Symptoms of dental periostitis with photos, treatment of inflammation of the periosteum of the lower or upper jaw. Causes, symptoms and treatment of jaw periostitis Periostitis local status

Acute or aggravated chronic periodontitis, in the absence of self-resolution or adequate treatment, can lead to the spread of the inflammatory process into the periosteum of the alveolar process of the upper or lower jaw and the adjacent soft tissues with the formation of acute periostitis of the jaw.
The share of patients with periostitis of the jaw accounts for 7% of the total number of patients who applied for treatment in clinics, and 20-23% of patients who were hospitalized. In acute form, periostitis occurs in 94-95% of cases, in chronic form - in 5-6%. On the lower jaw, periostitis occurs in 61% of patients, on the upper jaw - in 39%. Periostitis, as a rule, develops on one side of the jaw, most often affecting it from the vestibular surface (93% of patients).

Acute periostitis of the jaw

Etiology

The cause of acute periostitis can be acute and chronic periodontitis, periodontitis, acute or exacerbation of chronic sinusitis, pericoronitis, suppurating jaw cysts, benign and malignant tumors. Acute periostitis can develop after tooth extraction surgery as a complication of alveolitis. Surgical intervention in this case serves as a trigger for the disease, disrupting the immunobiological balance between the infectious principle and the factors of local and general defense of the body, thus provoking an exacerbation and development of the inflammatory process.

The acute form of the inflammatory reaction during periostitis is usually divided into two stages: serous and purulent.

The serous stage of periostitis occurs in 41% of patients. It is a reactive inflammatory process in the periosteum, accompanying acute or aggravated chronic periodontitis.
In the purulent stage (59% of patients), exudate from the affected periodontium penetrates into the periosteum through the system of Haversian and Volkmann canals or through a previously formed usura in the wall of the socket, and through the blood-lymphatic circulation system into the surrounding soft tissues.
The morphological picture is characterized by swelling and loosening of the periosteum. Its leukocyte infiltration develops and increases, and microcirculatory disorders develop. The inner layer of the periosteum melts, and serous, then serous-purulent, and subsequently purulent exudate accumulates between the periosteum and the bone. The accumulating mass of exudate exfoliates the periosteum, disrupting the blood supply in it, which contributes to the development of deeper pathological changes. Dystrophic changes occur in bone tissue: lacunar resorption of bone substance, fusion of Haversian canals and medullary spaces. As a result of these processes, significant thinning occurs, and in some areas, the disappearance of the cortical layer of bone and adjacent bone beams. At the same time, penetration of purulent exudate from under the periosteum into the Haversian canals and its transition to the peripheral areas of the bone marrow spaces is noted.

Clinical picture

It is varied and depends on the gender and age of the patient, the localization of the inflammatory process, the state of general and local reactivity of the body, the type and virulence of the microflora, the type of inflammatory reaction (Fig. 8-13).

In most cases, it is possible to establish a connection between the occurrence of periostitis and such previous provoking factors as hypothermia, overheating, physical or emotional stress. For patients with acute periostitis, the pain in the causative tooth subsides, but at the same time it begins to take on a diffuse character, becomes constant, aching, often acquires a pulsating character, radiates along the branches of the trigeminal nerve to the ear, temple, and spreads to the entire half of the head. Depending on the location of the inflammatory process, there may be complaints of limited, painful opening of the mouth (inflammatory contracture of the I-II degree), minor pain and discomfort when swallowing, moving the tongue, and chewing. Swelling of the soft tissues appears in the area of ​​the upper and lower jaw, which can be expressed to varying degrees. The localization of edema is usually quite typical and depends on the location of the causative tooth.
When examining the oral cavity in the area of ​​the causative tooth, hyperemia and swelling of the mucous membrane, smoothness of the transitional fold and the alveolar process of the jaw are detected (Fig. 8-14).

More often this is typical for the serous stage. When the process passes into a purulent form, a roller-like protrusion is formed along the transitional fold - a subperiodic abscess. If the pus melts the periosteum and spreads under the mucous membrane, a submucosal abscess is formed. In this case, self-resolution of the process may occur through the breakthrough of pus from under the gingival margin. The causative tooth becomes mobile, its crown may be partially or completely destroyed, the carious cavity and root canals are filled with putrid masses. Sometimes this tooth is filled. Pain during percussion of the causative tooth of varying intensity is observed in 85% of patients. There may be pain on percussion of adjacent teeth, numbness of the lower lip (Vincent's symptom) is observed only in patients with an inflammatory process localized in the area of ​​premolars and molars of the lower jaw. In most patients, regional lymph nodes are slightly painful, enlarged, have a dense elastic consistency, but retain mobility. The patients' well-being does not suffer much. Symptoms of intoxication (weakness, malaise, sleep disturbance, appetite, etc.) are mild or moderate. As a rule, a disturbance in general well-being is associated with fatigue from pain, poor sleep and appetite. During an objective examination, the general condition is often assessed as satisfactory. Body temperature is kept within subfebrile levels, rarely rising to +38 °C and above. The described clinical picture is characteristic of periostitis, characterized by the formation of a normergic type of reactive response. With hyperergy, all clinical symptoms are more pronounced. Intoxication develops rapidly, the process becomes widespread and within a short time (about a day) can spread to surrounding tissues, contributing to the occurrence of abscesses and phlegmon in the perimaxillary areas. In patients with reduced body reactivity, the disease develops more slowly, according to the hypoergic type. This course of the process is especially often observed in elderly and senile people, as well as in the presence of concomitant diseases, such as diabetes mellitus, circulatory disorders of the II-III degree, chronic diseases of the cardiovascular and digestive systems. With the hypoergic type of inflammatory reaction, the clinical symptoms are mild. Such patients rarely go to the doctor, while the subperiosteal abscess opens spontaneously with necrosis of the periosteum and mucous membrane, acute inflammation is stopped, and the process most often becomes chronic.
In many ways, the clinical picture of acute odontogenic periostitis depends on the location of the causative tooth. When an inflammatory process occurs in the upper jaw, in the area of ​​the incisors, there is significant swelling of the upper lip and wing of the nose, which can spread 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 with the formation of an abscess, especially with a low alveolar process.

When purulent exudate spreads from the incisors towards the hard palate in the area of ​​its anterior section, a palatal abscess is formed. When the causative tooth is the upper canine, the swelling spreads to the infraorbital and part of the cheek area, the corner of the mouth, the wing of the nose, the lower and even the upper eyelid. The source of inflammation is most often located on the vestibular surface of the alveolar process of the upper jaw. If the sources of infection are the premolars of the upper jaw, then collateral edema spreads to the infraorbital, buccal and zygomatic areas, often to the lower and upper eyelids. The nasolabial fold smoothes out and the corner of the mouth drops, indicating an inflammatory lesion of the terminal branches of the buccal branch of the facial nerve. When purulent exudate from the palatal roots of the first upper premolars spreads to the palatal surface, a palatal abscess can form in the middle part of the hard palate. Acute periostitis, which develops from the upper molars, is characterized by swelling that covers the zygomatic, buccal and upper part of the parotid-masticatory region, rarely in the lower eyelid, and can reach the auricle. A few days after the development of the process, the edema begins to shift downward, which can create a false impression that the pathological focus comes from the small and large molars of the lower jaw.
When the inflammatory process spreads from the palatal roots of the upper molars towards the palate, swelling of the soft tissues of the face is not observed. Detachment of the dense periosteum in this area causes severe aching and then throbbing pain in the area of ​​the hard palate. Due to the absence of a submucosal layer on the hard palate, the swelling is insignificant. Spontaneous opening of the abscess can occur on the 6-7th day, which leads to the development of cortical osteomyelitis.

For purulent periostitis developing from the lower incisors, characterized by the presence of edema in the area of ​​the lower lip and chin. At the same time, the chin-labial furrow is smoothed out. When the inflammatory process spreads from the lower canine and premolars, the swelling affects the lower or middle part of the buccal region, the corner of the mouth and spreads to the submandibular region. If the source of infection is the molars of the lower jaw, then collateral edema affects the lower and middle parts of the buccal region, the parotid-masticatory and submandibular regions. When the inflammatory process spreads to the periosteum in the area of ​​the angle and branch of the lower jaw, the swelling is not pronounced, but has a significant area. It should be noted that in the lower jaw, the inner bone wall in the area of ​​the molars is thinner than the outer one, so the clinical manifestations of periostitis can be localized on the lingual surface. In this area, there is hyperemia, swelling and bulging of the mucous membrane, spreading to the sublingual area.

Diagnosis of acute periostitis can be confirmed by laboratory blood tests. At the same time, a slight increase in leukocytes is observed - up to 10-11x109/l, due to a slight increase in the number of neutrophils (70-78%). ESR increases slightly, rarely exceeding 12-15 mm/h.
During radiographic examination of the jaws there are no changes in the bone structure. As a rule, only changes characteristic of granulating or granulomatous periodontitis, radicular cysts, semi-impacted teeth, etc. are detected.

Differential diagnosis

Many clinical signs of acute odontogenic periostitis of the jaws are also found in other acute inflammatory diseases.
Acute periostitis is differentiated from acute or exacerbation of chronic periodontitis, acute osteomyelitis, abscesses, exacerbation of chronic sialadenitis, inflamed jaw cysts, benign and malignant neoplasms of the jaws.

Acute periostitis differs from acute or aggravated chronic periodontitis in the localization of the inflammatory focus and the severity of the inflammatory reaction. In periodontitis, inflammation is localized in the projection of the apex of the root of the causative tooth; in periostitis, inflammation spreads under the periosteum. With periodontitis, a slight reactive edema can be detected in the area of ​​the periosteum and soft tissues from the vestibule of the oral cavity, and with periostitis, an inflammatory infiltrate is localized in this area and a subperiosteal abscess is formed. In acute osteomyelitis, in contrast to periostitis, the inflammatory infiltrate is localized on both sides of the alveolar process, covering it in a muff-like manner (bilateral periostitis). With osteomyelitis, the mobility of several teeth located in the affected area is determined, and Vincent's symptom develops. Acute osteomyelitis is accompanied by more severe general intoxication of the body and pain.

Acute odontogenic periostitis should be differentiated with sialadenitis of the sublingual and submandibular salivary glands. It should be remembered that with periostitis, the salivary glands are not involved in the inflammatory process. In the case of sialadenitis, when massaging the salivary gland, cloudy or purulent-streaked saliva is released from the mouth of the duct. In these cases, in patients with calculous sialadenitis, salivary stones can be detected using radiography of the floor of the mouth.
Acute periostitis has similar features to suppurating jaw cysts, benign and malignant tumors. These diseases are sometimes accompanied by the development of inflammation of the periosteum. With festering cysts and tumors, the signs of inflammation are less pronounced. Radiography allows you to identify a pathological focus. It should be remembered that in all cases when surgical intervention has been adequately performed and drainage is carried out, anti-inflammatory therapy is carried out, but there is no effect of treatment or tissue infiltration is increasing, it is necessary to think about a malignant tumor and purposefully look for it.

Treatment

Treatment of acute periostitis should be comprehensive . In surgical terms, the question of the advisability of removing or preserving the causative tooth should be decided. Usually, single-rooted teeth with a well-passable root canal that can be filled are preserved. If there is a focus of bone destruction near the root apex, it is recommended to perform resection of the root apex after complete relief of acute inflammatory phenomena. The issue of preserving multi-rooted teeth is the subject of debate, but most authors insist on their removal. Moreover, if tooth extraction is associated with significant trauma during surgery (impacted, dystopic tooth, etc.), then removal is postponed until the inflammatory reactions are completely eliminated, usually for 7-10 days.
When making incisions to open subperiosteal abscesses, the localization of the inflammatory process should be taken into account. The operation is performed under local anesthesia with premedication. In cases where it is necessary to simultaneously remove a tooth and open an abscess, the intervention begins with opening the abscess and then removing the tooth. When opening an abscess, the scalpel blade is positioned strictly perpendicular to the bone and guided along the transitional fold, i.e. along the border of the mobile and immobile mucous membrane of the gums (Fig. 8-16). If this boundary cannot be determined, then the incision is made, retreating from the gingival margin by 0.5-1.0 cm through the thickness of the infiltrate. You should not approach the gingival margin, as this may cause further gingival necrosis in this area. Also, you should not move away towards the mucous membrane of the cheek, where you can damage fairly large blood vessels and cause severe bleeding. The length of the incision should correspond to or slightly exceed the length of the inflammatory infiltrate. The mucous membrane and periosteum are dissected down to the bone, then the periosteum is peeled off in all directions from the cut by at least 1 cm, thereby fully opening the purulent focus. Through the incision, subperiosteally, a strip of glove rubber is inserted for drainage.

With periostitis, localized in the area of ​​the last molars of the upper jaw, the inflammatory process tends to spread to the tubercle of the upper jaw. Therefore, when exfoliating the periosteum, you should purposefully move a blunt instrument to the tubercle by 0.5-1.0 cm, introducing drainage mainly in this direction.
When the inflammatory process is localized in the area of ​​the second and especially third molar of the mandible on the vestibular side, it can spread to the lower sections under the masticatory muscle itself, which is clinically accompanied by severe inflammatory contracture of degree II-III. In this case, the incision should start from the retromolar triangle, downwards, reaching the transitional fold. When the periosteum is detached, one should penetrate to the lower parts of the masticatory muscle itself and under it, installing drainage there.
If the inflammatory process is located in the area of ​​the lower molars on the lingual side, it can spread under the lower sections of the medial pterygoid muscle, which is clinically determined by infiltration of this area and severe inflammatory contracture of degree II-III. In these cases, the incision also starts from the retromolar triangle and leads down to the lingual surface of the alveolar part of the lower jaw, and then parallel to the gingival edge, 0.7 cm away from it. When the periosteum is detached, a blunt instrument is used to penetrate downwards, posteriorly and inwardly in the direction under lower parts of the medial pterygoid muscle. Drainage is also introduced in this direction.
When opening a subperiosteal abscess localized in the area of ​​the premolars of the lower jaw, it should be taken into account that the mental foramen with its neurovascular bundle is located in this area. To avoid injury, an arcuate incision should be made, with the apex facing upward and closer to the gingival margin. When detaching the periosteum, you should work carefully to avoid injury to the neurovascular bundle. When opening an inflammatory process localized in the frontal part of the upper or lower jaw, you should avoid crossing the frenulum of the upper or lower lip, which can lead to scarring and shortening. In those rare cases when the infiltrate is located exactly in the center and intersection of the frenulum is inevitable, two incisions should be made, respectively to the right and left of it. When opening a subperiosteal abscess on the hard palate, triangular-shaped soft tissue is excised with a cut side of up to 1 cm. In this case, the edges of the wound do not stick together, its reliable drainage is ensured, and the development of osteomyelitis of the hard palate is prevented. Subsequently, the wound surface is covered with granulation tissue, followed by epithelization.
Treatment of the patient in the postoperative period is carried out in compliance with the general principles of treatment of purulent wounds. Warm intraoral rinses with various antiseptics are prescribed locally, which can be alternated or combined. The wound is dressed daily until the discharge of pus stops.
General treatment is in the prescription of antibacterial, analgesic, desensitizing and sulfonamide agents and vitamin therapy. Among the modern drugs with anti-inflammatory, analgesic, desensitizing and vasoactive properties, from the NSAID group, diclofenac (rapten rapid*) is used, which can be successfully used in the treatment of periostitis.
The next day after opening the abscess, it is necessary to prescribe UHF therapy in an athermic dose, flucturization or GNL therapy.

Complications

The most common complication in the postoperative period is the progression of the inflammatory process and its spread to surrounding tissues. They arise due to untimely tooth extraction, insufficient opening, emptying and drainage of the purulent focus. Treatment consists of prescribing a full range of medications and physiotherapeutic treatment. If the treatment package is insufficient, it needs to be expanded in compliance with all requirements.

Rehabilitation

Acute odontogenic periostitis is a fairly serious disease, and non-compliance with outpatient or inpatient treatment can lead to serious complications. The patient is disabled for a period of 5-7 days. In the first 2-3 days after surgery, bed rest is recommended. Patients are allowed to work after complete elimination of inflammatory phenomena. Subsequently, for 2-3 weeks he is freed from heavy physical activity. If this exemption contradicts working conditions, then the certificate of temporary incapacity for work is extended for this period.

Chronic periostitis of the jaw

It occurs in 5-6% of adults and children and, as a rule, is the outcome of an acute inflammatory process. However, in children and adolescents, chronic periostitis sometimes develops primarily, and therefore it should be classified as a primary chronic disease. The development of chronic periostitis is facilitated by the preservation of a focus of prolonged sensitization. This occurs in the presence of a chronic focus of infection: an affected tooth, chronic sinusitis, with insufficient sanitation of a purulent focus, with repeated exacerbations of chronic periodontitis without a pronounced inflammatory reaction and characteristic clinical manifestations, as well as as a result of trauma caused by removable and fixed dentures. Decreased immunity plays a big role.
There are simple, ossifying and rarefying forms of chronic periostitis. In the simple form, the newly formed osteoid tissue undergoes reverse development after treatment. In the ossifying form, bone ossification develops in the early stages of the disease and most often ends with the formation of hyperostosis. Referential periostitis is characterized by pronounced resorptive phenomena and restructuring of bone structures.

Upon morphological examination, the affected area of ​​the periosteum has the appearance of spongy bone tissue. The network of interwoven bone trabeculae has varying degrees of maturity - from osteoid beams and primitive coarse-fibrous trabeculae to mature lamellar bone tissue. The bone tissue found in these layers is also at different stages of maturation. Chronic proliferative inflammatory changes in the periosteum are difficult to reverse or cannot be reversed at all. The process is most often localized on the lower jaw.

Clinical picture

Patients usually do not make any complaints or complain of a feeling of discomfort and stiffness in the corresponding half of the jaw, of an externally determined deformation of the face. Some of them have a history of an acute stage of the disease. The configuration of the face can be changed due to slight protrusion of the soft tissues caused by the thickening of the jaw. The long-term existence of an inflammatory focus leads to enlargement and hardening of regional lymph nodes, which can be painless or slightly painful. Refractive periostitis occurs most often in the frontal region of the lower jaw, and is usually caused by trauma. As a result of the injury, a hematoma is formed, and its organization leads to compaction of the periosteum. When examining the oral cavity, a thickening of the jaw in the vestibular direction is determined (dense, painless or slightly painful). Edema of the mucous membrane is not detected, or it is mild; the mucous membrane is slightly hyperemic, cyanotic, and a vascular pattern may be pronounced. Radiologically, the shadow of periosteal thickening of the jaw is determined. With the long-term existence of the inflammatory process, ossification of the periosteum is visible. At longer periods, vertical striations and a layered structure of the periosteum (onion-shaped pattern) are noted.

Differential diagnosis

Chronic periostitis is differentiated from chronic odontogenic osteomyelitis of the jaw. Chronic osteomyelitis is preceded by a more pronounced acute stage, thickening of the jaw occurs both in the vestibular and oral directions, fistulas are formed, and Vincent's symptom is determined. In addition, chronic osteomyelitis is characterized by a certain x-ray picture with pronounced bone destruction.
In case of specific inflammatory processes (actinomycosis, tuberculosis, syphilis), there is no acute stage of the disease, the lymph nodes change, the data of specific studies are positive (skin test, Wasserman reaction, etc.).
Chronic periostitis is similar to some bone tumors and tumor-like diseases. Diagnosis is aided by medical history (history of acute inflammation), the presence of a causative factor, an x-ray pattern characteristic of neoplasms, and the results of morphological studies.

Treatment

In the early stages of the disease, it is enough to remove the causative factor and sanitize the inflammatory focus, which leads to the reverse development of the inflammatory process. In a later
During the period, removal of ossification is carried out in a hospital setting. Treatment of rarefied periostitis consists of conducting a revision of the pathological focus after peeling off the trapezoidal mucoperiosteal flap and removing the encysted hematoma. At the same time, the proliferatively changed part of the periosteum is excised, and the newly formed bone tissue is removed with bone cutters or a chisel. After removal of excess bone formation, areas of softening are found on the underlying cortical bone. The postoperative wound is sutured tightly. Intact teeth are preserved. The flap is placed in place and secured with sutures. Antibacterial, desensitizing, immunostimulating and restorative drugs are prescribed. Good results in the treatment of chronic periostitis are obtained by using electrophoresis of a 1-2% potassium iodide solution. Treatment of periostitis in older people is not much different from that in young people. You should pay attention to the prescription of physiotherapeutic procedures. They must be done with caution and taking into account concomitant diseases (hypertension, atherosclerosis, etc.).

Materials used: Surgical dentistry: textbook (Afanasyev V.V. et al.); under general ed. V. V. Afanasyeva. - M.: GEOTAR-Media, 2010

Periostitis of the upper and lower jaw is a common purulent-inflammatory disease of the maxillofacial area. Its symptoms are obvious, and treatment has a successful outcome.

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

A large number of people, especially those who do not carefully 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 dental surgeon will help you cope with the ailment that has arisen.

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 periosteum. The disease is characterized by severe, sometimes unbearable, pain, deterioration of health, and an increase in temperature to subfebrile levels.

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 that was not treated in a timely manner. Infection from the tooth cavity penetrates through the hole at the root apex into the periodontal tissue, 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 location of the edema varies.

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

1. Vestibular.
2. From the sky.
3. Diffuse bilateral inflammation.

In this case, the area on the face from the wing of the nose, the lower edge of the eye socket and the cheek itself swells. The danger of maxillary periostitis is associated with the likelihood of inflammation spreading to 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. A healthy tooth cannot cause the development of swelling of the periosteum. In order to start a purulent-inflammatory process, the presence of microorganisms is necessary.

If the tooth and gums around it are completely healthy, then bacteria do not penetrate inside. In case of poor-quality treatment of the dental cavity, the presence of periodontal pockets, the periosteum may be involved in the process.

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

Why does periostitis of the jaw occur:

• complicated caries is a source of spread of pathogenic microbes. Through microtubules they penetrate into the tooth, from where they spread through the apical foramen to the peri-root tissues;
• Chronic apical periodontitis is a common cause of periostitis. The long-existing pathogenic microflora in the canal system gradually moves deeper and, in the absence of proper treatment, initially affects the soft tissues, and later the periosteum;
• Staphylococcus is a permanent inhabitant of the oral cavity. When the immune system 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 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 cause complications on 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 time and nature of its course. Only a dentist can make an accurate diagnosis; to accurately determine it, the doctor prescribes an x-ray of the problem area, from which the doctor can assess the condition of the roots of the teeth and the periapical area. The thickening of the periosteum in the first three days is not shown in the image.

According to the type of process, periostitis is divided into:

1. Acute – has pronounced symptoms. Swelling of half the face, severe throbbing pain, formation of pus.
2. Chronic – sluggish, with periodic exacerbations.

According to the type of exudate, acute periostitis occurs:

1. Serous - often develops against the background of apical periodontitis, with infiltration of the periosteum and its thickening.
2. Purulent - is more severe, the patient is bothered by bursting pains, aggravated by hot temperatures. In some cases, pus finds its way out on its own through formation. If this does not happen, then the increasing pulsation of pain forces you to consult a dentist. He will dissect the periosteum and drain the contents.

Often retromolar periostitis develops in the lower jaw, resulting from. 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 disease. The nature of the development of the disease is influenced by the state of the immune system, as well as the presence of common 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 slight swelling of the gums and pain when pressing on the tooth. If you do not see a dental surgeon within the first 24 hours, then the next morning you may wake up with a swollen cheek.

Manifestations of periostitis with serous infiltrate:

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

When a purulent infection occurs, 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 the face;
• irradiation of pain along the branch of the trigeminal nerve;
• pulsation in the area of ​​edema;
• a fistulous tract may occur;
• when pressing on a swollen transitional fold, fluctuation is present - the phenomenon of fluid vibration.

Photo

Diagnostics

To establish the correct diagnosis, the dental surgeon carefully collects 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 the dentist to have a good understanding of the symptoms and clinical picture of various diseases.

Carrying out differential diagnosis is based on searching for similarities and distinctive features between other purulent-inflammatory diseases of the oral cavity.

• apical periodontitis in the acute stage - the purulent focus is located at the apex of the root. There are no external changes, but the X-ray image shows a rounded loss of bone tissue. It has clear contours, or it can be a blurry configuration. When eating and closing the jaws, it feels as if the tooth has lengthened and is preventing the mouth from closing. In this case, pain occurs when pressing. The resulting fistula allows pus to leak out;
• Cellulitis and abscess are serious diseases that greatly affect your well-being. A common cause is a bad tooth. Phlegmon is a diffuse inflammation, an abscess is a limited process. The diseased area is infiltrated, and the skin over it changes color to red and shine appears. With periostitis, no external changes are observed on the skin;
• sialadenitis – inflammation of the salivary gland. When palpating the gland, its density is determined, and in the oral cavity at the location of the duct there is inflammation, and salivation is difficult due to compression of the excretory canaliculus by edematous soft tissues;
• - inflammatory bone disease. When examining the x-ray, the main distinguishing signs are revealed in the form of bone destruction. At later stages, sequestra are formed.

Periostitis of the jaw and its treatment

The source of the disease in odontogenic periostitis is a periodontitis tooth. In the remission stage, this disease causes almost no discomfort, so many patients are in no hurry to see a doctor. However, the infection from the tooth cavity will not disappear.

When the body's immune defense is weakened, apical periodontitis gives a complication in the form of acute periostitis. The disease does not go away on its own, so you should not sit at home waiting for improvement, because this will lead to serious health consequences.

The treatment is carried out by a dental surgeon, so at the first symptoms of periostitis you should go to see him. Early detection of the disease allows limited therapeutic treatment with antibiotics.

But you should not self-medicate and take any antibacterial drug available in your home medicine cabinet, since this is a serious drug, and its use is strictly according to the instructions and only as prescribed by a doctor.

There are methods to eliminate and treat signs of periostitis:

1. Therapeutic treatment based on oral antimicrobials and local treatment of signs of inflammation in the oral cavity.
2. Surgical treatment consists of periostotomy - incision of the periosteum to release pus. In some cases, the causative tooth must be removed.
3. Traditional medicine based on the anti-inflammatory effects of herbs.

Surgical intervention

The operation allows you to clean the cavity from pathological contents and prevent purulent melting of the tissues with the process spreading deeper.

To treat periostitis of the jaw, dissection of the periosteum is used, which is carried out as follows:

• anesthesia - anesthesia of the affected area is carried out with modern drugs of the articaine or lidocaine series. You should know that in the case of severe purulent infiltration, painkillers do not have full effect, since an acidic environment is formed in the area with inflammatory phenomena, neutralizing the active substance of the drug;
• periostotomy - an incision along the transitional fold with capture of the periosteum to release pus and alleviate the patient’s condition;
• drainage of the wound - glove rubber is installed in the incision area to ensure the outflow of pus over the next days.

Based on the x-ray picture, the dentist decides on the advisability of preserving the causative tooth and the possibility of its further treatment to eliminate the source of infection.

Traditional methods

Traditional medicine is widespread due to its availability. The action is based on the anti-inflammatory and antiseptic properties of plants.

A disease such as periostitis cannot be cured at home without the help of a professional, because traditional methods only temporarily affect the symptoms of the disease, reducing its severity. To cure the disease, the source must be eliminated.

In unusual situations, when the pain comes by surprise, alternative medicine recipes can alleviate the patient’s condition. At the first opportunity, you should visit a doctor to provide qualified assistance.

1. Soda-salt rinses are the most commonly used method to reduce swelling and pain.
2. A decoction of calendula, sage or chamomile helps fight inflammation.
3. Cold compress to reduce swelling and soreness.

Consequences

If periostitis of the jaw is not treated on time, this leads to dangerous consequences. The following complications may occur:

1. Abscess or cellulitis.
2. Osteomyelitis.
3. Sepsis.
4. Mediastenitis.

When it is not possible to visit the dentist in a timely manner, the acute stage of periostitis turns into a chronic stage, which will be a source of infection in the body for a long time.

Prevention

The basis of preventive measures is constant monitoring of maintaining oral health:

The disease of the periosteum begins asymptomatically and almost imperceptibly. To monitor the condition of the roots of the teeth, it is recommended to perform an x-ray examination once a year.

Video: how to treat periostitis of the jaw (flux) in the “Live Healthy” program with Elena Malysheva.

Additional questions

ICD-10 code

Periostitis of the jaw in the international classification of diseases is numbered K10.2 “Inflammatory diseases of the jaws”.

What to do with periostitis of the jaw bones in children?

If a child experiences swelling and complains of pain, he should immediately consult a doctor. Self-medication is strictly contraindicated, as it can hide some symptoms of the disease, which leads to complications.

The periosteum of the tooth resembles a dense film that almost completely covers its root. When an inflammatory process develops in this area, they speak of periostitis. People call this disease “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 bonding the tooth with muscle tissue and ligaments. Due to such close proximity and a large number of vessels, any infection spreads unhindered in the periosteal elements, provoking an inflammatory process. Periostitis has such a development mechanism.

The disease can occur at any age, but is rarely diagnosed in children and the elderly. The favorite place for 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 poses the greatest danger to 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. The teeth in the oral cavity are constantly at work. If not properly cared for, they become a real target for various dental diseases.

Tooth decay most often occurs due to an infectious process. Food debris constantly accumulates 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 escape out. Breaking through all obstacles, it stops under the periosteum.

Among other causes of periostitis, dentists identify:

• traumatic damage to surrounding tissues;
• advanced carious process;
• inflammation of the gum pocket;
• neglect;
• infection through the bloodstream.

Decreased 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 injury to the gums. Within a few hours, severe swelling develops in this area. The gums increase in size, causing painful discomfort when eating.

Gradually, periostitis of the tooth spreads to adjacent soft tissues. As a result, the jaw, chin and lips become slightly swollen. On palpation, pain may occur. In some people, 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 dental periostitis have? Externally, 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. If the result is positive, the cavity cleanses itself. However, without adequate treatment, cases of relapse cannot be excluded. Abscesses will reappear at some intervals.

Classification of periostitis

Any disease varies in form, 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 photograph of the affected area and a study of the patient’s medical 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 and 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 the gums become infected.

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 and infiltration of the periosteum.
• Purulent periostitis. It is characterized by the appearance of an abscess and the formation of fistulous tracts through which pus flows out. Otherwise, serous discharge begins to accumulate and severe swelling occurs.

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

• Simple periostitis. 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 can be limited and diffuse. In the first case, fibrous thickening of the periosteum is observed in the area of ​​one tooth, and in the second - over the entire jaw.

Diagnostic methods

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

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

Differential diagnosis is carried out with the following diseases:

1. Acute periodontitis. Characterized by the development of an inflammatory process at the root apex. Having reached the stage of exacerbation, purulent exudate breaks out, forming a fistulous passage.
2. lymphadenitis. The listed pathologies are accompanied by the appearance of dense formations. The skin over them is slightly hyperemic.
3. Purulent secretion is released 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. Headaches may occur.

Based on the results of complex diagnostics, the doctor prescribes therapy.

Treatment with drugs

Regardless of the form of the disease, therapy always begins with the prescription of medications. For example, for purulent periostitis, antibiotics are recommended. The following drugs are characterized by the greatest effectiveness: “Lincomycin”, “Tsiprolet”, “Amoxicillin”. For topical use, various gels and ointments are used, also made on the basis of antibiotics (Levomekol, Metrogyl-Denta). In case of severe inflammation, it is better to take tablets or capsules. Treatment of flux with antibiotics is continued until symptoms disappear completely.

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

You need to understand that drug therapy is a component of the whole course of treatment. Therefore, when the first symptoms of periostitis appear, you should consult a doctor. Uncontrolled and prolonged use of medications can not only cause harm, but also aggravate the course of the disease.

Surgery

Treatment of flux with antibiotics is justified only at the initial stage of the disease. If the patient ignored its first manifestations and did not consult a doctor, an abscess may develop. In this case, surgery cannot be avoided. The operation is carried out to create conditions for the complete outflow of purulent secretions and eliminate the source of infection. It consists of the following stages:

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

In particularly serious cases, tooth extraction is indicated.

Recovery after surgery

Periostitis of the tooth, the treatment of which is 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 zero.

The recovery period includes rinsing the mouth with antiseptic solutions, using analgesics, and proper hygiene. Since the possibility of relapse still exists, it is necessary to examine the treated teeth every day. Both the gums and the tissues near them can become inflamed again.

Periostitis completely disappears in 10 days. During this time, you are allowed to eat food only at room temperature. In this case, you should pay special attention to its consistency. It is recommended to grind the meat into minced meat, and puree vegetables and fruits. After each meal you need to rinse your mouth with an antiseptic. They can be bought at every pharmacy.

How to remove flux at home?

The use of folk remedies in the fight against the disease is acceptable. However, you must first consult a doctor and eliminate the cause of the abscess. Otherwise, such treatment will only weaken 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 particularly effective:

• rinsing with a weak soda solution;
• 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 you should not 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 promptly treat all foci of infection. This applies to minor caries and serious forms of periodontitis. Many chronic diseases are characterized by an asymptomatic course, and they can only be seen on an x-ray. For the purpose of prevention, dentists recommend periodic examinations and professional teeth cleaning.

Periostitis of the jaw ICD 10: code K10.2 () – periostitis of the jaw (acute, chronic, purulent)

Damage to tooth enamel caused by mechanical, temperature, chemical or biological factors leads to the onset of destruction of dental tissue. A defect in the natural protective coating of the tooth makes the dental substance accessible to microorganisms, the destructive work of which leads to the appearance of which. Once the carious process has begun, it progresses, never stopping on its own. Only a dentist can stop tooth decay by installing a filling. In the absence of therapeutic measures, the carious cavity becomes deeper every day, approaching the core of the tooth.

The formation and constant deepening of a carious cavity in a tooth ultimately leads to the penetration of infection into the dental pulp, which as a result becomes inflamed. This causes severe pain, which can only be calmed by strong painkillers. But they also provide only a temporary effect, and after their effect ceases, the pain returns again. Only a dentist can cure pulpitis by removing the pulp, followed by cleaning and filling the dental canal.

Periostitis of the jaw (photo): appearance

Unfortunately, often a person is ready to endure pain for a long time and inflict a blow on his body with various chemical analgesics, stubbornly refusing to go to the dentist’s office. Often the reason for this behavior is fear of dental procedures. And toothaches in such people actually stop over time due to the death of nerve endings. The person calms down and completely forgets about the bad tooth. However, in reality, this is the beginning of truly serious problems.

An infection nesting in the pulp penetrates through the root canal into the periodontium - the tissue directly adjacent to the root. The excruciating pain begins again. However, to treat a developed disease - periodontitis - it may even be necessary to remove a tooth. The lack of treatment leads to serious complications - such as the transition of the disease to a chronic form, the development of cysts and granulomas, and the appearance of fistulas. In addition, with periodontitis, infection of the periosteum can occur, which results in the development of a serious disease, periostitis of the jaw. What is this disease?

What is periostitis of the jaw

This disease is an acute or chronic inflammatory process that has developed in the periosteum of the alveolar process. In the vast majority of cases, it is the acute form of periostitis that develops.

Inflammation of the periosteum can have both odontogenic and non-odontogenic origin. In the first case, periostitis is a complication of diseases of the tooth and surrounding tissues. In the second case, this disease is caused by other reasons. These include:

• or ;
• penetration of infection into the wound on the face;
• poorly performed dental surgery - or one that caused tissue injury or infection;
• the presence of infection in the blood or lymph due to an infectious disease.

If a tooth is extracted poorly, some part of it may remain in the gum, which causes inflammation that spreads to the periosteum.

The root of the tooth broke off. The fragment remained in the alveolar bone.

Periostitis of the jaw can begin even in the absence of medical errors during surgery. This occurs when there is already a focus of infection in the periodontium. Surgery in this case leads to the spread of infection to the periosteum. Such periostitis should be considered odontogenic, although it is provoked by external factors.

Inflammation of the periosteum affects only one side of the jaw. In this case, the inflammatory process usually develops on the surface of the jaw bone facing the cheek. Inflammation of the periosteum can be localized on any of the jaws, however periostitis of the lower jaw occurs more often than periostitis of the upper jaw.

Odontogenic periostitis, which occurs in an acute form, occurs as a complication of diseases such as:

• chronic periodontal inflammation;
• inflammation of the walls of the hole remaining in the place of the pulled out tooth ();
• complicated growth of wisdom teeth;
• suppuration of a cyst that has developed due to diseases of the tooth or surrounding tissues;
• periodontal inflammation.

The most common cause of periostitis is chronic periodontitis.

Acute periostitis, which developed as a complication of dental diseases, can occur in both serous and purulent forms.

What is serous periostitis of the jaw

This disease is an inflammatory process in the periosteum, resulting from its infection with bacteria, usually staphylococci, accompanying acute or chronic periodontitis. As a rule, this form of inflammation of the periosteum is a local disease localized near the diseased tooth. Serous periostitis is also characterized by mild signs of general intoxication, such as deterioration in health and a slight increase in temperature. The local clinical picture includes such phenomena as:

• formation of infiltrate in the area of ​​inflammation;
• accumulation of exudate in the periosteum;
• overflow of blood vessels with blood in the area of ​​the inflammatory process;
• swelling of the periosteum.

Serous inflammation of the periosteum is often provoked by factors such as:

• overheat;
• hypothermia;
• excessive physical activity;
• nervous stress.

Serous periostitis can be recognized by the following signs:

• the appearance of edema in the area of ​​the inflammatory process, which, with sufficient intensity of inflammation, disrupts the symmetry of the face;
• redness and swelling of the oral mucosa in the area of ​​the diseased tooth;
• and when tapping on it;
• smoothness of the transitional fold of the gums.

Serous inflammation of the periosteum is characterized by a slight enlargement of the lymph nodes located near the area of ​​inflammation, which at the same time retain elasticity, remain painless, and do not adhere to adjacent tissues.

Periostitis of the lower jaw (photo)

If serous periostitis develops as a complication of a disease of a tooth that has several roots, then this tooth is usually removed. After this, the periosteum is opened to remove the exudate. If the causative tooth has only one root, then they often do without extraction, carrying out conservative treatment. However, dissection of the periosteum is mandatory in this case as well.

Lack of timely treatment for serous periostitis leads to the transition of the disease to a purulent form, which can lead to severe complications and even death.

What is purulent periostitis of the jaw?

The purulent form of inflammation of the periosteum, colloquially called gumboil, is a serious and dangerous disease that develops as a result of the progression of serous periostitis. Purulent periostitis can develop not only as an independent disease, but also be an expression. With purulent inflammation of the periosteum, serous exudate turns into purulent. In children, the transition from the serous form of periostitis to the purulent form occurs faster than in adults due to the structural features of the body.

Periostitis of the upper jaw (photo)

With purulent periostitis, purulent exudate spreads through the bone tissue. As a result, the cortical layer is destroyed and the periosteum is detached, which melts and dies. At the periphery of the inflammation zone, young layered bone tissue is actively growing.

When diagnosing periostitis, it is important to differentiate it from other diseases with similar symptoms, in particular, from osteomyelitis. Thus, purulent inflammation of the periosteum develops only on one surface of the jaw, while osteomyelitis affects the bone on both sides.

The symptomatic picture of purulent periostitis includes both general and local manifestations. Local symptoms include tissue swelling, leading to facial asymmetry. The patient's cheek area adjacent to the area of ​​inflammation and lip swell.

Acute purulent periostitis of the jaw (photo)

A characteristic sign of the purulent form of periostitis is redness of the skin over the area of ​​inflammation. In addition, the patient develops regional lymphadenitis - an inflammatory process in the lymph nodes, leading to their enlargement and pain.

The symptoms of acute purulent periostitis include severe, often throbbing pain radiating to the ear and temple. The patient sometimes thinks that the whole half of his head hurts; it becomes painful for him to open his mouth, move his tongue and swallow.

If in the serous form of periostitis the transitional fold is smoothed out, then in the purulent form a ridge is formed, which is a sign of the development of a subperiosteal abscess. When the periosteum melts and pus penetrates under the mucous membrane, a submucosal abscess develops. When purulent exudate spreads towards the hard palate, a palatal abscess begins.

Abscesses may resolve by forming fistulas through which pus leaks into the mouth or onto the surface of the skin.

After removing the purulent exudate, the adult feels better for some time, but this does not mean recovery at all.

General symptoms of acute purulent periostitis include fever above thirty-eight degrees, headache, general weakness and other signs of intoxication.

Acute odontogenic periostitis (photo)

Purulent periostitis can cause serious complications, such as osteomyelitis - a purulent-necrotic infection of bone tissue, infection of the brain with subsequent development of meningitis, infection of remote internal organs, and general sepsis.

Chronic periostitis of the jaw

Typically, a chronic form of inflammation of the periosteum develops after acute periostitis. In children, however, there are cases of this disease developing as a primary pathology. The likelihood of developing chronic periostitis increases in the presence of a long-lasting focus of infection, which can be:

• bad tooth;
• chronic inflammatory process in the maxillary cavity;
• regular exacerbations of chronic periodontal inflammation without severe symptoms.

The cause of the development of chronic periostitis can also be trauma to the jaw tissue caused by various orthodontic structures. Often this disease occurs as a result of a weakened immune system.

The following types of chronic inflammation of the periosteum are distinguished:

1. Simple chronic periostitis.
2. Ossifying chronic periostitis.
3. Resolving chronic periostitis.

A chronic inflammatory process in the periosteum leads to its hypertrophy - the connective tissue first grows and then ossifies - ossifies. In simple chronic periostitis, after treatment, the newly formed osteoid tissue reverses. In the case of the ossifying form of the disease, ossification begins at an early stage of the development of periostitis and usually leads to hyperostosis - a pathological increase in the amount of bone matter. With recurrent periostitis, the most common cause of which is trauma causing a hematoma, the periosteum thickens, the structure of the bone tissue changes, and the bone is replaced with fibrous tissue.

Chronic periostitis of the jaw in a child (photo)

Chronic periostitis can last up to several years, leading to some changes in facial shape due to bone thickening. There is no pain when palpating the thickened area. A sign of this disease is also swelling and redness of the oral mucosa in the area of ​​the inflamed area of ​​the jaw.

Chronic periostitis is difficult to diagnose. When making a diagnosis, they rely on the medical history and the results of an x-ray of the jaw. In this case, the disease should be differentiated from chronic osteomyelitis of the jaw, as well as from damage to the jaw bone by actinomycosis or syphilis. In addition, some oncological diseases may have a clinical picture similar to periostitis.

Treatment of periostitis of the jaw

Treatment procedures for acute inflammation of the periosteum are carried out comprehensively. If the causative tooth has only one root, which has a canal with good patency, removal is often avoided. If the bone adjacent to the root tip begins to deteriorate, then this tip is removed. This operation is performed after the acute inflammation has subsided.

Teeth with multiple roots are usually removed. In the case where the extraction procedure has an increased level of trauma, the operation is performed after the inflammatory process has completely resolved. It takes seven to ten days for complete relief of inflammation.

If necessary, treatment of periostitis includes surgical opening of the abscess. If it is necessary to remove a tooth, then extraction is carried out after opening.

Treatment of jaw periostitis: direction of incision

After the surgical procedures are performed, the patient is prescribed to rinse the mouth with warm antiseptic solutions. In addition, the wound is dressed daily until the pus stops secreting.

In the postoperative period, the patient is prescribed sulfonamides and vitamins. In addition to drug therapy, UHF, in particular, is used during rehabilitation.

Physiotherapy is used in the treatment of chronic periostitis. If there is no effect for a long time, surgical removal of the ossification is performed.

Periostitis (flux)– inflammation developing in the periosteum of the alveolar process. The disease is infectious in nature and is a complication of caries, pulpitis, periodontitis, periodontitis.

Briefly about the disease

To learn more about the pathology of periostitis, you need to get acquainted with the anatomical features of the dentofacial apparatus.

The crown of the tooth has protective hard tissues - enamel and dentin. The outer shell reliably protects the internal vulnerable fibers from aggressive environmental factors and pathogenic microorganisms.

Caries leads to the destruction of enamel and dentin, weakening natural protective mechanisms. When infection penetrates the neurovascular fiber located in the root canals, acute pulpitis occurs. Without timely treatment, the nerve dies, decay products remain in the root canal. The pathological process involves the membranes of the roots of the tooth and adjacent tissues, and acute periodontitis is formed.

The penetration of infection into the periosteum and the development of an acute process in it causes periostitis. The inflammatory focus is located in a closed space and has no contact with the environment. As anaerobic bacteria multiply and the affected tissues decay, inflammation increases and the gums become swollen. Within a few hours, swelling can spread to the soft tissues of the face (lips, nose, cheeks, neck) causing facial asymmetry.

Causes of periostitis

Toothache of any intensity indicates the presence of an inflammatory process. Often, people ignore discomfort in the oral cavity and put off visiting the dentist. As a result, minor inflammation increases and leads to dangerous complications.

Periostitis is a consequence of one of the dental diseases:

• Caries– damage to hard dental tissues. There are several stages of the disease. At the initial stages, the enamel is destroyed, followed by dentin. Primary symptoms of pathology: change in enamel color, appearance of pigmentation, roughness, lack of shine and smoothness of the tooth. With medium and deep caries, dentin is involved in the pathological process, a cavity is formed, and pain symptoms appear. Treatment of initial and intermediate caries is carried out in 1 visit and is not a very expensive procedure. Detection of the disease at the stage of formation, and timely treatment helps prevent the development of more serious pathologies, allows the patient to maintain health and budget;
• Pulpitis– inflammation of the neurovascular bundle of the tooth. Occurs with medium and deep types of caries, with damage to enamel and dentin. The diagnosis is established on the basis of a visual examination (probing, caries test, percussion, cold test), and x-rays. Great importance is given to interviewing the patient. A person complains of pain in the area of ​​the affected tooth, which intensifies in the evening and at night. The unpleasant sensations are constant and do not depend on external influences. After taking analgesics, the pain is dulled for a short time. With chronic pulpitis, pain is periodic and of moderate intensity.
  Treatment of pulpitis consists of removing the affected tissue, antiseptic treatment of the dental canals, and their high-quality filling. After endodontic intervention, the tooth crown is restored with filling material. If healthy tissue is severely damaged, the issue of orthopedic treatment is decided (installation of an inlay, pin, crown);
• Periodontitis– inflammation of the tooth root membrane and surrounding tissues. The disease is a complication of caries or pulpitis, and can occur as a result of injury. Poorly performed dental treatment can also lead to the development of inflammation. The symptoms of periodontitis and periostitis are similar: pain when biting, increasing intensity, swelling in the area of ​​the affected tooth, disturbance in general well-being.
  Treatment of the disease consists of removing tissues affected by caries, opening infected root canals, and treating them with antiseptic. After eliminating the source of infection, the root canals are filled with medicinal paste. If the dynamics are positive, the canals are permanently filled and the tooth crown is formed;
• Periodontitis– inflammation of periodontal tissues. In advanced forms of the disease, deep gum pockets form. Bacterial contents accumulate in the cavities, contributing to the occurrence of purulent-inflammatory processes.
  Periodontitis is treated by a periodontist. At the initial stage of the fight against the disease, professional hygienic teeth cleaning is carried out, and the issue of surgical intervention is decided. After removing soft and hard plaque, the patient is treated with antibiotics, rinses his mouth with antiseptic solutions, and treats the mucous membranes with wound-healing preparations.

Periostitis can occur as a result of an injury or an infectious disease (lymphogenous, hematogenous route), after the removal of a diseased tooth.

You can learn about the causes and symptoms of periostitis from the video:

Endodontic treatment of pulpitis, periodontitis and periostitis should be carried out by an experienced dentist. Diagnoses are made based on x-rays. After therapy, a control x-ray is required. During treatment, sterility is maintained and a special cofferdam is used. The doctor is assisted in his work by modern equipment – ​​a dental microscope.

Symptoms

Periostitis rarely appears suddenly; most often it is preceded by one of the dental diseases. When questioned, patients confirm that they knew about the presence of a deep carious cavity, but could not find the time to treat it.

The asymmetry of the face with flux can be seen in the photo:

The main symptoms of periostitis:

1. Pain when biting or tapping of varying intensity. At the initial stage of the disease, people experience minor discomfort. As inflammation increases, the pain becomes constant and unbearable.
2. Tissue swelling, facial asymmetry. Initially, a slight swelling appears on the gum. Gradually, the pathological formation increases in size. If the cause of the development of periostitis is a tooth in the lower jaw, the lower lip, cheek, and neck swell. With the development of inflammation in the upper jaw, the upper lip, cheek, and wings of the nose swell.
3. Numbness of the tongue, jaw, lips, wings of the nose.
4. Having a diseased tooth. Upon examination, carious tissue damage is detected, or the patient indicates that endodontic treatment of an incisor, canine or molar was carried out in the past.
5. Decreased general health. There is an increase in body temperature, weakness, lack of appetite, sleep disturbance, and headaches.
6. Enlarged cervical lymph nodes.
7. The formation of a fistula (exit hole in the gum) is not a mandatory symptom.

The nasal sinuses are located on the upper jaw. In the absence of timely treatment, flux can be complicated by acute sinusitis.

Classification of the disease

Depending on the duration of the course, acute and chronic periostitis are distinguished. An acute disease develops over several hours and is accompanied by severe symptoms. Chronic flux occurs over a long period of time, has phases of remission and complications, contributes to the deterioration of the overall health of the body, and can lead to the development of osteomyelitis of the jaw.

Types of flux:

• odontogenic – the infection penetrates the periosteum through the diseased tooth;
• traumatic – inflammation occurs as a result of a previous injury;
• hematogenous - bacteria enter the periosteum through the bloodstream;
• lymphogenous - the infection penetrates the periosteum through the lymphatic tract.

The infection can be limited and diffuse (spread to the tissues of the entire jaw). Depending on the component of the exudate, purulent and serous periostitis are distinguished.

The diagnosis of periostitis is established based on a number of components:

1. External examination of the oral cavity. Percussion, probing, cold test, caries test.
2. Detection of swelling of the gums and soft tissues.
3. Interviewing the patient, taking a history of the disease.
4. X-ray images. The images reveal signs of granulating periodontitis and radicular cysts.

If necessary, the doctor prescribes laboratory blood tests.

Flux must be differentiated from acute or chronic periodontitis, osteomyelitis, jaw abscess, malignant or benign neoplasms.

Treatment

The main task of the doctor during periostitis is to open the infectious focus and release the accumulated exudate.

General tactics of a dental therapist for odontogenic periostitis:

• anesthesia with local anesthetic;
• elimination of affected tissues;
• root canal cleaning;
• antiseptic treatment of cavities.

After the manipulations, the tooth remains open. If there is severe swelling, the dental surgeon will open the source of infection and install a special drainage.

Treatment of dental periostitis surgically can be seen in the video:

For 5-10 days, as prescribed by the doctor, the patient takes antibiotics and performs antiseptic rinses. The effectiveness of treatment is assessed based on the patient’s well-being, the dynamics of external manifestations, and x-rays.

Question answer

At what age can flux occur?

Periostitis affects men and women with equal frequency. Children and the elderly are at risk because they have a reactive course of the disease.

Is it possible to get rid of flux yourself?

No. Dental diseases should be treated by a doctor. Independent use of medications and attempts to eliminate the disease will not lead to success, but will end in sad complications.