Remembering the structure of bone, including the jaws, it must be said that the bone is covered with periosteum (another synonymous name is periosteum). This means that any inflammation of the periosteum, whether serous or purulent, will be called periostitis. If this is inflammation, then it can be acute, chronic, or it can be an exacerbation of a chronic process - a relapse. Summarizing the above, it should be said that periostitis is an inflammation of the periosteum of the alveolar process of the upper jaw and the alveolar process of the lower jaw or the body of the jaw. In this article we will look at the etiology, clinical picture and treatment of acute periostitis.
What is the cause of acute periostitis?
Causes and symptoms of periostitis
Symptoms of periostitis include swelling of the gums and face, suppuration, fever, and severe pain. The severity of dental flux manifestations depends on the form and severity of the disease. Swelling and asymmetry of facial contours depend on the location of the inflammation. With periostitis of the upper jaw, swelling of the upper lip, cheek and infraorbital area occurs. With periostitis of the lower jaw, swelling can be observed in the lower part of the face.
The causes of flux can be:
- failure to comply with hygiene rules;
- diseased or untreated teeth;
- consequences of complex tooth extraction;
- jaw injuries;
- infectious and inflammatory processes in the body;
- weakened immunity.
Characteristic symptoms
Symptoms of acute periostitis of the jaw are determined by the form of the disease. The state of the patient’s immune system and the diseases he has are also influenced. But there are also characteristic signs that make it possible to make an accurate diagnosis.
The disease develops gradually. At first, the gums swell a little, and pressing on the tooth causes pain. Having discovered such signs, the patient should visit a doctor on the same day, otherwise the cheek may become swollen by the morning.
Signs of the form of the disease with serous infiltrate are:
- red color of the mucous membrane:
- the appearance of painful swelling in the fold between the gum and cheek;
- tolerable pain;
- temperature may rise to 37°C;
- facial asymmetry;
- submandibular and postauricular lymph nodes enlarge (lymphadenitis).
With a purulent infection, the condition becomes much worse:
- signs of intoxication and pain are observed;
- temperature (up to 38°C);
- the cheek becomes swollen;
- pain radiates along the trigeminal nerve;
- pulsation is felt in the swollen part;
- a fistula may occur;
- When you press in the area between the cheek and gum, you can feel the vibrations of the fluid.
Features of the treatment of dental periostitis
To treat tooth flux, conservative and surgical methods are used. The choice of treatment method depends on the causes and degree of neglect of the disease.
The conservative method (without surgery) is used:
- at the initial stage;
- caused by weak immunity;
- due to other inflammations in the body.
For non-surgical treatment of flux, anti-inflammatory and antibacterial drugs and physiotherapy are used. The tooth is not removed, but the gum is cut in the area of swelling and drainage is installed.
In the case of purulent inflammation associated with dental diseases (odontogenic periostitis), or when conservative treatment is ineffective, surgical intervention is used.
Prevention
Flux is easier to prevent than to treat. Prevention methods are simple and known to almost everyone. They consist of timely treatment of carious teeth, timely removal of the gum hood from wisdom teeth, the correct choice of toothbrush and toothpaste, and timely replacement of oral hygiene products. It is recommended that you visit your dentist at least twice a year and have your teeth professionally deep cleaned to remove plaque at least once a year.
IMPORTANT! Don’t forget about strengthening your immune system and giving up bad habits.
Dental flux is an unpleasant disease that requires treatment by specialists at an early stage of development. Self-medication in case of periostitis is unacceptable. With a favorable course and initial stage of development, conservative treatment is possible, but most often they resort to the surgical method.
Stages of surgical treatment of flux:
- anesthesia (usually local);
- opening the focus of suppuration (gum incision);
- removal of pus;
- drainage (installation of drainage to ensure the outflow of inflammatory fluid);
- X-ray (to determine the cause of periostitis);
- removal of a diseased tooth or drug treatment.
In addition, for acute purulent periostitis, antibiotics, physiotherapy and painkillers are usually prescribed. Treating periostitis with antibiotics at home without consulting a doctor can cause side effects and resistance of pathogenic bacteria to the drug.
Stages of the operation
When treating periostitis of the jaw, the surgeon must cleanse the cavity of pus so that the process does not spread deeper. To do this, he cuts the periosteum. The operation consists of several stages:
- Anesthesia . The affected area is numbed using modern drugs.
- Periostotomy . The surgeon makes a soft tissue incision along the fold between the gum and cheek, capturing the periosteum. This ensures the release of purulent exudate to improve the patient’s condition.
- Wound drainage . A rubber or gauze graduate is installed into the incision. This ensures the drainage of pus.
After opening the purulent lesion, the surgeon asks the patient to rinse his mouth with a disinfectant solution.
After this, chlorhexidine and similar solutions are used to wash the wound. Measures such as irrigation with dimexide with oxacillin and 15-minute applications of dimexide liniment are also effective.
After examining an x-ray of the tooth that caused periostitis, the doctor decides whether it can be preserved and treated in the future to eliminate the source of infection, or whether tooth extraction is necessary.
Treatment of various types of periostitis
Treatment of serous periostitis
Serous periostitis can occur due to jaw trauma. No special therapy is required to treat serous periostitis. At this stage, it is possible to clean the dental canal and create the opportunity for the independent release of fluid (exudate) during inflammation.
Treatment of acute purulent periostitis
In the case of acute purulent periostitis, the dentist cuts the gum, removes the pus and drains the suppuration. When draining, the tip of a rubber strip (drainage) is inserted into the cavity at the incision site. Drainage prevents the wound from healing too quickly and allows fluid to drain out. It is advisable to remove a diseased tooth, the source of infection of acute periostitis, if:
- severely damaged crown;
- obstruction of root canals;
- lost functionality;
- ineffectiveness of the non-surgical method;
- mobility.
In other cases, it is recommended to eliminate the relevant causes of infection (for example, inflammation of the tonsils and throat), as well as restore the immune system. The most effective approach to the treatment of acute purulent periostitis is complex therapy, combining surgery, drug therapy and physical therapy.
Treatment of diffuse periostitis
Diffuse periostitis is characterized by widespread infection, not limited to a local focus. This is a severe type of disease. As a rule, the patient needs the help of maxillofacial surgeons. In stationary conditions, an operation is performed to remove part of the periosteum or bone. Treatment of diffuse periostitis is complemented by drug therapy and detoxification.
Treatment of chronic periostitis
Chronic periostitis is a sluggish infection typical of patients with impaired immunity. If disease is present, the inflamed area is cleaned and physical therapy is prescribed to reduce symptoms and eliminate infection. In particularly difficult cases, the treatment of chronic periostitis may require serious surgical intervention to completely remove diseased tissue. In addition, with this form of flux, it is important to carry out therapy with vitamins and means to strengthen the immune system. An integrated approach stimulates an increase in the body's immunity.
Clinical picture
The main symptom for all types of flux is severe toothache at the site of infection, sometimes diffuse (with extensive bone damage). Swelling gradually begins to increase: first it is localized above the site of inflammation, and then along the surrounding tissues, sometimes affecting the neck, temple and eye.
Important! Sometimes flux occurs painlessly or with a mild pain effect, which, as a rule, indicates the development of a chronic form with sluggish inflammation and periodic relapses.
Inflammation is accompanied by the following symptoms:
- pulsation at the site of the lesion;
- increase in body temperature to subfebrile and febrile levels;
- headache;
- enlarged lymph nodes on the affected side;
- weakness, lethargy, lack of appetite;
- pain when swallowing, talking, opening the mouth;
- pain when pressing on the gum;
- redness of the oral mucosa at the site of the lesion.
Treatment of periostitis with physical factors
The complex approach to the treatment of periostitis is complemented by the use of therapeutic physical factors:
- ultra-high-frequency therapy (an electromagnetic field, or UHF, acts as a therapeutic factor in inflammatory processes);
- magnetic applicators (magnetotherapeutic treatment of inflammatory processes);
- medicinal electrophoresis (using an electric current of low voltage and low strength, a medicinal substance is introduced into the body as an additional therapeutic factor);
- helium-neon laser rays (have anti-inflammatory, bactericidal, regenerative effects).
Surgical intervention
With serous inflammation, as a rule, conservative therapy is limited. Pulpitis or periodontitis is treated, the patient is prescribed a course of physiotherapeutic sessions (UHF), rinsing with disinfectants. This leads to resorption of the infiltrate.
The acute purulent form requires surgical intervention to open the subperiosteal or submucosal abscess.
The milk tooth that caused periostitis must be removed. Severely damaged permanent teeth are also removed. Teeth that are capable of performing their functions need to be treated.
Treatment of gumboil with folk remedies
In order not to harm the body, folk remedies for treating flux can only be used for temporary pain relief or as a supplement during the recovery period.
- Infusions of oak bark, sage, St. John's wort, and calendula are used to rinse the mouth (strictly warm solutions).
- Chamomile flower tea is taken orally and is also used as a mouth rinse.
- Honey or honey propolis products are used to lubricate the gums.
In case of treating periostitis at home, you should consult a doctor. In any case, you should not postpone a surgical visit to the dentist when the first symptoms of gumboil appear on the gums or replace medical therapy with self-medication. When treating flux only with folk remedies, inflammation can spread further or develop into chronic periostitis.
With a timely and comprehensive approach to the treatment of periostitis, the disease is successfully cured. However, full recovery will require the help of a qualified dentist, medical procedures and medications.
How is periostitis diagnosed?
For an accurate diagnosis, the doctor collects anamnesis, conducts an external and internal examination, prescribes an x-ray and examines the x-ray. Since the symptoms of some dental problems are identical, the surgeon must have a good understanding of their symptoms.
When conducting diagnostics, doctors look for similarities and differences between chronic periostitis of the jaw or acute and other diseases of the oral cavity. An x-ray helps differentiate the disease from others (apical periodontitis, phlegmon, abscess, inflammation of the salivary gland, osteomyelitis).
Apical periodontitis is characterized by the presence of a purulent focus located at the top of the root.
Cellulitis and abscess are manifested by external changes on the skin. An infiltrate appears on the affected area, the skin over it turns red and becomes shiny.
With sialadenitis, it is necessary to palpate the salivary gland to determine its density. Osteomyelitis is diagnosed by X-ray - in the early stage of the disease, it shows decaying bones, in the late stage - formed sequesters.
Causes of the disease
An obligatory factor in the occurrence of the disease is the presence of infection. When there is dental disease, bacteria are always present. Cyst, periodontitis, pulpitis, periodontitis often precede the development of periostitis.
Infectious diseases of other organs are also common causes of periostitis. Lymphogenous and hematogenous infection is typical for children. Tonsillitis, otitis media, boils, and viral infectious diseases can cause damage to the periosteum of the jaw. This course of events often occurs in immunocompromised individuals.
The development of the infectious process can be facilitated by hypothermia, exposure to elevated temperatures, stress, and increased physical activity. These factors create favorable conditions for the development of infection.
Any injury that involves damage to the soft tissues and bone of the jaw can lead to periodontitis. Such wounds are always initially infected, so optimal conditions are created for the development of periostitis.
