Osteomyelitis is a very serious dental disease, accompanied by a purulent inflammatory process and the formation of accumulations in the voids of the bone tissue. According to medical statistics, pathology is observed mainly in young people and middle-aged people. According to qualified specialists, odontogenic osteomyelitis of the jaw can develop for a variety of reasons. They will be discussed in more detail later, but heavy smokers and people who pay insufficient attention to oral hygiene are at an increased risk. In addition, pathology may be the result of an immune failure, as a result of which the defense mechanisms do not begin to function at full strength and cease to cope with the activity of infectious agents. Let's take a closer look at what this disease is, why it is dangerous and what effective methods of therapy exist today.
A bit of history
First mention ofpurulent necrotic lesions of the jaw are found in the scientific works of the famous German surgeon Erich Lexer, dating back to 1884, who devoted about 12 years of his life to the study of diseases of infectious etiology. Throughout human history, the disease acute odontogenic osteomyelitis has occurred quite often. Most of all, they suffered from it in the Middle Ages, when no medicine, as such, and hygiene existed. However, these days, pathology is also often diagnosed by dentists.
As established by E. Lexer, in the vast majority of cases, the purulent-necrotic process in soft tissues begins as a result of the penetration of harmful microorganisms into the bone tissue from the primary focus through the bloodstream. However, at the beginning of the 20th century, this theory was severely criticized by Professor Genke, who, in the course of many experiments, failed to simulate odontogenic osteomyelitis.
The most reliable assumption was formulated by Russian scientist Sergei Martynovich Derizhanov. He introduced pathogenic microorganisms to animals, which eventually led to the development of an increase in the body's sensitivity to irritants and suppression of the immune system. Against this background, after a while, the inflammatory process began in the experimental subjects, accompanied by a purulent necrotic lesion of the soft tissues. Thus, taken together, the theories described above formed the modern understanding of this pathology.
Main reasons
Let's take a closer look at this. As mentioned earlier, the etiology of odontogenicosteomyelitis can be different. Doctors say that in almost 90 percent of cases, pathology develops due to the penetration of harmful bacteria into bone tissue along with blood. In some cases, the cause of the problem is pathogenic fungi that can enter the bone in one of the following ways:
- through a tooth traumatized by a strong blow or damaged by caries;
- through blood vessels;
- in case of damage to soft tissues by various infectious diseases occurring in acute or chronic form;
- poor or no oral hygiene;
- various dental diseases such as caries, granuloma, periodontitis, periostitis and many others;
- furunculosis on the face;
- purulent otitis media;
- inflammation of the palatine tonsils;
- scarlet fever;
- purulent-septic inflammatory lesion of the epidermis of the navel;
- diphtheria.
It is very important to determine the pathogenesis of odontogenic osteomyelitis, since the choice of medications and other modern methods of treatment depends on the nature of the development of the inflammatory and purulent process.
Causes of the development of the disease in children
This aspect should be given special attention. This kind of pathology in babies is diagnosed in very rare cases, however, they are also found in dental practice. As a rule, odontogenic osteomyelitis of the jaws in children proceeds in an acute form and is accompanied by pronounced clinical manifestations. Pathology is very dangerous, because withif left untreated for a long time, it can lead to general intoxication of the body, which poses a great threat to the he alth and life of the child. The causes of pathology can be both anatomical and functional. Among the most common doctors are the following:
- high sensitivity to pathogenic microorganisms;
- intensive development of bone tissue;
- deciduous and growth of permanent molars;
- reshaping of jaw structures;
- tooth plates too thin and wide tubular cavities;
- excessive branching of capillaries.
Odontogenic chronic osteomyelitis of the jaw develops as a result of the penetration of pathogenic microflora from teeth affected by various infectious diseases, as well as from other foci located in various parts of the body, as a result of pathogens entering the bloodstream and spreading throughout the circulatory system.
Disease types
Let's look at this aspect in more detail. As such, there is no classification of odontogenic osteomyelitis. But doctors divide pathology into three types depending on the stage and intensity of symptoms:
- spicy;
- subacute;
- chronic.
The first and last forms are the main ones, and the second one almost never occurs in dental practice. It should be noted that surgery has its own classification of osteomyelitis. In this area of medicinedistinguish its varieties:
- limited - the inflammatory process does not affect the entire jaw, but only a few molars;
- focal - there is necrosis of the soft tissues of the alveolar part of the bone body;
- diffuse - extensive necrosis of the entire lower or upper jaw, accompanied by the accumulation of a large number of purulent accumulations.
According to statistics, most often in children and adults there is odontogenic osteomyelitis of the lower jaw. What this is connected with is still unknown, but the fact remains. If the patient does not go to the hospital on time, but tries to cope with the problem on his own, then the disease flows into a chronic form, in which it is not only much more difficult to treat, but can also recur periodically, and also negatively affect the quality of a person’s daily life, introducing her many physical and psychological inconveniences.
Clinical manifestations
What should I pay attention to first of all? Signs of odontogenic osteomyelitis depend on many factors, the main of which is the stage of the pathology, the severity of necrosis of the jawbone, the state of immunity and the activity of infectious agents. Also, the symptoms will be more pronounced and intense if the pathology occurs against the background of any viral diseases, hypersensitivity to various substances and nervous strain.
The vast majority of people go to the dentist because of severe unbearable pain piercing the jaw. First shelocalized in the region of one or more teeth, and then gradually spreads throughout the oral cavity. Over time, patients begin to experience discomfort in the temple area, the inner ear, as well as the frontal and occipital parts. With a strong neglect of the disease, severe intoxication of the body is manifested. In this case, there are such local signs of acute odontogenic osteomyelitis as:
- pain;
- gum swelling;
- pathological loosening of teeth;
- stink from the mouth;
- discharge of pus on palpation of the gums.
Among the main symptoms are the following:
- malaise and weakness throughout the body;
- fatigue and prolonged fatigue;
- decrease in physical activity and work capacity;
- chill;
- lack of appetite;
- loss of sensation in upper or lower lip;
- swelling and soreness of the gums and face;
- reduced mandibular mobility;
- discomfort and pain while chewing;
- difficulty swallowing food;
- decreased articulatory function;
- shortness of breath;
- involuntary spasms of the facial muscles responsible for chewing functions;
- increased size of lymph nodes;
- sleep disorder.
The first symptoms may appear only 24-72 hours after the onset of the inflammatory process. If the trip to the doctor was postponed for a long time, then after a few months chronic odontogenic osteomyelitis develops. AtIn this form of pathology, the body temperature increases, which can stay at 38 degrees for several days. This is due to the fact that the rejection of dead bone tissue begins. The danger of this stage is that the main symptoms of the disease disappear, and the patient experiences a noticeable improvement in well-being. Almost completely disappear and pain, so most people simply turn a blind eye to the problem. However, further progression of odontogenic osteomyelitis continues. Left untreated can be dangerous as there is a high risk of serious complications.
What are the consequences of pathology
This aspect should be read first. In young and he althy people, the immune system works well, so complications are not observed as often. But in young children and the elderly, they are diagnosed much more often. This is due to hormonal imbalance and metabolic instability. Because of this, acute odontogenic osteomyelitis of the jaws is much worse tolerated by patients. The elderly suffer the most, as they have very low regenerative processes of soft and bone tissue.
Among the most common complications are the following:
- Complete death and subsequent rejection of soft tissues and bone.
- Acute inflammation of the facial blood vessels and their thrombosis. This condition is very dangerous and can even becomecause of death, so if there is even the slightest suspicion, you should immediately make an appointment with the dentist, because the longer treatment is not started, the more serious the consequences will be.
- Sinusitis and sinusitis. Advanced odontogenic osteomyelitis of the upper jaw leads to the fact that suppuration gradually spreads to the nasal and frontal sinuses, as a result of which suppuration forms in them.
- Inflammation of the lymph nodes and damage to the blood vessels. The course of the pathology and clinical manifestations depend on the location of the pathogenic microflora.
- TMJ Arthritis. Accompanied by acute pain in the temple and jaw joint that occurs during eating and talking.
- Fractured jaw. Extensive damage to bone tissue can lead to injury even with a slight physical impact on the jaw.
- The penetration of pathogenic microorganisms into the circulatory system and the spread of infection throughout the body. In this case, the treatment of odontogenic osteomyelitis almost never gives a positive result, so the patient dies.
- Facial asymmetry.
- Loss of permanent molars.
- Inferior retrognathia.
- Pathological change in the structure of soft tissues and scarring.
- Violation of the mobility of the jaw joints.
- Cavities in bone tissue.
- Inflammation of the brain and spinal cord.
- Septic shock.
- Development of cancer.
- Psychological and emotional depression.
So manyThe consequences of odontogenic osteomyelitis are very serious and can lead to the development of irreversible conditions, so it is very important to detect the disease as soon as possible and start treatment. At the same time, it is imperative to understand that it will bring a positive result only with an integrated approach. It will not work to defeat the disease on your own at home with folk remedies. Therapy must be carried out in compliance with all the prescriptions of the dentist.
Basic diagnostic methods
How does it happen and what is its peculiarity? As soon as the patient arrives at the hospital, the doctor performs a complete examination and palpation of the oral cavity. At the same time, the profiled specialist draws attention to the presence of the following signs:
- soft tissue swelling;
- is there any mobility of the teeth in the area of the inflammatory lesion;
- shade of gums and mucous membrane;
- state of the epidermis in the area of necrotic lesions;
- presence of places of accumulation of purulent masses.
In addition to a general examination and assessment of the patient's condition, the diagnosis of odontogenic osteomyelitis involves an x-ray examination. This method is considered one of the most effective, and also allows you to make a detailed clinical picture and detect the primary signs of the pathological process in the initial stages of its course. In addition, with the help of x-rays, the formation of nodules and a benign tumor can be detected. However, x-rays are not enough to establish an accuratediagnosis. A mandatory study is a general blood test. The following signs indicate the beginning of the development of a purulent process, as well as necrosis of soft and bone tissues:
- significant increase in white blood cells;
- decrease in erythrocyte sedimentation rate;
- Changes in the normal chemical composition of the blood, in particular, an increase in the concentration of C-reactive and simple water-soluble protein.
Also, the patient must pass urine for a general analysis. If the content of red blood cells and protein in urine significantly exceeds the norm, then this is a sure sign of an inflammatory process in the body. As soon as an accurate diagnosis is made, the doctor sends the patient for bacteriological culture, which is taken from the site of the necrotic lesion. This is necessary in order to establish the type and group of pathogenic microorganisms, due to which acute odontogenic osteomyelitis of the lower jaw began to develop. All these studies allow obtaining detailed information about the patient's he alth status and compiling a detailed clinical picture, as well as eliminating the possibility of other dental diseases that have similar clinical manifestations so that the patient is not prescribed inappropriate treatment. The use of inappropriate drugs can complicate the course of therapy and greatly increase the healing process.
Modern therapies
Let's take a closer look at this aspect. Nowadays for the treatment of odontogenic osteomyelitisThe jaw uses many schemes aimed at combating pathogenic microorganisms, stopping the further development of inflammation and necrosis of soft tissues and bones, strengthening the immune system and activating regenerative processes. The therapy program should be selected only by a specialized specialist based on the results of the tests. Only an integrated approach will achieve a positive result and minimize the risk of serious complications.
The therapy program is selected depending on the cause of development and the stage of the disease. Treatment should be carried out exclusively under the supervision of a qualified doctor so that he can monitor the patient's condition. If the inflammatory process proceeds in an acute form, accompanied by pronounced symptoms, then a surgical operation is prescribed. The dentist makes a small incision on the gum in the area of the abscess localization and installs a drain that ensures the removal of purulent accumulations. In addition, in order to quickly cure odontogenic osteomyelitis of the jaw, a course of drug therapy is also required. In most cases, the following drugs are prescribed:
- antibiotics;
- painkillers;
- drugs that reduce the permeability of blood vessel walls;
- drugs of the vasoactive group, contributing to the normalization of metabolic processes at the cellular level.
In addition to all of the above, the patient is advised to exclude or at least minimize physical activity and try as much as possiblerest. If a person asked for medical help too late, as a result of which the disease has become chronic, then more serious treatment of odontogenic osteomyelitis is required in this case. The patient must also adhere to strict bed rest and take the medications listed above in accordance with the dosage prescribed by the doctor. In addition, the therapy program includes drugs that normalize blood circulation and prevent further spread of the infection. Due to this, sequesters are released, which are then removed surgically. After the operation, a person needs a good rest and a course of taking vitamin complexes and drugs that help strengthen the immune system. In addition, periodic examinations at a dental clinic are required.
Acute odontogenic osteomyelitis in children is treated in much the same way as in adults, but there are some differences. The main task of therapy is the elimination of the focus of purulent-necrotic lesions and the restoration of all impaired functions. However, every parent should know that the treatment of osteomyelitis in children at home is strictly prohibited. This is due to the fact that their immune system is still poorly developed, so the body resists viruses and infections much worse. If you find your baby has the symptoms listed above, then you should immediately take him to the hospital or call an ambulance.
The faster the surgery, the greater the chance of a successful recoverychild without any serious or irreversible complications. Radical therapy consists in pulling out a diseased tooth, due to which an inflammatory process began in the baby. In addition to it, the temporary molars involved in the formation of the bite are subject to removal. Permanent teeth can be saved in most cases. As a rule, the treatment of odontogenic osteomyelitis of the mandible in children does not require the installation of drainage, since purulent masses normally exit through the hole left after the removal of the molar. But if they accumulate in the medullary spaces, then dentists have to work hard to do a good cleaning.
To reduce the risk of developing abscesses, it is imperative to make a dissection on the periosteum, sanitize purulent formations, and treat the wound with antibiotics and special antiseptic agents. After being discharged home, the child must undergo a course of drug therapy based on taking drugs that have a depressing effect on pathogenic microflora, strengthen immunity and relieve inflammation.
If a patient has been diagnosed with chronic odontogenic osteomyelitis, then treatment can take place at home. But in this case, the patient must periodically visit the doctor so that he can monitor the patient's he alth, as well as make the necessary adjustments to the therapy program, which includes the following:
- taking antibiotics and antiallergic drugs;
- general strengthening and immunostimulating therapy;
- physiotherapy;
- laser therapy;
- ultra-high frequency therapy.
It is worth noting that after the completion of the treatment program, the patient must undergo a course of rehabilitation. It will reduce the likelihood of developing various complications and speed up the healing process of wounds. In addition, children and adults will be able to restore chewing function much faster, eliminate any cosmetic defects and return to their usual way of life. The rehabilitation program may include the following activities:
- surgery;
- plastic surgery;
- when teeth fall out, dentists put dentures in their place;
- special exercises aimed at improving the mobility of the jaw joint.
Children under the age of 16 are registered by doctors at the dispensary, which involves a dental examination at least once every 6 months.
Prevention of pathology
So what is she like? Odontogenic osteomyelitis is one of the most serious pathologies in dental practice, which can lead not only to the development of various complications, but also cause death. If the first suspicions of this pathology arise, it is recommended to contact the dental clinic as soon as possible to undergo an examination, and, if necessary, start treatment. But, according to qualified specialists, it is much easier to avoid the development of osteomyelitis than to cure it later. To do this, you only needfollow a few tips from experienced dentists that will prevent the development of the disease. The main ones are as follows:
- proper oral care;
- treatment measures to improve the whole body;
- regular visits to the dental office;
- strict compliance with all doctor's prescriptions;
- rejection of harmful foods and habits.
These very simple tips will help minimize the risk of developing osteomyelitis. As practice shows, if a person brushes his teeth twice a day, eats right and does not engage in any sports associated with injuries, then he will never have problems with oral he alth.
Conclusion
Despite the seriousness of osteomyelitis, thanks to the high level of development of modern medicine, the disease can be easily and quickly cured. According to dentists, if the patient went to the hospital on time, when the purulent-necrotic process had not yet managed to affect large areas of soft and bone tissues, the disease responds quickly and well to treatment. At the same time, there are no serious complications that can negatively affect the quality of human life. Therefore, if you suspect that you have osteomyelitis, then do not waste time trying to get rid of it with the help of folk remedies, since they are ineffective in this case. The sooner you do this, the better your chances of a full recovery. Don't risk your he alth, sign up nowto see a dentist.
