Causes of appearance, diagnosis and treatment of the disease “Acute purulent periostitis”

Many people are familiar with the phenomenon of gumboil - when the cheek next to a sore tooth swells literally before our eyes and painkillers do not relieve acute pain. This is the periosteum of the tooth becoming inflamed, or, as doctors say, odontogenic periostitis of the jaws has developed. This disease in itself is a complication of dental problems (periodontitis, periodontitis), but in the absence of proper treatment, such inflammation can also cause the development of even more serious complications.

Why can the periosteum of a tooth become inflamed?

The most common is odontogenic periostitis of the jaws, that is, an inflammatory process provoked by diseases of the teeth or periodontal tissues. Deep caries, pulpitis, periodontitis (inflammatory process at the apex of the tooth root), periodontitis - all these diseases, if not treated in time, lead to the appearance of gumboil. Also, one of the reasons for the development of the inflammatory process may be alveolitis - inflammation of the tooth socket, which in some cases occurs after tooth extraction. Inflammation of the periosteum after tooth extraction usually develops in those patients who do not rush to see a dentist when the first signs of complications appear in the postoperative period.

Much less common is toxic periostitis, caused by infection through the blood or lymph (usually due to some general infectious disease). The disease can also be caused by injuries to the jaw bone or surrounding soft tissue.

Causes

The main reason for the development of osteomyelitis of the jaw is the penetration of highly pathogenic microorganisms into the bone tissue. Infection can occur in several ways:

1. Odontogenic way, when the source of the infectious agent is a tooth affected by caries. In this case, microorganisms first enter the pulp tissue, after which they spread through small lymphatic vessels or dental tubules to the bone tissue.
2. Hematogenously, when pathogenic microorganisms spread to the maxillofacial area through blood vessels from the primary source of infection. This role can be played by any infectious focus present in the body: acute or chronic tonsillitis, erysipelas or furunculosis. In addition, some specific infections can provoke osteomyelitis: typhus, scarlet fever or even the common flu.
3. Traumatically, when osteomyelitis occurs against the background of infection after a fracture or surgery on the jaw. It is most rarely seen in dentistry.

With the odontogenic route, the lower jaw is most often affected, and with the hematogenous route, the upper jaw is most often affected. If the infection occurs hematogenously, then the localization of the purulent focus will be deep in the bone tissue, and the phenomenon of periostitis will be minimal.

Inflammation of the periosteum of the tooth: symptoms

Depending on the form and localization of the process, symptoms may be as follows:

• General symptoms: severe pain in the area of ​​inflammation, swelling, noticeable swelling, discoloration of the gums, mobility of the dental unit, which served as a source of spread of the pathological process. Depending on the location of the source of infection, facial swelling will look different: when inflammation develops near the front teeth, the upper lip or middle third of the face swells; when inflammation occurs near the chewing teeth, the cheek, sometimes the lower eyelid, and parotid area swell. You can evaluate what different types of edema look like during inflammation of the periosteum of the tooth using a photo.
• Acute serous periostitis of the lower or upper jaw is accompanied by severe redness of the mucous membranes, rapid development of edema, and increased body temperature. The general symptoms of this form of inflammation are especially pronounced.
• In the acute purulent form of the disease, severe sharp pain is characteristic, and the pain subsides under the influence of cold and becomes stronger when exposed to heat. Sleep and appetite are disturbed, the temperature rises noticeably, and the patient’s general condition worsens. Pain in most cases radiates along the branches of the corresponding nerves. For example, acute purulent periostitis of the lower jaw can make itself felt by pain in the neck, chin, ear and temporomandibular joint. Purulent periostitis of the upper jaw most often provokes pain in the orbital area, temporal bone, and ear.
• The chronic form of the disease is quite rare, and chronic periostitis of the lower jaw usually develops. The symptoms are mild, the swelling is almost unnoticeable and can gradually develop over a very long time. Pain and discomfort appear from time to time (periods of exacerbation).

At the initial stage of the inflammatory process, it usually has a serous form, later, without treatment, it becomes purulent. With a large accumulation of pus, the formed abscess can burst with the flow of purulent contents into the oral cavity. At the same time, the swelling decreases and the pain subsides. In this case, some patients calm down, believing that the problem has been solved, and are in no hurry to see a dentist. In fact, this is only temporary relief, since the pathological process can resume at any minute.

Periostitis in children

In children, the inflammatory process usually develops as a result of untreated caries of baby teeth, infectious diseases or injuries. Due to the peculiarities of the physiology and anatomy of the child’s body, as well as due to the immaturity of the child’s immune system, the pathology develops quickly and rapidly, and the infection quickly spreads through the bloodstream and lymph flow, so multiple lesions can form.

Periostitis of the upper jaw in a child requires special attention, which, when localized in the palate, may not change facial features - swelling forms inside the oral cavity and can only be noticed by the characteristic convex swelling on the palate. The abscess gradually grows, capturing the mucous areas of the pharynx and tongue, which causes pain when swallowing and chewing. If a child develops symptoms such as fever, loss of appetite, or painful swallowing, it is imperative to check whether such a condition is caused by developing gumboil.

Prevention

Competent prevention can significantly reduce the risk of developing periostitis and other dental diseases.

Preventive measures include:

• Systematic visits to the dentist for examination;
• Timely treatment of caries;
• Maintaining normal vitamin balance;
• Rejection of bad habits;
• Strengthening immunity;
• Maintaining oral hygiene.

Periostitis is a serious problem that can only be eliminated with dental intervention, in combination with drug therapy and physiotherapeutic procedures.

Treating periostitis on your own is ineffective and unsafe, so if symptoms characteristic of the disease appear, you should seek the help of a doctor.

Possible complications and diagnosis

If the disease is not treated properly, very serious complications soon develop: osteomyelitis (purulent inflammation of bone tissue, provoking its necrosis), phlegmon (a diffuse purulent process that affects nearby tissues and requires immediate surgical intervention), sepsis (a general infection of the body, often ending in the death of the patient ). Each of these conditions requires emergency medical care and long, painstaking treatment. Therefore, it is better not to let the situation lead to complications and contact a dentist at the first signs of an inflammatory process.

To establish an accurate diagnosis, the doctor will need to conduct a differential diagnosis using instrumental diagnostic methods (radiography, CT). This disease is similar in symptoms to acute periodontitis, acute inflammation of the salivary glands, lymphadenitis, and osteomyelitis. Therefore, in order to prescribe adequate treatment, it will be necessary to exclude these conditions and accurately determine the cause of the patient’s poor health.

Consequences and rehabilitation after osteomyelitis of the jaw

The consequences of acute or chronic osteomyelitis of the jaw bone can be quite serious and significantly worsen a person’s quality of life.

1. Often, during the surgical treatment of such a pathology, it becomes necessary to remove not only the causative tooth, but also several others. This leads to the fact that in the future the person will need orthodontic treatment and prosthetics.
2. Extensive bone tissue defects can lead to jaw deformities, which is not only a cosmetic defect, but also significantly disrupts the normal functioning of the maxillofacial apparatus.
3. Damage to soft tissues often leads to scar deformation, which is also a serious cosmetic problem that needs to be solved with plastic surgery.
4. The spread of infection to the joint can provoke inflammation (arthritis) or arthrosis, which subsequently causes the development of ankylosis and a sharp limitation of jaw mobility.
5. The consequences of septic conditions against the background of osteomyelitis may also include disruption of the functioning of internal organs, hematopoietic processes and the functioning of the immune system.
6. Osteomyelitis affecting the upper jaw can spread to the zygomatic bone and even the orbit with the development of an abscess or phlegmon of the eyeball. This leads to complete loss of vision without the possibility of recovery.

Rehabilitation after suffering purulent inflammation of the oblique jaw sometimes continues for several years. All patients are subject to dispensary registration, from which they are removed only after correction of all violations that have arisen.

Rehabilitation measures include:

• use of physiotherapeutic techniques;
• if necessary, prosthetics for lost teeth;
• repeated surgery for cosmetic or medical reasons;
• prevention of recurrence of such pathology.

Inflammation of the periosteum of the tooth: treatment

Periostitis of the lower and upper jaw requires almost the same treatment, despite some differences in symptoms and localization of lesions. Moreover, complex therapy will be required, which will quickly eliminate the infectious-inflammatory focus and prevent relapses:

• Surgery. Opening the purulent sac with removal of the contents and thorough cleaning of residual pus is a mandatory procedure in this case. The intervention is performed under local anesthesia. At the initial stage of the disease (with its serous form), it is possible to do without surgical intervention. In this case, the doctor carries out endodontic treatment (depulpation, cleaning and treatment of root canals, antibacterial therapy).
• Drug therapy. Prescribing antibacterial and anti-inflammatory drugs to eliminate inflammatory phenomena (swelling, hyperemia, fever, pain) and infection.
• Physiotherapeutic procedures. Iontophoresis, ultrasound or laser therapy, electrophoresis, paraffin therapy - all these procedures are usually aimed at resolving compactions formed as a result of the pathological process. As a rule, physiotherapy is used for chronic forms of the disease, but in some cases it can be used in the complex treatment of acute purulent forms.

Antibiotics for inflammation of the periosteum of the tooth are prescribed during the treatment process; they are necessary to eliminate the bacterial infection, which is one of the causes of the development of the purulent-inflammatory process. The doctor selects medications based on the severity of the disease, the general condition of the patient’s body and the possible presence of concomitant diseases. Along with antibiotics for periostitis of the jaw, antihistamines (antiallergic) are also prescribed as treatment, which can reduce the drug load on the immune system, as well as calcium supplements.

The success of treatment largely depends on the patient’s timely visit to the doctor and the effectiveness of the therapy itself. And if in the first case everything depends on the patient - his conscious attitude towards his own health, then in the second the success of treatment is completely determined by the qualifications and experience of the dentist to whom the patient turned. A competent specialist with extensive clinical experience will quickly and successfully cope with even such a complex disease, while an amateur can further aggravate the problem. Therefore, choosing a good specialist is important here - these are the specialists who work at the 32 Dent clinic. Our doctors have extensive experience in successfully treating any purulent-inflammatory diseases of the oral cavity, including periostitis.

Treatment methods

Treatment of purulent periostitis is a complex process, including medicinal procedures and dental surgery. The treating dentist, first of all, needs to determine whether the tooth can be saved or whether it needs to be removed.

Surgical therapy

Therapeutic procedures are prescribed in accordance with the characteristics of the clinical picture, the localization of the inflammatory process, and its severity.

Main methods of treatment:

• Surgical treatment of purulent periostitis

  Opening the abscess. The most common treatment option for periostitis. Under local anesthesia, the patient is incised into the inflamed area to allow the pus to drain out. To ensure that the outflow of purulent exudate occurs continuously, a thin drainage tube is placed at the incision site.

• Resection of the root apex. It is used if periostitis occurs against the background of deep caries and periodontitis. The soft tissue is excised, the affected areas are removed along with part of the root. The diseased tooth is cleaned of carious lesions, disinfected, and then filled.
• Removal of a tooth. It is the most radical method of treatment. It is performed simultaneously with opening the abscess under local anesthesia.

After surgical procedures, the patient must regularly rinse the mouth with antiseptic agents and take antibiotics for 6-10 days.

A gentle diet is also indicated, which includes avoiding solid and difficult-to-chew foods.

General therapy

It is carried out using medicinal methods.

These include:

• Antibiotics. Drugs are prescribed that have an effect against a wide range of pathogenic microorganisms. These drugs include: Amoxicillin, Amoxiclav, Doxycycline, Biseptol, Tsiprolet, Flemoxin Solutab.
• Painkillers. Prescribed to eliminate pain due to acute periostitis. Patients may be prescribed drugs Analgin, Ibuprofen, Solpadein, Nurofen.
• Anti-inflammatory drugs. The action is aimed at reducing the severity of the inflammatory process, eliminating swelling and pain. For flux, drugs based on Diclofenac are actively used. Drugs based on Paracetamol, Nimesulide, Ketolorac are also prescribed.
• Antiseptic rinses. They are used to provide an antimicrobial and bactericidal effect. When treating flux, it is recommended to use the drugs Angilex, Miramistin, Chlorhexidine, Rotokan, Furacilin.

Important to remember! Any medications should be taken only as prescribed by a doctor, in accordance with the dosages specified in the instructions.

Physiotherapy

Physiotherapeutic procedures are prescribed to relieve the inflammatory process.

The following procedures apply:

• Electrophoresis with hyaluronidase;
• Exposure to ultrasound;
• UHF therapy;
• Fluctuarization;
• Darsonvalization.

With a timely approach to therapy, severe flux symptoms disappear within 1-2 days after the start of treatment. Full recovery occurs, on average, after 6-8 days.

How to treat inflammation of the periosteum of a tooth before visiting a doctor?

Self-medication for any purulent processes is very dangerous, so it is recommended to consult a dentist at the first symptoms of the disease. However, before visiting a doctor, the patient can alleviate his condition somewhat by applying cold to the cheek on the affected side and rinsing his mouth with an antiseptic solution at room temperature (chlorhexidine soda-saline solution, chamomile or sage decoctions). Here's what you absolutely can't do:

• Apply warm compresses and drink hot drinks.
• Apply any bandages yourself or use medications without a doctor’s prescription.
• It is better not to take analgesics before visiting the dentist.
• If you are undergoing surgery (opening an abscess), you should not take aspirin, since it changes the rheological properties of the blood and can cause bleeding.