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Periostitis: symptoms and treatment

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Periostitis The name "periostitis" comes from the word "periosteum", meaning "periosteum." In literal translation - inflammation of the periosteum (connective tissue covering the jaw).

Periostitis is a complication of dental diseases of the teeth, periodontal and periodontal (ligamentous apparatus of the tooth). The absence of treatment or its unfair implementation contributes to the transition of the inflammatory process from the periodontal gap under the periosteum.



Classification of periostitis

The classification of the disease is carried out according to several criteria.

1. Depending on the degree of participation of pathogenic bacteria in the development of the inflammatory process:

  • Purulent periostitis;
  • Aseptic periostitis.

2. By the nature of exudative secretions:

  • Exudative periostitis;
  • Proliferative periostitis.

3. Depending on the severity of the process:

  • Acute;
  • Chronic.

4. Classification by the form of the disease:

  • Simple periostitis;
  • Fibrous periostitis;
  • Serous periostitis;
  • Purulent periostitis;
  • Ossificiruyuschy periostitis.


Causes of periostitis

Most often, periostitis appears as a complication of any disease of the teeth, but there may be other causes that contribute to its occurrence. Depending on the etiological factor, in medicine there are the following types of periostitis:

  1. Inflammatory periostitis - a consequence of a progressive inflammatory process in the oral cavity, which is localized in the periodontal.
  2. Toxic may occur if an infectious agent enters the soft tissue of the jaw along with the bloodstream. This situation occurs when the patient suffers from common diseases of the body.
  3. Traumatic (radiating). The name speaks for itself: the infection gets into the tissues of the oral cavity during a bruise or injury of the jaw or gum.
  4. Specific periostitis accompanies such diseases as actinomycosis, tuberculosis , etc.

Also rarely are allergic and rheumatic periostitis.

The most common are two types of periostitis: acute purulent and chronic.

Acute purulent periostitis

This form of the disease is an acute purulent inflammatory process in the periosteum of the jaw body or its alveolar process (the jaw section in which the roots of the teeth are fixed).

The vestibular (anterior) side of the alveolar process is affected in 86% of cases, the palatal - in 5%, the sublingual fold - in 9%.

Predominantly acute purulent periostitis is localized in the lower jaw in the area of ​​large multi-rooted teeth in people of middle or young age. Less commonly, the region of wisdom teeth and premolars (small molars) is affected, and periostitis of canines and incisors occurs in isolated cases.

Periostitis of the upper jaw may develop if the infection spreads from molars and premolars (4th, 5th, 6th and 7th teeth from the center of the jaw).

The etiology of acute purulent periostitis can be identified by examining pus from the affected area. Usually found mixed microflora from staphylococci, streptococci, gram-negative and gram-positive rods, as well as putrefactive bacteria.

This shows that bacteria are the main cause of the disease.

The process trigger can be:

  • Obstructed teething;
  • Inflammation of the polyurethinized and impacted teeth;
  • Suppuration of radicular cysts;
  • Odontoms;
  • Periodontal disease;
  • Trauma during tooth extraction;
  • Periodontal disease.

Common factors contributing to the development of acute purulent periostitis are:

  • Overwork;
  • Hypothermia;
  • Frequent stressful situations.

Symptoms and mechanism of periostitis

The acute form of purulent periostitis is a complication of the acute or chronic periodontitis.

The suppurative focus that occurs during previous diseases can sometimes be emptied through the canal of the tooth (if the canal is empty and communicates with the carious cavity), through the fistula (if any) or gingival pocket. But when outflow does not occur for one reason or another, purulent exudate spreads from periodontal tissues under the periosteal plate through micropores in a compact plate or through lymphatic vessels.

After the bacteria reaches its destination, purulent exudate begins to accumulate in the space between the jaw bone and the periosteum. The area of ​​inflammation can capture a number of standing teeth.

In some patients, the course of the disease is more sluggish than in others. This is due to the fact that with a decrease in immunity the body does not respond sufficiently pronounced to the development of the inflammatory process. For this reason, it seems that periostitis occurs in a milder form.

Symptoms characteristic of acute purulent periostitis depend on the etiological and pathogenetic factors, localization, as well as the extent of the inflammatory phenomenon.

There are:

  • Acute serous periostitis,
  • Acute limited purulent,
  • Acute diffuse purulent
  • Chronic periostitis.

With a limited purulent form of periostitis, only the compact plate of the alveolar process is affected, and with diffuse, the body of the jaw to the very base is affected.

Acute serous form in the first few days of development is characterized by pain and severe swelling of the soft tissues of the jaw. Exposure to cold can calm the pain for some time, and heat, on the contrary, intensifies it.

The patient's condition is somewhat improved when a swelling occurs in the face or when a purulent exudate breaks through the periosteum under the gum. At the same time the transitional fold (the place of transition of the mucous membrane of the gums to the cheek) is smoothed.

When examining the oral cavity, the percussion of the causal tooth is painful. A history of the fact that at first there was pain, and only then began to swell soft tissue.

The limited purulent periostitis , localized from the vestibular side of the jaw, is characterized by:

  • Intense pain
  • Swelling of facial tissues
  • Increased body temperature
  • The deterioration of the general condition of the body.

The pain and swelling at the beginning of the disease are small, but within three days they develop quickly and intensify. Painful sensations sometimes spread throughout the jaw and radiate along the branches of the trigeminal nerve to the ear, eye or temple.

As a result of intoxication of the body, the patient appears

  • Headaches;
  • General weakness;
  • Loss of appetite;
  • Brokenness;
  • Insomnia.

Localization of inflammatory edema and its distribution depend on the tooth, which was the source of the disease. With the development of periostitis in the area of ​​the front teeth, swelling of the upper lip or middle part of the face is observed. If the pus has spread from the molars, the cheek, cheekbone, parotid region, and sometimes the lower one, the eyelid, swell.

Obligatory accompaniment of acute purulent periostitis is an increase in regional lymph nodes. The alveolar process thickens in the form of a roller and captures about 4-5 adjacent teeth. Pus can shine through a thinned gum, giving it a yellowish color. On palpation, fluctuation clearly occurs (fluctuation of pus under the gum, visually noticeable).

An abscess can self-burst and pour the contents into the oral cavity. After this, there is a marked relief of symptoms.

If the inflammatory infiltration captures the lingual area, the process of swallowing and talking becomes difficult for the patient. Edema extends not so much on the cheek as on the submandibular region. Swelling of the tonsils is possible.

If the pus has spread to the sky, swelling in the face is not observed. But in the sky you can see the formation of spherical or oval shape - palatine abscess. In the center of the formation, tissue softening and fluctuation are determined by palpation. With the further development of the disease, an abscess captures the soft palate (soft tissues in the posterior part of the arch of the oral cavity) and the palatine arches.

Pain can be intense, pulsating and aggravated by eating and talking. A week later, palatine abscess in most cases opens itself and pours the contents into the oral cavity.

What diseases can confuse periostitis?

Diagnosis of the disease should be based on clinical data and laboratory tests.

Differential diagnosis is carried out with:

  1. Acute periodontitis . The difference lies in the localization of the lesion: with periodontitis, the swelling does not spread beyond the boundaries of the causative tooth, and with periostitis it captures several adjacent teeth.
  2. Various types of abscesses, lymphadenitis (inflammation of the lymph nodes), phlegmon (diffuse inflammation in the soft tissues of the face and neck). Phlegmon, lymphadenitis and abscess are palpated as dense formations in the thickness of the tissues in the face and neck, over which the skin is stretched, shine and hyperemic. And periostitis is like softening of tissues with fluctuations in the mucous membrane and swelling of certain areas of the face without hyperemia (redness) and tissue tension.
  3. Acute sialoadenitis (inflammation of the salivary glands). Sialoadenitis differs from periostitis in that the inflamed salivary glands secrete purulent exudate from their ducts, and in the mouth cavity the teeth remain healthy.
  4. Acute osteomyelitis . Osteomyelitis is characterized by severe intoxication of the body, which is manifested by fever, fever, headaches, chills, weakness. Roller-shaped thickening of the alveolar process is observed not from one particular side, as with periostitis, but from both sides.

Treatment of periostitis

Treatment of the acute form of purulent periostitis should include both surgery to dissect an abscess and conservative drug therapy.

At the very beginning of the development of the disease, when the serous form is still present, it is possible to do without an incision if you open the cavity of the tooth, clean the canal and create the opportunity for independent exudate outflow. In some cases, it is necessary to remove the causative tooth in order to achieve complete recovery of the patient.

Any medical intervention is carried out under infiltration or conduction anesthesia.

When the disease passes into a purulent form, it is necessary to carry out periostotomy - a surgical intervention with incision of the periosteum in the area of ​​inflammation.

During the manipulation, local anesthesia is used, which is carried out using a fine needle. In this case, the drug is injected into the mucous membrane along the intended line of incision, but in no case should anesthetic be injected into the cavity with purulent contents. In this case, anesthesia will not happen and, moreover, the gum will swell to even larger sizes.

After the abscess has already been opened, the patient should be allowed to rinse the oral cavity with a weak solution of manganese or sodium bicarbonate. Then the wound should be washed with a solution of gramicidin, chlorhexidine or ethacridine lactate.

A tooth that causes inflammation should be removed if it no longer represents an aesthetic or functional value due to severe destruction. When a causal tooth is removed, the outflow of pus improves, and the inflammation subsides faster.

When indications for the preservation of the dental unit should be carefully processed endodontically and sealed in accordance with the rules of asepsis and antisepsis.

Drug treatment is presented by prescription to the patient:

  • Sulfonamides - sulfadimetoksina, norsulfazola, sulfadimezina.
  • Nitrofurans - furadonin, furazolidone.
  • Antihistamines - suprastin, dimedrol, diazolin.
  • Calcium preparations.
  • Vitamins and multivitamins.

In recent years, doctors began to refuse the appointment of sulfonamides, since the bacterial flora has a low sensitivity to them. Instead, they recommend taking antibiotics (lincomycin, metronidazole derivatives, broad-spectrum antibiotics, macrolides) and nitazole preparations.

On the second day after surgery, the patient is carefully examined and determined the degree of subsidence of the inflammation process.

If the intervention was carried out for acute purulent periostitis, on the second day physiotherapy procedures are prescribed:

  • Light heat treatment;
  • Warm mouth baths with deodorizing or antiseptic solutions;
  • Dressings with petrolatum, sea buckthorn oil, dog rose or camphor oil;
  • UHF and microwave;
  • Laser therapy with helium-neon and infrared lasers;
  • Fluctuarization.

The outcome of the disease depends on how early the treatment is started and on its effectiveness.

If acute purulent periostitis is treated correctly and at the very initial stage of development, it is safe to speak about full recovery. Within 5 days after the start of treatment, the patient is able to work again.

If the disease proceeds in the form of palatine abscess, the abscess may not open spontaneously, which leads to the formation of dead sections in the jaw bone or becomes osteomyelitis.

Unfair or inadequate treatment contributes to the chronization of periostitis, its transition to osteomyelitis, abscess or phlegmon.

Prevention of periostitis is the timely treatment of diseases of the teeth, periodontal and periodontal before complications arise.

Chronic periostitis

This form of jaw periostitis is quite rare and is found in patients with a primary or secondary immunodeficient disease or condition.

Chronic periostitis is more common in children and adolescents.

After the acute stage subsides in case of acute periostitis (with insufficient or spontaneous emptying of the abscess), there is a roller-like thickening on the gum. There comes a chronic stage with periodic relapses.

Chronization of the process with the absence of the acute stage of periostitis is possible.

The clinical picture is characterized by a long course of the disease, which can last from three months to one year with occasional exacerbations.

At external examination of the patient, slight changes in the configuration of the face are noted, and during palpation - a painless, dense bone thickening. Submandibular lymph nodes are enlarged, but painless or slightly painful with palpation. In the oral cavity where inflammation is located, edema, hyperemia and thickening of the alveolar part in the region of several teeth are visually determined.

Diagnosis is a certain difficulty due to the lack of features of the clinical picture. The basis for the final diagnosis is a thorough questioning of the patient, the presence of symptoms of acute periostitis in the past and radiological data.

On the x-ray visible shadow of periosteum thickening of the jaw in the early stages of the disease.

If periostitis is present in the oral cavity for more than two months - ossification is determined at the site of thickening of the periosteum.

A longer course of chronic periostitis on the radiograph is marked by areas of neoplasm in the bone. Clearly visible layered structure of bone tissue and randomly scattered areas of the tumor.

Differential diagnosis of chronic periostitis is carried out with:

  • Chronic osteomyelitis;
  • Actinomycosis;
  • Syphilis;
  • Tumors;
  • Tumor-like formations.

The treatment includes the obligatory removal of the causative tooth, as well as undergoing physiotherapeutic procedures:

  • Iontophoresis of Dimexidum, Dimedrol, Potassium Iodide and Calcium Chloride;
  • Laser therapy with infrared and helium-neon rays.

If the treatment does not give the desired result, the ossified areas are surgically removed.

The prognosis, despite the fact of the chronic course of the process, is favorable. Full recovery is possible with the appointment and passage of appropriate treatment.

Prevention of chronic osteomyelitis is the elimination of chronic, odontogenic foci of infection and correction of failures of the immune system.


    | March 22, 2014 | | 7 699 | Dentistry
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    jeremy smith: I have a similar situation where the gum started to swell around a broken tooth. After 2 days of antibiotics it seems like the swelling tissue started to come off. Idk how else to say it. Then began to bleed for about a minute pretty hard. Was that the tooth draining the "pocket" or is it something else?

    Ꮇiຖt Ǥᑌᗰᗪᖇᗝᑭ: i falled and hit one tooth and its shaky and painful it doesnt affect my cheek and jaw but the dentist said maybe the nerves are damage and i might need root canal 😭

    Lorry Lorry: I have a question! Prior to RCT a gumboil is already present. I started RCT, did incision and drainage already, and prescribed antibiotics. We are on our 5th session and the gumboil is not subsiding, I even placed medicaments on the tooth like Caoh. What advice can you give me with this matter? How can I get rid of the gumboil so I could obturate the tooth? Thank you, hoping for ur reply.

    Howie C Stylez: Thanks a lot, I sure hate to spend $800 with dental insurance for a root canal but there’s no choice. I have a huge ball hanging from my upper gum😰

    zestydude87: Yep, i think this is what I have right now. Ive been in severe pain for the past 3 days. Time to visit the dentist I guess.

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