Osteomyelitis of the jaw: symptoms and treatment
Osteomyelitis in dentistry is quite common in relation to other areas. This is due to the fact that the jaws have teeth, which are the source of infection. Besides the jaw bone is provided with a large number of vessels. It is characterized by the development of the inflammatory process in the bone with the formation of pus. Its pathogenesis is quite complicated, and causes a lot.
Possible causes of osteomyelitis
In dental practice osteomyelitis can occur in different ways:
The most common cause is a bad tooth. Another way to say that infection by odontogenic. It all starts with tooth decay. It might seem like a small hole in the tooth can cause a purulent inflammation of as much bone tissue? But the untimely appeal to the dentist has consequences. The infection gets into the tooth nerve, and thence through the channels in the roots of the tooth to the periodontium. If you do not cure periodontal the inflammation spreads under the periosteum and in the bone itself. Hematogenous route due to the entry of infection through the blood from any inflammatory process in the body. Traumatic and occurs due to fractures, wounds and other damages. Sometimes it can be a complication after undergoing surgery on the jaw bone.
The clinical picture of osteomyelitis
Osteomyelitis of the jaw has different symptoms, depending on shape. It can be acute, subacute and chronic. For each state, their symptoms and treatment. It is therefore necessary to become more familiar with each form of the clinical course.
Osteomyelitis of the jaw is a suppurative inflammation of the bone structures. In the lower jaw it is much more common than on the upper. In most cases, the disease develops acutely, but sometimes it so happens that immediately goes into the chronic stage. In addition to the nature of the disease, he is subdivided in proportion to the square of the lesions in localized and generalized.
It occurs for several months after the development of the disease. Its onset can describe the appearance of the fistula. Of it is pus mixed with the liquid. Because of the creation of a temporary outflow occurs relief. The patient for a few days ceases to feel pain, bursting. But unfortunately, because of this ease it does not call for help because he thinks that’s all gone now. The disease does not disappear by itself. The source of the infection is still preserved and it extends further, passing into the chronic form. In subacute tooth mobility is maintained. Subside also the General signs of inflammation.
Chronic osteomyelitis of the jaw
This stage is characterized by complete relief of the symptoms of the disease. The temperature falls, headaches cease. But the weakness and pallor of the skin and mucous membranes are preserved. In addition, fistula is found. The allocation may continue. Teeth are also loose condition. Openings of the fistula can be located on the skin and in the mouth. Appear in jaw bone sequesters. Because of them, it thickens and can cause pathological fracture. At this stage it is not necessary to count on the fact that the disease is eliminated independently.
The acute form of osteomyelitis
Clinic starts pretty quickly. There is a strong pain in the area of the affected tooth. Progression of pain is also amplified and transferred to the jaw tissue. Causal tooth body can be loosened. If osteomyelitis is of a generalized nature, and the adjacent teeth involved in the process. Because of this possible loss, despite the fact that they absolutely can be healthy. On examination revealed swelling and redness of the gums and soft tissues. When performing palpation there is a sharp pain.
If the inflammation goes on temporo-mandibular joint, arthritis develops, the patient feels difficulty when he wants to close his mouth. Along with local pattern occur and common symptoms, characterized by the presence of any inflammatory focus in the body.
Osteomyelitis on different jaws
Most common osteomyelitis of the mandible. It is characterized by among other symptoms of numbness of the lower lip and chin area because of the injury to the mandibular nerve and its branches. The disease is of traumatic origin also occurs more frequently in the lower jaw, because she is more prone to fractures and other injuries. Osteomyelitis of the maxilla occurs less frequently and mainly as a result of rhinogenous infection. More affected infants. They need to be very careful, because the disease develops much faster than that of an adult. Swollen cheek on the affected side and the eye area. The face becomes asymmetrical. In any case, osteomyelitis of the jaws is a terrible disease and the sooner it is identified and given the necessary assistance, the better for the patient. This is especially true of infants and children.
The diagnosis is osteomyelitis of the jaw bone
In the acute form to diagnose the disease only based on clinical manifestations and laboratory data. Therefore, at this stage important a thorough history, i.e. the history of the development of the disease. As for the subacute and chronic forms, the presence of fistulas is already evidence that there is osteomyelitis of the jaw. Helps to confirm the diagnosis x-ray examination, which will reveal the presence of bone destruction. Also clearly visible to the sequesters.
Possible consequences and complications of purulent inflammation of the maxillary bone
By itself, the osteomyelitis of the jaw is a severe disease that brings a lot of discomfort in the General condition and severe pain. But if it is not time to diagnose and treat, the consequences will be even worse. Complications arising due to delayed treatment:
- Abscesses and phlegmon of the surrounding soft tissues and spaces;
- Infection of the meninges, meningitis;
- The spread of purulent inflammation of the eye and on the optic nerve, resulting in complete blindness on this side;
- Blood poisoning, which can lead to death within a few days.
Most often the disease ends with the development of cellulitis — unlimited inflammation of any region. But time on time is not necessary and so it is advisable to immediately contact the appropriate specialist for help.
Treatment of osteomyelitis of the jaw should start with elimination of the source of infection. Odontogenic form in the first place, and remove the causal tooth. When hematogenous and traumatic should be treated the inflammatory process in the body and to eliminate the injury. Usually after eliminating the cause of disease symptoms begin to subside. But it should not count. If you have time to develop another abscess or cellulitis, produce an incision of soft tissues and their drainage. Is assigned a more General treatment.
How to treat osteomyelitis of the mandible
After eliminating the cause, it is necessary to conduct remedial measures to eliminate inflammation and bacterial flora, to avoid re-infection. The wound is thoroughly washed with antiseptic solutions and establish drainage for a few days. Usually, purulent discharge is terminated when the drain out himself, and the wound is delayed. Assigned to physiotherapy, specifically the treatment of nitrogen. It helps the process of healing and recovery at the application site and suppresses pathogenic bacteria and microbes.
Therapeutic measures used in the defeat of the maxillary bones
In this case it is also necessary to remove causal tooth. If the infection has advanced in the paranasal sinuses or orbital region, these units also sanitize. Given the fact that the upper jaw is pneumatic bone and a loose, pus may propagate more quickly to the next area faster than the lower ones. So often revealed subperiosteal abscess. After removal of the tooth necessary to produce a slit along the entire length of the abscess to remove the purulent content and pharmacological treatment of wounds.
The treatment of chronic osteomyelitis of the jawbone
If the process is localized and since the outbreak of the disease was less than one and a half months, it is possible to manage conservative treatment. Otherwise, you have to refer to the surgical method. You need to remove the sequesters, and nekrotizirovannye the affected tissue. In addition, if you have loose teeth, they chinasouth. You can do stripes or Ribbond orthodontic method. To replace the missing bone is sometimes used osteoplastic preparations. But they can be used only after complete subsiding of all symptoms ostemyelitis current and its effects, if any. Also prescribed fisioterapia — UHF, magnetic therapy, ultrasound.
Osteomyelitis of the jaw needs to be treated comprehensively, otherwise some of the local activities of the wing may not be. First and foremost, of course, are appointed Antibacterials broad-spectrum. For this disease, they are administered parenterally — intramuscularly or intravenously. The increasing popularity of clindamycin. Sometimes penicillin is appointed and if he has no allergic reactions. The first drug is administered every six hours and the second every four.
Also prescribe anti-inflammatory medicines, for example, methyluracil. They need to use during the month. To improve the immune system are assigned to vitamin complexes. Definitely need good nutrition with a great predominance of protein intake. This is necessary in order to quickly restore lost power. Also undergoing physiotherapy.
The effects of osteomyelitis
Unfortunately, sometimes it happens that you have to remove and adjacent teeth when they are not subject to any splinting. So after calming down inflammation patients need prosthetic. After chronic there are significant defects of the jaw bone. This leads not only to violation of the appearance, but also functionality. After removal of the fistula, there are scars, and it is possible to eliminate only by surgery. The transition of infection in the jaw joint develops osteoarthritis or arthritis. As mentioned above, if the infection is in the upper jaw pass into the orbit, the optic nerve is affected and may atrophy. Lost all of its functions and the eye on that side becomes completely blind.
With regard to traumatic and hematogenous flow, the patient will not be able to prevent the development of the disease, unfortunately. But given the fact that osteomyelitis often develops because of the patient’s teeth, prevention is possible and necessary to conduct. In principle it does not differ from that of other diseases of the oral cavity:
- Personal personal hygiene — brushing teeth twice a day ;
- Rinsing with antiseptics;
- Professional hygiene;
- Visit a dentist regularly;
- Upon detection of the carious process in the tooth immediate appeal to the specialist;
- And of course, avoid situations in which you may experience injuries to the face, particularly the jaws.