflammatory reaction in the form of a dense edema, which does not significantly change facial features.
At the site of inflammation, bone thickens, and lymph nodes increase. At the same time, the mucous membrane of the mouth can have swelling and redness. Chronic periostitis for a long time does not pass and can develop for 4 to 8 months, and sometimes several years, making itself felt periodic exacerbations.
Diagnostics
Most of the signs of periostitis of the jaw are diagnosed during routine dental examination. To the findings, symptoms include: infiltration, hyperemia, fluctuation, as well as deformation of the crowns of patients with teeth and other signs of periostitis.
Chronic periostitis is diagnosed with the help of an X-ray method, however, to detect this by acute the form of the disease is not possible due to the lack of pronounced changes in the structure of the periosteum.
Effects
All purulent foci are fraught with the spread of infection both on adjacent tissues and organs, and on the entire body. Purulent periostitis can lead to the following diseases:
- osteomyelitis of the jaw;
- phlegmon soft tissues of the head and neck;
- upper mediastinitis;
- sepsis.
It is the probability of these menacing complications that require immediate treatment at the first sign of purulent inflammation.
How to treat a periostitis?
To wait and hope that the edema will pass independently, and the pains will cease - it is not necessary. Periostitis of the jaw is one of the diseases that does not pass by itself. It is obligatory to help a specialist, namely, a dental surgeon.
If periostitis is detected at an early stage, the treatment is to take antibiotics to prevent inflammation and swelling. After the symptoms of periostitis subsided, the causative tooth is either treated or removed. This is decided by the doctor on the basis of visual inspection, X-ray and the patient's mood.
However, the most often performed surgical treatment of periostitis. In this case, under local anesthesia, the inflamed portion of the gum is cut, then the flux is drained, washed with an antiseptic solution. After the operation, the patient is advised to strictly observe the hygiene of the oral cavity within a few days, and do not neglect regular rinsing with the prescribed means.
Already after removal of the periostitis, antibiotics are prescribed to eliminate the infection, reduce inflammation in the gum and accelerate the process of its regeneration. Possible use of such antibiotics with periostitis, as Rifampicin, Ceftriaxone, Clindamycin, Penicillin, etc.
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