Periostitis of the lower jaw — dental abscess: symptoms and treatment

Periostitis of the mandible, aka the flu, is an infectious inflammation of the periosteum. Can have traumatic or infectious origin. Accompanied by the development of severe General and local symptoms. Requires fast medical assistance. According to the international classification of diseases, pathology refers to the section «inflammatory disease of the jaws» and has the code K10.2.
Periostitis of the upper jaw is found in 1.5–2 times less. Local symptomatology is slightly different from that in the inflammation in the mandibular area. Common symptoms of the disease do not have differences. A chronic form of periostitis occurs no more than 5% of cases. 95% of applicants for assistance patients suffer acute periostitis.
Uncomplicated forms of the disease do not require hospitalization. Their treatment is on an outpatient basis in a dental clinic. Heavy the abscess, accompanied by severe General symptoms and the presence of an abscess requires opening. The procedure is conducted after admission of the patient to the Department of oral and maxillofacial surgery.

Background and causes

Inflammation of the periosteum on the upper or lower jaw can develop for the following reasons:

  • Inflammatory diseases of teeth and gums;
  • Caries grade 3-4;
  • The presence of foci of infection in nearby organs and tissues;
  • Injuries to the skin and muscles on the face;
  • Fractures and injuries of the jaw;
  • The infection of the tooth after its removal.

In a separate, though extremely rare cases, the abscess is allergic or rheumatic origin. Treatment of such forms requires some correction relative to standard therapies.

Predisposing to the development of inflammation of the periosteum of the factors is:

  1. The decrease in the level of immune protection;
  2. In the acute stage of infectious diseases;
  3. The lack of adequate hygiene of an oral cavity;
  4. Repetitive stressful situation.

Periostitis of the jaws in children sometimes develops if the child does not wash his hands before eating. The infection is transferred to the mouth by dirty hands, can penetrate into the zone of the periosteum via an existing, but not yet revealed gate (deep decay, minor damage to the mucosa).

In adulthood, the disease can occur with improper growth of wisdom teeth. Fully or partially impacted teeth are often the foci of chronic infection.

The etiology and pathogenesis of periodontitis

For periostitis can be acute or chronic. The chronic form of the disease characterized by the appearance in the pathological focus of the young bone tissue, which makes the inflammatory process sluggish and reduces its intensity. The symptoms of the disease can be blurred, unclear.

Acute periostitis occur in two stages:

  • Serous stage;
  • Purulent stage.

Serous stage of the disease is diagnosed in 40-41% of patients, occurs without the formation of pus is of a reactive nature. Suppurative periostitis is diagnosed in about 59-60% of patients.

In this case purulent exudate is formed in the lesion (aching tooth), gaversovyh channels penetrates into the area of the periosteum, where it accumulates, leads to the development of the inflammatory process, leading to mechanical detachment, loosening, atrophy of the periosteum.

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The second way of infection collegesa tissues is the lymph flow in the corresponding vessels. Lymphogenous by infected soft tissues of the face, the distant parts of the body, there is regional lymphadenitis. The accumulation of purulent exudate and the development of the inflammatory process in the periosteum, the disease can take over new portions of the jaw, taking a generalized form. The direction of the outflow of pus in gaversovyh channels is changed. The exudate begins to penetrate the opposite direction, and also extend to the peripheral zone of the bone marrow space.

Fractures of the jaw inflammation is usually granulomatous in nature. While the focus of pathology is not detected pathogenic microflora does not form a purulent exudate with subsequent spread of the inflammatory process. Aseptic inflammation is considered a normal stage of the wound process.

Symptoms and diagnosis

Depending on the condition of patients with a diagnosis of periostitis of the jaw, local symptoms may have some differences. As a rule, patients complain of the following signs of illness:

  1. Diffuse aching pain in the area of pathology;
  2. Irradiation of pain in the ear, head, half head, which is attended by inflammation;
  3. Difficulty swallowing, chewing, pronunciation of sounds;
  4. Numbness of the lower lip.

Objectively, these patients could identify swelling in the area of the inflammatory lesion, redness of the mucous membranes of the mouth, the smoothness of the transition folds. In most cases, clearly visible tooth, which has become a source of infection. It may wander, to change his position, to have a bare neck to be painful when tapped on it. The crown of such a tooth is usually partially or totally destroyed.

Periostitis of the jaw leads to common symptoms such as:

  • Regional lymphadenitis;
  • The increase in body temperature;
  • Weakness;
  • Headache;
  • Pain in the muscles;
  • Pains in the bones;
  • The reduction in muscle tone.

The intensity of development of symptoms depends on the level of immune defence of the patient, his age, allergic caution, the General condition of the body. In one embodiment, the entire symptom complex arises during the day, in other — the development of the disease requires a week or more.

Flux (swelling of the inflammation zone) usually occurs in the first hours of the disease. Thus, patients with marked facial asymmetry, pain in the swollen area. In some cases, an abscess formed in the region of the periosteum, may resolve itself. The pus exits through the affected tooth or mucosal damage. At the break of abscess of the inflammatory process abates, and the flux can pass on their own.

The diagnosis of «abscess» is placed after visual inspection, palpation, and radiographic examination of the patient. This establishes not only the fact of the inflammation, its extent, stage and extent. Differential diagnostics is conducted with diseases such as periodontitis, osteomyelitis, sialadenitis, cancer of the jaw apparatus.

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First aid

First aid in the home when the abscess is only in situations where an immediate visit to the dentist impossible. In all other cases, to treat the patient from beginning to end needs a doctor.

To slow down the course of the pathological process, the patient is given broad-spectrum antibiotic, capable of penetrating bone tissue. Such drugs include:

  1. Lincomycin;
  2. Amoxiclav;
  3. Ciprofloxacin;
  4. Tsiprolet.

Antibiotics should be taken strictly on time, at maximum dosage. It’s important to consider a patient’s absolute and relative contraindications. In the initial stages of development of flux antibacterial agents sometimes allow you to completely stop inflammation.

In addition, the patient is recommended to rinse your mouth with a solution of herbs that have antibacterial and anti-inflammatory (chamomile). In severe pain use any non-steroidal anti-inflammatory drug (ibuprofen, analgin).

Treatment of periostitis

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When periostitis of the jaw treatment should be comprehensive, including both surgical and conservative methods.

Surgical treatment

The mainstay of treatment of suppurative periostitis is surgery. The abscess is opened, its cavity sanitize. The inflamed periosteum is mechanically peeled by not less than 1 inch, providing a full outflow of pus and wound exudate. The nidus is washed with antiseptic solution or antibiotics. At the end of the operation the cavity of the abscess drained by a strip of rubber glove, thereby providing outflow of wound content in the future.

The removal of a tooth, which has become a source of infection only in the case that its retention is associated with serious technical difficulties or significantly increases the risk of postoperative complications. As a rule, are subject to removal Mnogomernye teeth, which heavy-going. Root teeth are often sealed and kept.

In some cases, the treatment of periostitis of the mandible may require resection of the gingival region of the tooth. The procedure is performed only after remitting inflammatory phenomena. To perform this resection during the operation for opening an abscess is unacceptable.

Conservative treatment

Therapeutic post-operative treatment corresponds to that in the presence of any purulent wounds. The patient is prescribed:

  • Broad-spectrum antibiotics (drug of choice lincomycin);
  • Painkillers and anti-inflammatory drugs (the drug of choice — diclofenac);
  • Desensitization drugs (the drug of choice is zyrtec);
  • Multivitamin complexes or monovalency injectable form.

Locally assigned mouth rinse with antiseptic solutions. In the future, can be used antibacterial and restorative ointment. The first change of dressings is carried out not later than the day after the operation. Thus it is necessary to assess the nature and quantity of wound discharge. If there are signs of bleeding in the treatment regimen include gemostatiki (menadione, etamsilat). A large number of pus continued for several days, is grounds for a change in anti-infective drug.

The next day after surgery the patients assigned physical therapy. Can be applied sunscreen dose UHF, HNL-treatment, fluctuarization.

The recovery period

During treatment of the abscess the patient is considered incapacitated. In most cases, the length of hospitalization does not exceed 5-7 days. However for another 2-3 months, the patient must avoid strenuous exercise, or hypothermia. To work, the patient is allowed only after the inflammation subsided.

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Possible complications

The flux can lead to complications as in the absence of treatment, and its lack of effectiveness. For possible complications of such diseases as abscess of the jaw, include:

Phlegmon of the soft tissues. Cellulitis develops when the low effectiveness of antibiotic therapy and infectious lesion of soft tissues of the head. This raises the risk of life of the patient. Swelling may affect the Airways and mechanical to prevent the filling of the lungs with oxygen. Assistance in such situations, emergency tracheotomy and subsequent tracheostomy.
Osteomyelitis. Osteomyelitis inflammatory process occurring in the thickness of the bones that affects the bone marrow. Develops when infection from the periosteum to the deeper layers of the jaw.
Sepsis. Sepsis is a systemic inflammatory response that develops as a response to a local outbreak of infection. The cause of sepsis may be extensive cellulitis, or osteomyelitis.
The transition of acute forms to chronic. Acute flux proceeds to chronicity in two situations:

  • The lack of efficiency of antibacterial therapy;
  • A good immune defense, not allowing to develop acute process, but is unable to suppress the pathogen.

Periostitis of the jaw in a chronic form can occur for a long time. The disease is difficult to treat, may worsen under the influence of precipitating factors.

Forecasts

The prognosis for the abscess favorable for life and health only in the case when the necessary measures of medical care are undertaken in a timely manner. The taking antibiotics at the first sign of the disease allows to completely stop the progression of the disease.

  • In the presence of a purulent inflammation of a favorable prognosis becomes after surgical operation. Noticeable improvement usually occurs 4-5 days after the autopsy a purulent focus.
  • The lack of treatment or its late onset makes prediction periostitis is unfavorable. The disease leads to the development of osteomyelitis, abscess, lesions, sepsis, which directly threatens the patient’s life.

Independent opening of abscess is very rare. The presence of such phenomena dramatically improves prognosis even in the absence of treatment. Out the pus allows the immune protection system to operate effectively, destroying existing inflammation pathogens.