Periostitis of the upper jaw symptoms treatment. Jaw Periostitis: Symptoms of Disease and Treatment

5.2. PERIOSTITIS

Periostitis - this is a disease that is characterized by the spread of the inflammatory process to the periosteum of the alveolar process and the bodies of the jaw from an odontogenic or dishonorogenic focus.

The periostitis of the jaws occurs in 5.2-5.4% of patients who are treated in the clinic (Ya.m. Bieberman, 1965; A.N. Fokina, D.S. Sagatbaev, 1967). Among the patients with odontogenic inflammatory processes of jaws, the periostites of 3.42% were treated outpatient and 19.17% in the hospital (Mauks, 1975). According to our data (A.A. Timofeev, 1983), in 20-23% of patients who were in inpatient treatment with inflammatory diseases, periostitis was observed, mainly its acute form (in 94% of patients).

The periostitis on one side of the jaw was localized, more often hitting it from the vestibular surface (in 93.4% of patients). In the region of the lower jaw, the periostitis was observed in 58.9% of patients, the top - in 41.1% (ha. Vasilyev, T.G. Robustov, 1981), and according to our data, - respectively, 61.3 and 38.7% (A.A. Timofeev, 1983).

♦ Acute periostitis

The emergence of acute odontogenic periostite is preceded by the following diseases: the aggravation of chronic periodontitis - in 73.3% of patients; Alveolitis - in 18.3%; Lubricated teething tooth of wisdom - 5.0%; Voaging odontogenic cysts of the jaws - in 1.7%, periodontitis - in 1.7% of patients. The disease is more often developing after a traumatic tooth removal operation, with its incompletely removal and less often - after the atravically performed operational intervention. The injury associated with the removal of the tooth can cause the intensification of the dormant infection in the periodontal slit, which leads to the spread of the inflammatory process under the periosteum.

Acute odontogenic periostitis is serous and purulent. Serous periostitis is considered as a reactive inflammatory process in a periosteum, which accompanies the aggravated chronic periodontitis. Under the purulent periostitis, the exudate from the inflamed periodontal penetrates the periosteum through the Volkmann and Gavers channels, on the lymphatic vessels or through the previously formed Uzura in the wall of the well (ha. Vasilyev, 1972).

I believe that with such a mechanism for the spread of the infectious process, it is difficult to imagine acute odontogenic periostitis, complicated by abscesses and phlegmon, which flows without a pronounced destruction of bone tissue. In an experiment conducted on animals and corpses of people in the introduction of the tooth in the hole, the root canal or periodontal slit under pressure of the solution of methylene blue, A.I. Vasilenko (1966) noted its distribution along bone marrow beams in all departments of the lower jaw and surrounding soft tissues.

According to M.M. Solovyov and I. Khudoyarova (1979), the distribution of the infectious process under the periostess of the lymphogenic path is less likely, since in these cases it is rather possible to expect a delay in microbes, toxins and tissue decay products in regional lymph nodes and the subsequent development of lymphadenitis and adenoflems. The authors believe that the formation of a glanist in the occasional soft tissues is associated not with a breakthrough of pus under the periosteum, but with the formation of the "own" pus in this place under the influence of microorganisms, bacterial toxins and tissue decay products.

In my opinion, the products of the fabric breakdown of microorganisms, toxins, and sometimes the microbes themselves from odontogenic foci penetrate into the periosteum along the vessels that pass in the channels of the compact bone layer. The first penetration of these substances usually does not cause the development of the inflammatory process, but only forms the local sensitization of tissues. The subsequent contact of the microbes into the body, as well as a decrease in its reactivity, with an increase in allergyization, with parallergic reactions (overcooling, overheating, physical overvoltage, etc.) causes the development of infectious-allergic inflammation with the subsequent flow of exudate for periostly jaws (A.A. Timofeev, 1982).

It was established that non-pathogenic staphylococcus is usually acting as a causative agent. Since the products of the vital activity of this microflora do not have a damaging effect, then the author of allergies will take a special role in the emergence of an odontogenic periostite.

When studying with intradermal samples and laboratory tests of microbial sensitization of the organism of the patient to the pathogens located in the focus of purulent jaw inflammation, we found that in patients with acute odontogenic periostitis, it arises in response to the action of some bacterial allergens. On allergen staphylococcus, the body sensitization was 3 times higher than the norm, on Allergen Streptococcus - in 2 (A.A. Timofeev, 1982). In the occurrence of acute odontogenic periostitis of the jaws, the main predisposing factor is microbial sensitization to staphylococcus, the frequency and severity of which correlate with the severity and prevalence of the process. With uncomplicated acute odontogenic periostitis, we are registered by us in 22% of patients, and with the complication of its flow by purulent processes in the occasional soft tissues - in 46%.

Thus, the participation of allergy mechanisms explains the causes of the development of odontogenic inflammation caused by non-pathogenic microflora, and the preemptive lesion of the occasional soft tissues arising from individual forms of sharp odonogenic inflammatory diseases (M.M. Solovyov, I. Khudoyarov, 1979).

Clinical picture . Clinical manifestations during the acute odontogenic periostitis of the jaws are diverse and largely depend on the total and local reactivity of the patient's body, such as an inflammatory response, microflora virulence and the localization of the inflammatory process in periodontal and the age of the patient. In most cases, it is possible to establish a link between the occurrence of the periostite and the preceding para-barric reactions: supercooling, overheating, physical or emotional overvoltage. In other patients, especially with a reduced organism reactivity, the disease develops more slowly. Especially often, this course of the process is observed in individuals of elderly and senile age, as well as in the presence of concomitant diseases, such as diabetes mellitus, circulatory disruption of II-III degree, chronic diseases of the digestive apparatus.

According to our research, the cause of the acute periostitis of the lower jaw in 22.9% of patients is the focus of inflammation, located in the tissues of the first large indigenous teeth, in 17.8% of the third large indigenous teeth, in 12.3% of the second small indigenous teeth. The development of acute odontogenic periodite of the upper jaw is due to 24.8% of patients with the presence of the focus of inflammation in the tissues of the first large indigenous teeth, in 11.6% of the second large indigenous teeth (A.A. Timofeev, 1982).

In acute periostitis, the inflammatory process develops vestibular in 93.4% of patients and proceeds in acute serous form in 41.7%, in acute purulent form - 58.3%. With this form of an acute odontogenic periostitis, the detachment of the periosteum for 1 tooth is noted in 20% of patients, for 2 teeth - in 56%, throughout 3-4 teeth - in 24%.

Patients complain of pain in the teeth, increasing when tongue with a tongue or a dental antagonist, swelling of the face. The pain that was previously localized in the region of the causal tooth, during this period is characterized as pain in the jaw. In 8.9% of patients, the irradiation is marked by the branches of the trigeminal nerve in the ear, temple, eyes. The overall condition of the patients is worsening, weakness, headache, sleep disorder, loss of appetite, chills, indiscrimination.

The paresthesis of the lower lip (symptom of Venasan) is noted in 11.7% of patients and are determined only in those of which the inflammatory process is localized on the lower jaw in the field of large and small indigenous teeth.

The body temperature in 92% of patients increases: in 20% - from 37 to 37.5 ° C, in 28% from 37.6 to 38 ° C, in 44% from 38, GS and higher.

With acute odontogenic periostite, the jaws appears swelling of soft tissues, which can be expressed in one degree or another. The localization of edema is usually quite typical and depends on the location of the causal tooth. At the beginning of the disease, swelling of soft tissues is most pronounced. According to V.G. Lukyanova (1972), the magnitude of the edema depends on the structure of the vascular (venous) network of periosteum. With a finely felt shape of the branching of the vessels of the lower jaw, the swelling of soft tissues is not very pronounced, with a trunk (the area of \u200b\u200bthe wall of the upper jaw, the angle and the branches of the lower jaw) - has a significant extent. The expressed swelling of soft tissues around the affected area was observed in 67% of patients with acute odontogenic periostitis of the upper and lower jaws.

When palpation of soft tissues, a dense, painful infiltrate was determined in the location of the subprinted inflammatory focus. In 82% of patients, regional lymph nodes were painful, increased, had a dense elastic consistency, but retained mobility. When localizing the inflammatory process in the field of large indigenous teeth, 60% of patients with sharp periostitis were observed inflammatory contracture muscles:I.- when there is only a small restriction of the opening of the mouth;II. - when the mouth opens by 1 cm;III - When the jaws are tightly reduced and the independent opening of the mouth is impossible.In other cases, the restriction of the opening of the mouth is associated with the fear of widely open the mouth due to pain, which occurs.

When inspecting the oral cavity in the area of \u200b\u200baffected teeth, it is possible to detect hyperemia and swelling of the mucous membrane of the transitional fold and the alveolar jaw process. As a result of a survey of patients with acute odontogenic periostitis of jaws, 42% was revealed by its serous form, 58% is purulent. In the transition of the process into the purulent form in the transitional fold, a rolic-like protrusion is formed - an indinterate abscess. If the pus melts the periosteum and applies to the mucous membrane, it is formed pope neva (sublimated) abscess.

The crown part of the causation tooth is partially or completely destroyed, the carious cavity and root channels are filled with putrid content. In the area of \u200b\u200bthe tooth, which served as a source of infection, a deep sedentine pocket can be detected. Sometimes this tooth is mined. The painful reaction to the percussion of the causation tooth was noted in 85% of the surveys, and the neighboring teeth (one or two) - in 30%. The causal tooth in 37% of patients becomes mobile. In the occurrence of acute periostitis, as a result of the alveolitis, in 10% of the patients, we observed (within 2-3 days) the release of purulent exudate from the remote tooth well. In 60% of patients with odontogenic periostitis, an acute hymorite was revealed, which was the complication of the inflammatory process on the upper jaw in the localization of it in the field of large and small indigenous teeth (A.A. Timofeev, 1982).

With a radiographic study of the jaws, the changes characteristic for acute periostitis were not identified, the preceding process of granulating or granulomatous periodontitis, the breakfast cysts, pastened teeth et al. (Fig. 5.1.1-5.1.5).

Changes in phagocytic activity of neutrophilic granulocytes of peripheral blood in patients were not identified (the exception was the patients with the presence of concomitant diseases). The results of the blood test in the initial period of the development of the disease indicate an increase in the number of leukocytes (9-12 * 10 9 / l), and sometimes higher. Only in some patients, the number of leukocytes is within the normal range or leukopenia is observed. An increase in the number of leukocytes occurs due to segmented neutrophilic granulocytes (70-76%) and their hawk-core forms (8-20%). The amount of eosinophilic leukocytes can decrease to 1%, and lymphocytes - up to 10-15%. ESO increased to 19-28 mm / h, and sometimes more. In patients with acute odontogenic periostitis, an increase of 2-4 times (compared to healthy people) is the activity of alkaline and acid phosphatase of neutrophilic granulocytes of peripheral blood. In most patients in urine tests, changes have not been found, only some people with high body temperature in the urine appeared protein (from traces up to 0.33 g / l), sometimes leukocytes.

When studying the microbial sensitization of the body, its presence is established in 22% of patients with acute odontogenic periostitis and in 46% - when it is complicated by purulent processes in the occasional soft tissues. On the allergen staphylococcus, the sensitization of the body increased 3 times, on Allergen Streptococcus - 2 times. The presence of pre-microbial sensitization was further served as the basis for non-specific microbial hyposensibilization with patients with this disease (A.A. Timofeev, 1982).

Features of the clinical course of acute odontogenic periostitis depending on the localization of the process . The clinical course of acute odontogenic periostitis depends on the location of the tooth, which caused the cause of the development of the inflammatory process.

When distributing the inflammatory process from the hearth, located on the upper jaw from the vestibular side,in the region of the incisors, there is a significant edema of the upper lip and the wing of the nose, which can spread to the bottom of the lower nasal stroke. In some cases, purulent exudate can penetrate the periostess of the PE-RED department of the nasal cavity, especially at a low alveolar process, and the abscess is formed there. In the case when the inflammatory process begins from the focus located in the center of the central cutter, edema can spread to the entire upper lip, and if in the region of the side cutter, then the soft fabrics of one half of the person can capture. When the purulent exudate is propagated from the side cutter towards the solid nose, in the region of its front department, the swelling of a semi-alone or oval shape appears, when appropriate, is formed, and a labeled abscess is formed.

In cases where the cause of the disease is the inflammatory process, located in the field of the upper fangs,the edema applies to the supporting and part of the cheat area, the angle of the mouth, the wing of the nose, the bottom and even the top eyelid. The focus of inflammation is always on the vestibular surface of the alveolar tower of the upper jaw.

If the source of infection is inflammatory hearth, located in the tissues of small indigenous teeth of the upper jaw,that collateral swelling captures a significant segment of the person and is located a few. It applies to the attribute, cheeky and zicky region, often on the bottom and top of the eyelid. The nasolabial fold is smoothed, and the angle of the mouth is descended. The swelling of the face may be absent when purulent exudate from the root roots of 414 teeth spread to a roast surface. In this case, in the middle part of the solid, a semi-shaped protrusion is formed - a chicken abscess. The permanent contact of the chicken abscess with the language causes an increase in pain, so food intake and speech is difficult.

Acute odontogenic periostitis, arising from the source of inflammation, located in the field of the upper large native teeth, is characterized by swelling, breathtaking, chewing and upper part of the vigorous-chewing regions. At the lower eyelid, the swelling is rarely distributed, and on the top - almost never spreads. Edema comes to ear shell. A few days after the development of the process of swelling of soft tissues, it starts to fall down the book, which can create a false idea that the pathological focus comes from small and large indigenous teeth of the lower jaw. When spreading the purulent exudate from the root root of 616 teeth in the direction of the neba asymmetry is absent. The detachment of the dense in this section of the periosta causes a strong one, and then a pulsating pain in the area of \u200b\u200bthe nose. Due to the fact that there is no submembricted layer on a solid nose, edema is negligible. Spontaneous opening of the abscess occurs usually on the 7-10th day, which can lead to the development of cortical osteomyelitis.

For purulent periodite at which the inflammatory process spreads from tissues to the lower cutters area,characteristic is the presence of edema of the lower lip, chin and chin area. At the same time, the chief of the groove is smoothed. When the inflammatory process is distributed from the focus located in the region lower fang and small indigenous teeth,edema captures the lower or middle deposits of the roasting area, the angle of the mouth and applies to the submandibular region. If the source of infection is the focus of inflammation in large indigenous teeth of the lower jaw,the collateral edema captures the lower and middle deposits of the roaming region, the near-wing chewing and subband. When the inflammatory process is spreading to the angle in the area of \u200b\u200bthe angle and the branches of the lower jaw, the edema is expressed, but has a significant length. Due to the fact that chewing muscles are located here, inflammatory contractures appear.

The study of lymph nodes during acute purulent periodites, especially when localizing the process on the lower jaw, it makes it possible to note that not single nodes are increased and painful, but their integers.

Anatomically on the lower jaw. The inner bone wall is thinner than the outer. Therefore, acute periostitis, the cause of the development of which came the hearth, located in the field of large indigenous lower teeth, may spread to the pagan surface of the alveolar process.At the same time, hyperemia, the edema of the mucous membrane of the alveolar process and the sub-surround region, is observed. Podium roller on the side of the lesion increases and empty between the language and the lower jaw. The tongue is eaten, covered with a raid, the prints of the teeth, the movement of it are painful, it is raised and is shifted in a healthy side. If the inflammatory process extends from the lower teeth of wisdom, the infiltrate can be located in the area of \u200b\u200bthe walled-mandibular fold and anterior blackhead, which causes sharp soreness when swallowing. In the case when inflammation captures the wonderful muscles, an inflammatory contracture arises.

These are the main signs of the clinical manifestation of acute odontogenic periostitis. It should be emphasized that most of them are inherent in other acute inflammatory diseases of the jaws, so differential diagnosis is necessary.

Patomorphological changes with periostite jawscharacterized by the accumulation of purulent exudate between the bone and the periosteum. In bone tissue, dystrophic changes occur: lacunar resorption of bone substance, expansion of gaverca channels and bone marrow spaces. As a result of these processes, significant thinning occurs, and in some areas the disappearance of the cortical layer of the bone and the adjacent bone beams. At the same time, the penetration of the purulent exudate from the periosteum in Gaverca channels and the transition of it to the peripheral sections of bone marginal spaces (hectares of Vasilyev, 1973).

DIAGNOSTICS . The differences of acute (aggravated chronic) periodontitisfrom acute odontogenic periostitis, it is determined by the fact that in the first case the focus of inflammation is localized within one tooth, and in the second - the inflammatory process goes beyond its limits and applies to periosteum. The course of acute odontogenic periostite is characterized by such signs as chills, asymmetry of the face, thickening of the alveolar process, the mobility of the causal tooth, the positive percussion and the mobility of the neighboring teeth, inflammatory contracture of the jaws (when localizing the process in the field of large indigenous teeth of the lower jaw). With the help of laboratory methods, it is proved that in patients with acute odontogenic periostitis, the activity of phosphatase of neutrophilic granulocytes in the early phase of inflammation was significantly increased (A.A. Timofeev, 1981).

In the clinical picture of an acute odontogenic periostite, uncomplicated and complicated by the occasional purulent processes, we did not identify a reliable difference in the frequency of the occurrence of clinical symptoms, according to which the differential diagnosis of this disease can be carried out and acute odontogenic osteomyelitis of jawsin the early phase of inflammation. From what has said it follows that the conduct of their early diagnosis only on individual clinical symptoms has great difficulties and is based on the totality of clinical data. (A.A. Timofeev, 1982).

Acute odontogenic periostitis should be differentiated from inflammatory diseases of the approximate and subband glands and their ducts.It should be remembered that during the periostites, the salivary glands are never involved in the inflammatory process. When massaged the inflamed salivary glands and their ducts from the mouths of the output ducts, a turbid or purulent lifes of saliva is distinguished. With the help of a radiographic study of soft tissues of the mouth of the oral cavity, salivary stones can be detected (with calculous siadenicoenites).

During the differential diagnosis of acute odontogenic periostitis and acute altopogenic lymphadenitait is necessary to inspect the alveolar process of jaws. In the lymphadenitis of uncommon origin, there are no changes from the teeth and the mucous membrane of the alveolar process of jaws, which are found in acute periostitis.

TREATMENT . With acute serous odontogenic periostite, the removal of a causal tooth leads to recovery. The sinking of inflammatory phenomena facilitates the purpose of physiotherapeutic treatment methods (UHF in an athermic dose, warming compresses, dubrovin bandages, fluctuorization, the rays of the helium laser, etc.).

In acute purulent periostitis, the tooth is removed, which served as a source of infection if it does not represent functional and cosmetic value. In other cases, it is preserved and after the element of the inflammatory process, it is subject to treatment. Simultaneously with the removal of the tooth, an autopsy of the substitute abscess. The incision is made through three teeth, cutting the mucous membrane and periosteum in transitional fold to the bone. To prevent the muzzle of the wound edges, it is drained. Drainage is left in the wound for 1-2 days. After opening the abscess on solid nose, a small portion of soft tissues (triangular shape) produces an excision. In this case, the edges of the edges of the wound and the reliable drainage of the nose abscess is ensured. In the case when the inflammatory focus is located with the paternal side of the lower jaw, the umnot is opened with a linear section, which is above the location of the alveolar mucosa of the alveolar process into the sublard area.

In the postoperative period, medical treatment is prescribed: antibiotic therapy - prescribed only to weakened persons or with concomitant diseases (ampicillin or oxacillin sodium salt, oleandomycin phosphate or yoletin, monomatin, canamycin, sulfanilaminamide preparations - sulfadimetoxin, sulfapyridazine; Paintaling agents (amidopyrin, analgin, phanecitin or paracetamol); Sad preparations.

Due to the fact that patients with acute odontogenic periostite jaws revealed presence of preliminary microbial sensitization, which can be eliminated by conducting a course of non-specific hyposensitizing therapy, we have all prescribed the following drugs: Dimedrol, diazoline, Supratin, and more.

To remove a pus excreted from the wound into the oral cavity and the speedy resorption of inflammatory infiltrate was prescribed rinsing of the oral cavity (40-42x) with a warm weak solution of potassium permanganate, 1-2% sodium bicarbonate solution or a solution of furacin (1: 5000) 3-4 times a day. For antiseptic rinsing, you can use chamomile flowers, calendula, sage leaf and other medicinal plants. IG Lukomsky (1955) believes that moving in the oral cavity (during rinse) of the warm mass of the solution is an effective hydroter imperative procedure that contributes to the speedy elimination of inflammation. The use of higher temperature solutions for these purposes causes stagnant phenomena in the focus of inflammation (Yu.I. Vernadsky et al., 1983).

Particular attention was paid to the treatment of regional lymphadenitis, as this complication may proceed to an independently existing disease and thereby significantly lengthen the disability of the disability of patients. On the 2nd - 3rd day, patients were prescribed UHFherapy in an athermic dose, fluctuorization. For the treatment of lymphadenitis, it is also possible to use warming semi-short compresses overnight, electrophoresis with potassium iodide, magnetic applicators, rays of a helium laser.

In order to prevent an acute hymorite, which may occur as a complication of an odontogenic periodite of premolars and molars of the upper jaw, it is necessary to prescribe daily use (for 5-6 days) of vasoconstrictor drugs (1-3% ephedrine solution, 0.1% naphtizin or saninarine solutions , Galazoline) and UHF or microwave on the region of the maxillary sinus. To make sure that the sharp sinusitis did not take a chronic course, after 2 weeks it is possible to conduct a control x-ray study of the apparent cavities of the nose.

♦ Chronic periostitis

In adults, the disease is rarely developed and, according to our data, occurs in 5.3-6% of patients with periostitis (V.V. Roginsky et al., 1983). The pathological process occurs more often in young or childhood, it is localized more often on the lower jaw. (V.G. Lukyanov, 1972). Distinguish simple and precisitive chronic periostitis,as well as it rareful shape.For simple chronic periostite the newly formed osteoid fabric after treatment is exposed to reverse development, osset form - the ossification of the bone is developing in the early stages of the disease and ends most often by hyperostosis. Rareful periostitis it is characterized by pronounced resorbative phenomena and the restructuring of bone structures.

The cause of chronic periostitis of the jaws,as a rule, is the transition from an acute form of the disease. Preceded chronic periodontitis and injury. The disease may occur in the suppuration of the cyst of jaws, inflammatory processes in the maxillary sinuses, as well as as a result of injury applied by removable and non-removable dentures. The presence of a chronic inflammatory hearth in a periodontal causes in some patients the current localized inflammation of the periosteum with the predominance of the productive component (Ya.M. Bieberman, A.G. Shargorodsky, 1985). Since chronic periostitis does not always precede the sharp phase of the process, it should be attributed to primary-chronic diseases. For pathoanatomy studyit can be seen that the affected area of \u200b\u200bthe periosteum is a spongy bone tissue, on the surface of which is a thin cortical layer. The network of intertwined bone trabeculs has a different degree of maturity - from osteoid beams and primitive coarse-fiber trabeculs to a mature plate bone tissue. The bone tissue detected in these layers is also at different stages of ripening (Ya.I. Gutner, N.I. Kushnir, 1970). Chronic proliferative inflammatory changes in the field of periosteum with difficulty can be denominated or at all of the reverse development.

Periostitis (Flux) - Inflammation, developing in the field of periosteum of the alveolar process. The disease has an infectious nature, is a complication of caries, pulpitis, periodontitis, periodontitis.

Briefly about the disease

To learn more about the pathology of the periostitis, it is necessary to get acquainted with the anatomical features of the dental machine.

The tooth crown has protective solid fabrics - enamel and dentin. The outer shell reliably protects internal vulnerable fibers from aggressive environmental factors and pathogenic microorganisms.

Caries, leads to the destruction of Enamel and Dentin, weakens protective natural mechanisms. When infection in the neuro-vascular fiber, located in the root canals, there is a sharp pulpit. Without timely treatment, the nerve dies, decay products remain in the root canal. In the pathological process, the shells of the tooth roots and adjoining tissues are involved, sharp periodontitis is formed.

The penetration of infection in the periosteum and the development of an acute process in it causes periostitis. The inflammatory hearth is located in a closed space, does not have contact with the environment. As the anaerobic bacteria and the decay of the affected tissues are breeding, inflammation increases, the dumility appears. For several hours, edema can spread to the soft fabrics of the face (lips, the wings of the nose, cheeks, neck) caused by the asymmetry of the face.

Causes of periostita appearance

The dental pain of any intensity indicates the presence of an inflammatory process. Often, people ignore the unpleasant sensations in the oral cavity and postpone the visit to the dentist. As a result, slight inflammation increases and leads to dangerous complications.

Periostitis is a consequence of one of the dental diseases:

• Caries - Defeat of solid tooth tissues. There are several stages of the disease. At the initial stages, enamel destroys the dentin. Primary symptoms of pathology: Changing the color of the enamel, the appearance of pigmentation, roughness, no gloss and smoothness of the tooth. With an average and deep caries, dentin is involved in the pathological process, the cavity is formed, pain symptoms appears. Treatment of primary and medium caries is carried out in 1 visit, is not too expensive procedure. Detection of the disease at the formation stage, and timely treatment helps to prevent the development of more serious pathologies, allows the patient to preserve health and budget;
• Pulpitis - Inflammation of the neuro-vascular tooth beam. It occurs with an average and deep form of caries, with the defeat of Enamel and Dentin. The diagnosis is established on the basis of visual inspection (sensing, caries test, percussion, cold sample), X-rays. The patient's poll is greatly valid. Man complains of pain in the affected tooth, amplifying in the evening and night. The unpleasant sensations are constant, do not depend on external influences. After taking analgesics, pain is dulled for a slight time. With chronic pulp, periodic pain, moderate intensity.
  Treatment of pulpitis is to remove the affected tissues, antiseptic treatment of dental channels, their high-quality sealing. After the endodontic intervention, the tooth crown is restored by sealing material. With severe damage to healthy tissues, the question of orthopedic treatment (installation of the tab, pin, crowns) is solved;
• Periodontitis - Inflammation of the shell of the root of the tooth and the surrounding fabrics. The disease is a complication of caries or pulpitis, may occur as a result of injury. Refrigerated dental treatment can also lead to the development of inflammation. The symptoms of periodontitis and periostites are similar: pain in the emphasis, increasing intensity, swelling at the place of affected tooth, violation of general well-being.
  Treatment of the disease is to remove tissue-affected caries, disclosure of infected root channels, their antiseptic processing. After eliminating the focus of infection, the root canals are sealing therapeutic paste. With a positive dynamics, a constant sealing of channels is carried out and the formation of the tooth crown;
• Perdontitis - Inflammation of periodontal tissues. During the struck form of the disease, deep gums are formed. Bacterial contents accumulate in the cavities, contributing to the occurrence of purulent inflammatory processes.
  The treatment of periodontitis is engaged in a periodontalist. At the initial stage of combating the disease, professional hygienic cleaning of teeth is carried out, the issue of surgical intervention is solved. After removal of a soft and solid, the patient is treated with antibiotics, with antiseptic solutions with antiseptic solutions, processes the mucosa by height-inhauling drugs.

Periostitis may occur as a result of injury or suffered infectious disease (lymphogenic, hematogenous path), after removing the patient's tooth.

About the causes of development and symptoms of periostitis can be found from the video:

Endodontic treatment of pulpitis, periodontitis and periostitis should be conducted by an experienced dentist. The diagnoses are installed on the basis of X-rays. After therapy necessarily conduct control radiography. In the treatment, sterility is observed, use special bidders. In the work of the doctor helps modern equipment - a dental microscope.

Symptoms

Periostitis is rarely manifested suddenly, most often it is preceded by one of the dental diseases. When survey, patients confirm that they knew about the presence of a deep carious cavity, but could not find time for her treatment.

Asymmetry of the face with flux can be seen in the photo:

The main symptoms of periostite:

1. Surability when emphasis, climbing various intensity. At the initial stage of the formation of the disease, people are experiencing minor unpleasant feelings. As inflammation is increasing, pains become permanent, unbearable.
2. Fabric swelling, face asymmetry. Initially, a small swelling appears on the gum. Gradually, pathological education increases in size. If the cause of the development of the periostite, the tooth in the lower jaw, swells the lower lip, cheek, neck. With the development of inflammation on the upper jaw, the upper lip, cheek, wings of the nose blows.
3. Numbness of language, jaw, lips, wings of the nose.
4. The presence of a patient tooth. In case of inspection, carious lesion of tissues is detected, or the patient indicates that endodontic treatment of the cutter, canine or molar has been carried out in the past.
5. Reduced overall well-being. There is an increase in body temperature, weakness, lack of appetite, sleep disorder, headaches.
6. An increase in cervical lymph nodes.
7. The formation of a fistula (outlet in the gum) is not a mandatory symptom.

On the upper jaw are nasal sinuses. In the absence of timely treatment, the flux may be complicated by sharp sinusitis.

Classification of the disease

Depending on the duration of the flow, acute and chronic periostitis are isolated. Acute disease develops for several hours and is accompanied by severe symptoms. Chronic flux flows for a long time, has phases of remission and complications, contributes to the deterioration of the general health of the body, can lead to the development of osteomyelitis of the jaw.

Types of flux:

• odontogenic - infection penetrates the periostep through the patient tooth;
• traumatic - inflammation arises as a result of the previously transferred injury;
• hematogenous - bacteria fall into the periostep with blood flow;
• lymphogenic - infection penetrates the periosteum on the lymphatic paths.

Infectious damage is limited and diffuse (spread on the tissue of the whole jaw). Depending on the component of the exudate, purulent and serous periostitis are isolated.

The diagnosis of periostitis is established on the basis of a number of components:

1. External examination of the oral cavity. Percussion, probing, cold test, caries test.
2. Detection of the swelling of gums and soft tissues.
3. Patient survey, painting anamnesis of the disease.
4. X-rays. The pictures show signs of granulating periodontitis, radicular cysts.

If necessary, the doctor prescribes the conduct of laboratory blood tests.

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

Treatment

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

The total tactics of the therapist dentist during odontogenic periostitis:

• anesthesia by local anesthetic;
• elimination of affected fabrics;
• cleansing root channels;
• antiseptic cavity treatment.

After the manipulations carried out, the tooth remains open. If there is a pronounced edema, the dentist surgeon performs an opening of the infection focus and sets a special drainage.

Treatment of the periostite of the toothsurgical path can be viewed on video:

Within 5-10 days, by appointing a doctor, the patient takes antibiotics, conducts antiseptic rinsing. The effectiveness of treatment is evaluated on the basis of the patient's well-being, the dynamics of external manifestations, X-rays.

Question answer

At what age can the flux arise?

Periostitis with the same frequency amazes men and women. Children and older people are in the risk group, since they have a reactive course of the disease.

Is it possible to get rid of the flux yourself?

No. The treatment of dental diseases should practice the doctor. Independent application of medical preparations and attempts to eliminate the disease will not lead to success, but will be completed by sad complications.

Ignoring problems with teeth often leads to the emergence of complications and the emergence of new dental diseases. Among these, the honorable place occupies the periostitis of jaw, more famous in the people as a flux. Most of those who face this problem are not fully aware of the seriousness of this disease. The lack of treatment is fraught with serious problems, so it's not worth taking off the visit to the doctor.

Periostitis - What is it?

Despite the fact that the disease appearance looks like a donning of the gums, in fact, is inflammation of the periosteum or periosta. The disease amazes a thin layer of connective tissue over the jaw bone. There are other varieties of the disease: the periostitis of tibia, heel and other bones. If you do not proceed in time to treatment, the layer of connective tissue gradually becomes thicker and starts peeling than it delivers even more problems.

The essence of the disease lies in the fact that serous fluid begins to gather in the cavity between the jaw bone and the perception. The beginning of the disease is accompanied by such symptoms as severe pain, which manifest themselves first only when feeding food, gradually dismissed into continuous acute pain. None of any inflammation passes without increasing the temperature, and with acute jules, it can reach a subfebrile magnitude.

The disease of the perception occurs in people of different ages, less often among young children. The first sign of flux is a strong swelling of the cheek. Many patients mistakenly believe that the heating of the sore place has a positive effect, but the inflammatory process is activated, pain becomes unbearable and complications appear in treatment.

Varieties and symptoms of the disease

The classification of this disease is quite complicated. In dentistry, divide it into several forms depending on the following factors:

The classification of the disease does not end this, since some of these forms have their subspecies, for example, an acute form of periostitis is purulent or serous, depending on which fluid accumulates in the cavity between the jaw and the periosteum, and the chronic flux is divided into a simple and besified. In the first case, the inflammatory process and changes occurring in bone jaw tissue are reversible, and in the second case, hyperostosis occurs and an ossification begins.

Linear odontogenic periostitis is a disease that begins due to launched dental diseases (caries and others). In the lymphogenic disease, the infection affects not only periosteum, but also lymph nodes. Through the blood, the source of infection falls when hematogenous form of acute periostitis. If the disease appeared due to the injury of periosteum, then we are talking about the traumatic form of the disease.

When the disease amazes fabrics in one or more teeth, this disease has a limited form. Diffuse acute purulent periostitis affects all bone.

With toxic form, the disease occurs by entering the cavity of the mouth of the infection, and inflammation is a consequence of launched dental diseases that are accompanied by inflammatory processes. The specific form of the disease occurs against the background of the pathological conditions of the oral cavity and teeth.

Top jaw

In the event of inflammation in the field of the upper jaw, the infection is activated in the front and chewing teeth. There is swelling and inflammation of the tissues of the upper lip, sometimes the nose, which can deliver a lot of inconvenience and discomfort. Periostitis formed on the jaw is often accompanied by an election of the eyelids, cheekbones and temples.

Purulent inflammation most often amazes the sky, purulent masses through mucous membranes penetrate inside the shell, followed by its detachment. Often, this process is accompanied by inflammation of lymph nodes, and the outlines of the person in this case remain virtually unchanged, and a lightweight swelling can be observed. With an inflammatory process on the upper jaw, the patient is difficult to talk and eat due to severe pain and limited swelling opportunities.

Rarely, the place of suppuration spontaneously bursts, bursts, after which the contents of the cavity flows and occurs significant relief and passes swells. With strong pains, it is not necessary to wait for everything to break by itself, it is better to go to dentistry to open the abscess and cleared the cavity, where it was going to pus, special antiseptic means.

With periostitis on the upper jaw, the sinuses, and the middle ear are highly vulnerable, which is fraught with complications on ears, eyes and sinusitis. Purulent sharp periostitis is much more difficult and entails serious problems than the periostitis of the lower jaw.

Lower jaw

The periostitis of the lower jaw occurs against the background of the progressive purulent disease. On the lower jaw, pathological changes are possible not only in bone tissues, but also in soft. Often not treated caries and launched dental diseases are the cause of the periostitis of the lower jaw. Odontogenic periostitis is a common form of inflammation, one of whose symptoms has edema, which can be seen in the photo below.

On the lower jaw, the periostitis happens more often than on the top. The first characteristic feature of this type of disease is a stupid growing pain, which at the beginning of the disease is manifested during meals or when pressed to the tooth, and swelling zone of the lower jaw. Over time, pain is enhanced, in the ear, in whiskey, swelling increases.

The tooth periostitis is often found among children who have dental problems due to launched caries or pulpitis. The infection spreads through blood and lymph. Ignoring problems leads to aggravation of the situation and complications in the form of a periostite of the neck, or children and other zones.

The inflammatory process in the periosteum may also occur due to the reduction of the immunity and the weakening of the protective function of the body, as a result of which the odontogenic acute periostitis of the jaw is developing. This disease refers to recurrent, which, after another exacerbation and relapse, can grow into a chronic form. The disease may be a consequence of injury to the region, and the beginning of aseptic (traumatic) jaw inflammation.

Other types of periostita

The inflammatory process in the periosteum is possible not only in jaw bones, but also on the heel, nasal, shoulder, tibial, small-terber bones. Symptoms of the disease may also differ. There are the following varieties of the disease:

Treatment of inflammation of the periosteum

Treatment of the periostite of the upper and lower jaw can be carried out depending on the situation, the size of tumors, gravity and form of the disease with different methods. Often, dentists use several methods at the same time to speed up the process of treating acute purulent periostitis and increase its effectiveness. The method of treatment of periostite jaws may be as follows:

• surgical (operational);
• therapeutic;
• drug;
• physiotherapeutic;
• unconventional.

In surgical intervention, the inflamed gum is revealed and all the contents are removed from the cavity of the cavity, and the tissue-affected tissue amplified. Then the dental canals are revealed, which are thoroughly cleaned from the pus, after which the dentist processes them with a drug and sets a temporary seal. A few days later, in the next visit to the doctor, the channels are seal, and a constant seal seal is installed. To ensure the effectiveness of the treatment of the patient is assigned a control x-ray.

The therapeutic method involves an autopsy of the tooth, cleaning it from the serous fluid and sealing the channels. This method is effective only with acute serous form of inflammation of the periosteum.

In many cases, there is no need for surgical intervention. The doctor prescribes a patient a complex of medicines that will help stop the process of growing flux, will remove inflammation and will resist bacterial infection. Often prescribed antibiotics, anti-inflammatory, analgesic agents, antihistamines. It is categorically not recommended to assign and take antibiotics on their own, this should make a doctor.

The physiotherapeutic method is resorted most often in cases of chronic and traumatic forms of the tooth periostitis. The essence of the method is to exposed to the tumor with such devices as a laser, UV lamp, electrophoresis and others.

Among folk treatment methods, solutions and pupils of grass of rinsing are used. The most effective soda-saline solve, as well as decoction of chamomile flowers, calendulas, sage and other herbs with antiseptic, wound-healing and anti-inflammatory properties. Warming up and compresses are strictly prohibited, as it will only aggravate the inflammatory process.

Complications of the disease

Incompretable treatment of periostite and non-serious attitude to this problem may cause a number of complications and make it difficult to treat the treatment. If not to treat purulent periostitis, it can cost life, at best such a negligent attitude to health will lead to the fact that the acute form smoothly go into chronic. The most harmless form of this disease is an acute serous, unlike purulent periostitis, which is a huge risk to human health and life.

With acute purulent periostitis without surgery, it is not necessary to do without each flux can be opened without the help of a doctor. For example, if the abscess is located in the sky zone, then its independent opening is impossible, and the absence of timely treatment is fraught with a nematic bone and osteomyelitis.

The earlier qualified help assistance will be provided, the greater the chances of a prosperous outcome and rapid cure. Do not delay with treatment, since the inflammatory process spreads rapidly, and it becomes more difficult to cure it.

Prevention of Periostita

Prevent the appearance of the periostitis of jaws and possible complications in the form of sepsis, osteomyelitis and other serious diseases will help compliance with prevention measures.

Be sure to keep proper care for the oral cavity and teeth. It will give the opportunity to avoid a number of problems - caries, stomatitis, pulpitis and purulent maxillary periostitis.

1. To clean the teeth should be used high-quality toothpaste, thread, brush, and use toothpicks and chewing rubber bands, if there is no possibility to brush your teeth after each meal intake. After cleaning the teeth, it is advisable to carefully rinse the mouth with a special tool, which removes what is left after cleaning and struggles with pathogeful bacteria.
2. The fear of dentists can cause dental diseases, including acute periostitis. It is necessary at least twice a year in dentistry, since the regular inspection of the doctor will help to identify the problem in time and immediately eliminate it, even if it is the periostitis of the chronic form of tibia.
3. Balanced nutrition enriched with vitamins, useful and vital microelements is the key to the health of the entire body, including in the dental part.

Periostitis is a serious pathology at which there is strong inflammation of the periosteum. The disease is quite common and is often diagnosed. With this disease, the patient does not feel pain, but suffers from heat and swelling, it is formed by purulent content. Assist in this case can only a surgeon doctor.

Deal may develop absolutely at any age, but it is rarely diagnosed among children's and elderly population.

It is very simple to distinguish the disease from others: it is accompanied by a strong swelling, which simply can not notice. As a rule, the pathological process is due to infection.

Periostitis of the upper jaw

When the roots are inflated or the channels of the teeth are affected, the infectious process applies to the tissue and mucous membranes. As a result, pus is formed in large quantities, which breaks through the bone. Here and occurs swelling and pain.

Periostitis of the upper jaw (Photo above), causing the fact that the pathological process can spread to the sinuses. A person will swell most of the face. Plowness occurs based on the causation of the tooth. In this case, lips, cheeks and other parts of the person can swollen.

However, this form of the disease is not common. As a rule, the periostitis of the lower jaw (photo below) is diagnosed. Most often the last teeth are affected. They grow quite difficult and exposed to different pathologies. Often patients remove eights.

Periostitis of the lower jaw

Etiology

As already mentioned, the most common disease is due to the presence of infection. This happens when the channels are damaged when the nerves are inflated or with ineffective therapy of these diseases. Bacteria fall into the oral cavity from food and thread.

Insufficient oral hygiene, suffered physical and mechanical injury, infectious blood diseases, which can lead to adverse consequences.

Hence the infection of the lymphatic system.

Given the factors of the appearance of the disease classify on:

• inflammatory form, which is a consequence of various different dental pathologies;
• traumatic, resulting in a flux;
• toxic, in which infection falls into the oral cavity;
• specific, resulting from serious pathological processes in the body.

Varieties of pathology

Pathology varies with the symptoms and other criteria. Correct the definition of the form of the disease can only professional. Tactics of treatment will depend on the stage of pathology.

Distinguish two forms Pathological process: acute and chronic. The first is accompanied by a strong swelling and formation of pus.

In chronic form, the course of the ailment is somewhat sluggish, muffled, develops quite a long time.

If the disease occurs in acute form, it can be:

• serous, when the average volume of serous contents and infiltration is formed;
• acute when abscess and fistulating paths are formed, through which purulent contents outlines outward. If there are no fistulous moves, then the content is going very much and a strong swelling appears in the patient.

In the chronic stage, the disease is also distinguished by categories:

The fibrous form of illness also has a chronic nature of the flow. At the same time, fibrous thickening of the periosteum is formed. Under the defeat stage, the disease is classified on limited and diffuse. The first is striking one or several teeth, while with diffuse there is a defeat of the whole whole jaw.

Clinical picture

It is characterized by its symptoms for each disease. With the help of these signs, one disease can be easily distinguished from another. The course of illness depends on the degree of defeat and protective forces of the body and the overall state of health. However, other common symptoms of the top and lower jaws are also characteristic.

If we talk about serous form, then with it there is a swelling of the mucous membranes, an increase in lymph nodes. With purulent form, the patients worsen the overall well-being, which manifests itself with weakness, violation of recreation and wakefulness, headaches. Discomfort can be felt both in the zone of the pathological tooth, and to give to other parts of the person.

In the chronic flow, a person feels periodic pain, the thickening of the alveolar part is observed, hyperemia and the swelling of the mucous membrane occurs.

Punchness is a normal phenomenon for this disease. It may disappear when fistula moves are formed on the mucous membrane. In no case should you leave a disease without attention, otherwise everything can endure crying.

How to distinguish from other pathologies

At the reception, the doctor will ask the patient in detail about the symptoms of pathology, prescribes an x-ray examination and laboratory tests. However, similar manifestations are often observed with other diseases that should be differentiated, otherwise therapy will be ineffective.

Periodontitis

Related diseases:

• in periodontitis, the root is also inflamed, over time the pathological process is increasingly progressing. Purulent contents in the exacerbation stage breaks out, creating a fistula;
• diseases in which dense education arise. The periostitis of the jaw is manifested by mitigating the mucous membranes and swelling of the face without any special discharge on the skin;
• inflammatory process of salivary glands. In this case, the infection falls from salivary moves, and not from a sick tooth;
• osteomyelitis is accompanied by general intoxication. There are high temperature indicators, fatigue, headaches, fever. This disease occurs as the result of unpriced periostitis.

Complications of periostita

Many people, due to some reasons and circumstances, pull out their visit to the doctor for a long time. Even if they begin to disturb severe pain, they are confused by all sorts of home methods to drown out, but do not turn to the doctor. The reasons for such behavior are absolutely unjustified: the lack of finance, time, dislike for doctors. One way or another, the appeal to the dental clinic is the first thing, on which your further tactics of behavior depends.

If you do not take time time, it will definitely go to another more severe stage, which will lead to irreparable complications. Purchase flux is not difficult, but the negligence to his health can even lead to death.

The most common complications are the formation of abscesses and phlegmon. If I ignore the problem, purulent content sooner or later breaks through its capsule on the surface.

In the absence of an appropriate course of therapy during phlegmon, they increase in size, affect healthy bone and muscle tissue. The process proceeds with strong pains, an increase in body temperature, weakness, soreness when swallowing, speech and respiratory disorders.

If you do not take a timely aless in a timely manner, it will definitely go into a more severe stage

Do not ignore such an infectious disease as periostitis. This pathology is very dangerous in that infection sooner or late penetrates blood, which causes the overall making and poisoning of the entire body.

Features of therapy

Patients often ignore this problem, not understanding the seriousness of the situation. They explain their behavior by the fact that if there are no pain, then you do not need to contact a specialist. It is worth saying that this behavior is unacceptable for a sensible person. The earlier you begin treatment, the more favorable forecast.

Not reasonable to sit in anticipationthat pain will leave on your own. NEWS NOT PASSES IN ALLOWS AND it requires special attention. When the disease is diagnosed at an early stage, the patient is prescribed antibiotics to prevent the inflammatory process. Sick tooth can delete or treat, if appropriate. After inspecting the X-ray picture, the doctor will decide what to do in a particular case.

If swelling occurs, the therapy is carried out in several steps. First of all, therapeutic activities should be aimed at removing the inflammatory process and swelling. The doctor makes a surgical autopsy, as a result of which the pus comes to the surface. A person immediately becomes better and his condition comes back to normal.

Opening of the periostite produced in the place of the greatest swelling

After this manipulation, a drainage is installed in the wound, which does not allow the wound to delay. This is done in order to give a fully pusa fully and carry out recurrence. Together with these events, the patient is appointed by the course of antibiotics and after that the decision to remove or treat the tooth is made.

Unconventional methods

Treat this disease at home is not correct.

A complete recovery can be achieved only in a hospital, but how to help yourself, when there is no possibility to get to the medical institution?

Folk remedies will help slightly alleviate the symptoms of the disease until you get to the doctor. Rinse your mouth with soda and salt or grain character. Chamomile is suitable, sage, St. John's wort. In no case are not attempting to take antibiotics yourself. Only the doctor is engaged in the appointment of such drugs, otherwise you will harm the whole body.

The acute or aggravated chronic periodontitis in the absence of the process of self-discharge or adequate treatment can lead to the spread of the inflammatory process in the periosteum of the alveolar process of the upper or lower jaw and the soft tissue adjacent to them with the formation of acute periostitis of the jaw.
Patients with periostitis of jaws account for 7% of the total number of patients treated for treatment in clinics, and 20-23% of patients who were in inpatient treatment. In acute form, the periostitis occurs in 94-95% of cases, in chronic - in 5-6%. At the lower jaw, the periostitis occurs in 61% of patients, on the top - in 39%. Periostitis, as a rule, develops on one side of the jaw, more often affecting it from the vestibular surface (93% of patients).

Acute periostitis of jaws

Etiology

The cause of acute periostitis can be acute and chronic periodontitis, periodontitis, acute or exacerbation of chronic hymorite, pericoronitis, ventilated cysts of jaws, benign and malignant tumors. Acute periostitis can develop after a tooth removal operation as a complication of alveolitis. Surgical intervention in this case serves as a trigger of the disease that violates the immunobiological equilibrium between the infectious start and factors of the local and general protection of the body provoking the aggravation and development of the inflammatory process.

The sharp form of the inflammatory response with periostitis is customary to divide into two stages: serous and purulent.

The serous stage of the periostite is found in 41% of patients. It is a reactive inflammatory process in a periosteum, concomitant acute or aggravated chronic periodontitis.
Under the purulent stage (59% of patients), the exudate from the affected periodontal on the system of gavers and folkman channels or through the hole previously formed in the wall in the wall penetrates into the periosteum, and according to the bloodowal circulation system - into the surrounding soft tissues.
The morphological picture is characterized by the ethnicity, rupture of the periosteum. Its leukocyte infiltration develops and increases, microcirculatory disorders are developing. The inner layer of the periosteum is melted, and serous, then serous-purulent accumulate between the perception and bone, and then the purulent exudate is subsequently. The accumulative mass of the exudate peers the periosteum, disturbing the blood supply in it, which contributes to the development of deeper pathological changes. In bone tissue, dystrophic changes occur: lacunar resorption of the bone substance, the merge of the gaverca channels and bone marrow spaces. As a result of these processes, significant thinning occurs, and in some areas the disappearance of the cortical layer of the bone and the adjacent bone beams. At the same time, the penetration of the purulent exudate from the periosteum in the Gaverc canals and the transition of it to the peripheral sections of bone marginal spaces.

Clinical picture

The diversity depends on the floor and the age of the patient, the localization of the inflammatory process, the state of the general and local reactivity of the organism, the form and virulence of the microflora, such as an inflammatory reaction (Fig. 8-13).

In most cases, it is possible to establish a link between the occurrence of periostitis and such preceding provoking factors as overcooling, overheating, physical or emotional overvoltage. For patients with acute occasionitis, the sacrament of pain in the causal tooth is characteristic, but at the same time it begins to take a spilled character, becomes a constant, which often acquires a pulsating nature, irradiages along the branches of a trigeminal nerve in the ear, the temple spreads to the entire half of the head. Depending on the localization of the inflammatory process, complaints may be joined by a limited, painful opening of the mouth (inflammatory I-II contracture), minor pain and discomfort when swallowing, movements of the tongue, chewing. There appears the edema of soft tissues in the area of \u200b\u200bthe upper and lower jaw, which can be expressed to one degree or another. The localization of the edema is usually quite typical and depends on the location of the causal tooth.
When examining the oral cavity in the region of the causation tooth, hyperemia and the edema of the mucous membrane, the smoothing of the transitional fold and the alveolar jaw process (Fig. 8-14) is found.

It is more often characteristic of the serous stage. When the process is transition to the purulent form in a transitional fold, a rolic-shaped protrusion is formed - an applied abscess. If the pus melts the periosteum and applies to the mucous membrane, then the abscess presses are formed. At the same time, a self-destruction of the process by a pus breakthrough from under the gum edge can occur. The causal tooth becomes moving, its crown can be partially or completely destroyed, the carious cavity and root channels are filled with pothrid masses. Sometimes this tooth is mined. The pain at percussion of the causation tooth of various intensities is noted in 85% of patients. There may be pain in percussion and neighboring teeth, the numbness of the lower lip (symptom of Wenzan) is observed only in patients with an inflammatory process, localizing in the field of premolars and molars of the lower jaw. In most patients, regional lymph nodes are slightly painful, enlarged, have a density consistency, but retain mobility. The well-being of the patients does not suffer much. Symptoms of intoxication (weakness, malaise, sleep disturbance, appetite, etc.) are expressed weakly or moderately. As a rule, a violation of general well-being is associated with fatigue from pain, bad sleep and appetite. With an objective examination, the general state is more often assessed as satisfactory. The body temperature is kept within subfebrile numbers, rarely rises to +38 ° C and higher. The described clinical picture is characteristic of a periostite characterized by the formation of a normergic type of reactive response. With hypergia, all clinical symptoms are more pronounced. Inxication is rapidly developing, the process acquires a common nature and for a short time (about a day) can switch to surrounding tissues, contributing to the occurrence of abscesses and phlegmon near the occurrence of abscesses. In patients with reduced reactivity, the disease develops more slowly, on a hypourgic type. Especially often, the course of the process is observed in individuals of the elderly and senile age, as well as in the presence of concomitant diseases such as diabetes mellitus, blood circulation disorder II-III degree, chronic diseases of cardiovascular and digestive systems. With a hypourgic type of flow of inflammatory reaction, clinical symptoms are poorly expressed. Such patients rarely appeal to the doctor, while the substitute abscess expands spontaneously with the necrosis and mucous membrane, acute inflammation is stopped, and the process most often acquires a chronic character.
In many ways, the clinical picture of acute odontogenic periostitis depends on the location of the causal tooth. If the inflammatory process occurs on the upper jaw, in the region of the incisors, there is a significant edema of the upper lip and the wing of the nose, which can spread to the bottom of the lower nasal stroke. In some cases, purulent exudate can penetrate the front department of the bottom of the nasal cavity with the formation of an abscess, especially with a low alveolar process.

In the propagation of purulent exudate from the cutters in the direction of solid neb, in the field of its front department, a non-bodied abscess is formed. When the upper fang is a causal tooth, the enemy applies to the podgladnichny and part of the brush region, the angle of the mouth, the nose wing, the lower and even the top eyelid. The focus of inflammation is most often located on the vestibular surface of the alveolar tower of the upper jaw. If the sources of infection are the premancers of the upper jaw, then the collateral edema applies to the attribute, the brushes and the zilly region, often to the lower and upper eyelid. The nasolabial fold is smoothed, and the angle of the mouth is descended, indicating the inflammatory damage to the final branches of the brush branch of the facial nerve. When purulent exudate from the root roots of the first upper premolars applies to a roast surface, then a chicken abscess can be formed in the middle part of the solid. Acute periostitis, which developed from the upper molars, is characterized by an edema covering the zhilass, the most profound and the upper part of the near-chewing area, rarely at the lower eyelid, can reach the ear shell. A few days after the development of the process, the edema begins to shift the book, which can create a false idea that the pathological focus comes from small and large indigenous teeth of the lower jaw.
When the inflammatory process is spreading from the root roots of the upper molars toward the nose, the edema of soft fabrics is not observed. The density detachable in this section of the peripost causes a strong number, and then a pulsating pain in the field of solid chicken. Due to the lack of a submembraty layer on the NEBE, the edema is negligible. Spontaneous autopsy of the abscess can occur on the 6-7th day, which leads to the development of cortical osteomyelitis.

For purulent periostitis, developed from lower cuttersThe presence of an edema in the field of the bottom lip and chin. At the same time, the chorean-lipoger smoothes. When the inflammatory process is spreading from the lower fang and premolars, the edema captures the lower or middle department of the brush region, the angle of the mouth and applies to the subsidiary. If the source of the infection is the molars of the lower jaw, then the collateral edema captures the lower and middle deposits of the brush region, the near-chewing and subband. When the inflammatory process is spreading to an angle in the area of \u200b\u200bthe angle and the branches of the lower jaw, the enemy is expressed, but has a significant area. It should be noted that on the lower jaw the inner bone wall in the field of molars is thinner than the outer, so the clinical manifestations of the periostite can be localized on the pagan surface. In this area there is hyperemia, edema and empty of the mucous membrane, which goes on the sublard area.

Diagnosis of acute periostita Can be confirmed by data of a laboratory testing of blood. In this case, a slight increase in leukocytes is observed - up to 10-11x109 / l, due to a certain increase in the number of neutrophils (70-78%). ESO increases slightly, rarely exceeded 12-15 mm / h.
With a radiographic study of the jaws There are no changes in the bone structure. As a rule, only changes are detected characteristic of granulating or granulomatous periodontitis, radicular cysts, sealedated teeth, etc.

Differential diagnosis

Many clinical signs of acute odontogenic periostitis of the jaws are found at other acute inflammatory diseases.
There are acute periostitis with acute or exacerbation of chronic periodontitis, acute osteomyelitis, abscesses, aggravation of chronic sialdenitis, inflated jaw cysts, benign and malignant jaw towns.

Acute periostitis It differs from acute or aggravated chronic periodontitis localization of the inflammatory hearth and the severity of the inflammatory response. When periodontal inflammation is localized in the projection of the root of the cause of the cause of the tooth, with periostitis, inflammation applies to the periosteum. With periodontitis in the field of periosteum and soft tissues from the opposite side of the oral cavity, it is possible to determine a small reactive edema, and the inflammatory infiltration is localized in this area, and an impernection abscess is formed. With acute osteomyelitis, unlike periostite, inflammatory infiltration is localized from two sides of the alveolar process, covering it (double-sided occasionitis). In osteomyelitis, the mobility of several teeth located in the lesion zone is determined and develops a symptom of Wenzan. Acute osteomyelitis is accompanied by a more pronounced general intoxication of the body and pain.

Acute odontogenic periostitis It should be differentiated with the systatenitis of sub-alleged and subband salivary and subband. It should be remembered that when the periostitis, the salivary glands are not involved in the inflammatory process. In the case of Xialadenit, during the massage of the salivary gland, a turbid or purulent streaks of saliva is separated from the mouth of the duct. In these cases, salivary stones can be detected in patients with calculose systinite. With the help of radiography, the oral cavity can be found salivary stones.
Acute periostitis It has similar features with ventulous cysts of jaws, benign and malignant tumors. These diseases are sometimes accompanied by the development of inflammation of the periosteum. With incuting cysts and tumors, signs of inflammation are less pronounced. Radiography allows you to identify a pathological center. It should be remembered that in all cases, when surgery is adequately conducted and drainage is carried out, anti-inflammatory therapy is carried out, but there is no effect on treatment, either tissue infiltration increases, it is necessary to think about a malignant tumor and purposefully look for it.

Treatment

Treatment of acute periostitis must be complex . In a surgical plan, it should be resolved about the feasibility of removing or preserving the causal tooth. Typically retain single-darned teeth with well-passable fill with root canal. In the presence of the focus of the dice of the bone near the root of the root, it is recommended to perform the operation of resection of the root of the root after a complete relief of sharp inflammatory phenomena. The question of the preservation of multi-corneous teeth is the subject of discussion, but most authors insist on their removal. At the same time, if the removal of the tooth is associated with a significant injury during surgery (retained, dystoped tooth, etc.), then the removal is deposited until the elimination of inflammatory reactions is usually 7-10 days.
When carrying out cuts to open the subprove abscesses, the localization of the inflammatory process should be considered. Operation is carried out under local anesthesia with premedication. In cases where at the same time it is necessary to remove the tooth and open the abscess, the intervention starts from opening the abscess, and then remove the tooth. When opening an abscess of the scalpel blade, there is strictly perpendicular to the bone and lead along the transitional fold, i.e. Along the boundary of the movable and stationary mucous membrane, the gums (Fig. 8-16). If it is not possible to determine this border, the incision is carried out, departing from the gum edge by 0.5-1.0 cm through the thickness of the infiltrate. Do not approach the gingny edge, as it can cause in the future necrosis of the gums in this area. Also should not be left toward the mucous membrane of the cheek, where you can damage rather large blood vessels and cause strong bleeding. The length of the cut must correspond or slightly exceed the length of the inflammatory infiltrate. Dissect the mucous membrane and periosteum to the bone, then peerate the periosteum in all directions from the cut at least 1 cm, thereby fully opening the purulent focus. Through the incision, it is sufficient, the strip of glove rubber is introduced for the drainage.

With periostitis, localized in the region of the last molars of the upper jaw, the inflammatory process tends to spread to the bug of the upper jaw. Therefore, when peeling the periosteum should be purposefully walking through a stupid tool to a bugarh by 0.5-1.0 cm, with the introduction of drainage mainly in this direction.
When localizing the inflammatory process in the region of the second and especially the third mulager of the lower jaw with the vestibular side, it can spread to the lower departments under the chewing muscle itself, which is clinically accompanied by a pronounced inflammatory contracture of II-III degree. In this case, the incision should be started from a retro-bearing triangle, a book with a transitional fold. When detaching the periosteum should be penetrated to the lower departments of the nesting muscle and under it with the installation of drainage there.
If the inflammatory process is located in the region of the lower molars from the paternal side, it can propagate under the lower departments of the medial wingid muscle, which is clinically determined by the infiltration of this area and the expressed inflammatory contracture II-III degree. In these cases, the incision is also starting from the retro-bearing triangle and lead down the pagan surface of the alveolar part of the lower jaw, and then - in parallel to the guessing edge, retreating from it by 0.7 cm. When the supervisette is detachment, a blunt tool penetrate the book, the post and knutrice in the direction under Lower departments of the medial woven muscle. Drainage is also introduced in this direction.
When opening a subperiodal abscess localizing in the field of lower jaw premolars, it should be borne in mind that in this area there is a chiffer hole with its vascular-nerve beam. In order to avoid its injury, an arc-shaped cut, addressed the top up and closer to the gingival edge. When detachment, the periosteum should work carefully to avoid injury to a vascular beam. With the opening of the inflammatory process, which is localized in the frontal area of \u200b\u200bthe upper or lower jaw, should avoid intersection of bridles of the upper or lower lip, which can lead to their scarring and shortening. In those rare cases when infiltrate is located exactly in the center and the intersection of the bridle is inevitable, two cuts should be performed, respectively, to the left of it. At the opening of the substitute abscess on the solid nose, excision of soft tissues of the triangular shape with a side of the incision of up to 1 cm. At the same time, the edges of the wounds are muted, its reliable drainage is ensured, the prevention of the development of osteomyelitis of solid nose. In the future, the wound surface is covered with granulation tissue with subsequent epithelization.
Treatment of the patient in the postoperative period is carried out in compliance with the general principles of therapy of purulent wounds. Locally prescribed warm intrarocratic rinsing with various antiseptics that can be alternating or combined. The ligation of the wound is carried out daily to the cessation of the selection of pus.
General treatment is In the appointment of antibacterial, painful, desensitizing and sulfonamide products and vitamin therapy. Of the modern drugs with anti-inflammatory, analgesic, desensitizing and vasoactive properties, from the NSAID group, diclofenac (Rapten Rapid *) are used, which can be successfully used in the treatment of periostite.
For the next day, after opening the abscess, it is necessary to assign UHF therapy in an athermic dose, fluctuating or acute therapy.

Complications

The most frequent complication in the postoperative period becomes the progression of the inflammatory process and its distribution to the surrounding tissues. They arise in connection with the late removal of the tooth, insufficient opening, emptying and drainage of purulent focus. The treatment consists in the appointment of a complete complex of drug and physiotherapeutic treatment. If the treatment complex is insufficient, it is necessary to expand it, in compliance with all the requirements.

Rehabilitation

Acute odontogenic periostitis is a rather severe disease, and non-compliance with the outpatient or stationary treatment regimen may result in serious complications. The patient is disabled for a period of 5-7 days. In the first 2-3 days after the operation, bedding is recommended. Patients admit to work after complete elimination of inflammatory phenomena. In the future, within 2-3 weeks, it is liberated from such physical exertion. If this liberation contradicts the conditions of labor, then a leaflet of temporary disability is prolonged.

Chronic periostitis of jaws

It occurs in adults and children in 5-6% and, as a rule, it happens the outcome of the acute inflammatory process. However, in children and adolescents, chronic periostitis is sometimes primary, and therefore it should be attributed to primary-chronic diseases. The development of chronic periostitis contributes to the preservation of the focus of long sensitization. This occurs in the presence of a chronic focus of infection: an amazed tooth, chronic sinusitis, with insufficient rehabilitation of purulent focus, with repeated chronic periodontitis exacerbations without a pronounced inflammatory reaction and characteristic clinical manifestations, as well as injuries caused by extractive and non-coordinate dentures. A large role is played by the decrease in immunity.
There are a simple, precipitating and rareforming form of chronic periostitis. With a simple form, the newly formed osteoid fabric after treatment is subjected to reverse development. With a precisitating form, the ossification of the bone is developing in the early stages of the disease and ends most often by the formation of hyperbate. Rareful periostitis is characterized by severe resorbative phenomena and restructuring of bone structures.

With a morphological examination, the amazed plot of periosteum has the appearance of spongy bone tissue. The network of intertwined bone trabeculs has a different degree of maturity - from osteoid beams and primitive coarse-fiber trabeculs to a mature plate bone tissue. The bone tissue detected in these layers is also at different stages of maturation. Chronic proliferative inflammatory changes in the field of periosteum with difficulty can be denominated or at all of the reverse development. The process is more often localized on the lower jaw.

Clinical picture

Sick complaints usually do not prevent or complain about the feeling of discomfort and stiffness in the appropriate half of the jaw, the definable deformation of the person. Some of them in history are noting the presence of an acute stage of the disease. The configuration of the person can be changed due to a small swelling of soft tissues caused by the thickening of the jaw. The long existence of an inflammatory focus leads to an increase and sealing of regional lymph nodes, which may be painless or weakly accepted. Rareful periostitis occurs most often in the frontal departure of the lower jaw, and the cause is usually injured. As a result of injury, hematoma is formed, and its organization leads to the seal of periosteum. When examining the oral cavity, the thickening of the jaw in the vestibular side is determined (dense, painless or weakly meat). The ethics of the mucous membrane is not determined, or it is expressed weakly; The mucous membrane is slightly hyperemic, a vascular drawing can be expressed. X-ray determines the shadow of the periosal thickening of the jaw. With a long existence of the inflammatory process, the periposis is used. For longer periods, the vertical allocated and the layered structure of the periosteum (bulb) is noted.

Differential diagnosis

Differentiate chronic periosteitis with chronic odontogenic osteomyelitis of jaws. Chronic osteomyelitis is preceded by a more pronounced acute stage, the thickening of the jaw occurs both in the vestibular and oral side, the fistula is formed, is determined by the symptom of Wenzan. In addition, chronic osteomyelitis is characterized by a certain X-ray picture with a pronounced dye destruction.
With specific inflammatory processes (actinomycosis, tuberculosis, syphilis) there is no acute stage of the disease, the lymph nodes are changed, these specific research data (skin sample, the reaction of vasserman, etc.) is positive.
Chronic periostitis has similarities with some bone tumors and tumor-like diseases. Diagnostics Help data (acute inflammation in history), the presence of a causal factor, characteristic of the neoplasms, the X-ray picture, the results of morphological studies.

Treatment

In the early stages of the disease, it is sufficient to remove the causal factor and the sanitation of the inflammatory hearth, which leads to the reverse development of the inflammatory process. In later
The period of deletion of ossification is carried out in a hospital. The treatment of raration periostitis is to conduct a revision of the pathological focus after peeping the trapezoidal mucous and obcorate flap, the removal of the accused hematoma. At the same time, excision of a proliferatively modified part of the periosteum, and the newly formed bone tissue is removed by bone pads or chisels. After removal of excess bone formation, the softening portions are detected on the cortical layer of the dice. Postoperative wound is sewn tightly. Intact teeth are saved. The flap is placed in place and fix the seams. Assign antibacterial, desensitizing, immunostimulating and tensile drugs. The good results of the treatment of chronic periostitis gives the use of electrophoresis 1-2% of the potassium iodide solution. The treatment of periostitis in the people of the elderly is not much different from those of the young. Attention should be paid to the appointment of physiotherapeutic procedures. They must be done with caution and taking into account the concomitant diseases (hypertension, atherosclerosis, etc.).

Materials used: Surgical dentistry: textbook (Afanasyev V. V., etc.); under total. ed. V. V. Afanasyev. - M.: Gootar Media, 2010