Osteomyelitis is a very serious dental disease, accompanied by a purulent inflammatory process and the formation of clusters 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 described in more detail below, but at increased risk are malicious smokers and people who pay insufficient attention to oral hygiene. In addition, the pathology may be the result of an immune failure, as a result of which the protective mechanisms begin to function not at full strength and cease to cope with the activity of infection pathogens. Let's take a closer look at what this disease is, how dangerous it is and what effective methods of therapy exist today.
A bit of history
The first mention of a purulent necrotic lesion of the jaw is found in the scientific works of the famous German surgeon Erich Lexer, dated 1884, who devoted about 12 years of his life to the study of diseases of infectious etiology. Throughout human history, acute odontogenic osteomyelitis disease has been encountered quite frequently. Most suffered from it in the Middle Ages, when no medicine, as such, and hygiene did not exist. 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 the 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 subjected to harsh criticism by Professor Genke, who, in the course of many experiments, was unable to model odontogenic osteomyelitis.
The most reliable assumption was formulated by the Russian scientist Sergei Martynovich Derizhanov. He introduced pathogenic microorganisms to animals, which over time led to the development of an increase in the body's sensitivity to irritants and suppression of the immune system. Against this background, after some time, the experimental process began an inflammatory process, accompanied by purulent necrotic damage to the soft tissues. Thus, in aggregate, the theories described above formed the modern idea of this pathology.
Main reasons
Let's dwell on this in more detail. As mentioned earlier, the etiology of odontogenic osteomyelitis can be different. Doctors say that in almost 90 percent of cases, pathology develops due to the penetration of harmful bacteria into the bone tissue together with blood. In some cases, the cause of the problem is pathogenic fungi, which can penetrate the bone in one of the following ways:
- through a tooth injured as a result of a strong blow or damaged by caries;
- through the blood vessels;
- with damage to the soft tissues by various infectious diseases that occur in acute or chronic form;
- poor oral hygiene or its complete absence;
- various dental diseases such as caries, granuloma, periodontitis, periostitis and many others;
- furunculosis on the face;
- purulent otitis media;
- inflammation of the tonsils;
- scarlet fever;
- purulent-septic inflammatory lesion of the navel epidermis;
- diphtheria.
It is very important to determine the pathogenesis of odontogenic osteomyelitis, since the choice of medications and other modern treatment methods 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. A similar kind of pathology in babies is diagnosed in very rare cases, however, they also occur 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 with prolonged absence of treatment it can lead to general intoxication of the body, which poses a great threat to the health and life of the child. The causes of the pathology can be both anatomical and functional. Among the most common doctors distinguish the following:
- high sensitivity to pathogenic microorganisms;
- intensive development of bone tissue;
- prolapse of dairy and the growth of permanent molars;
- reconstruction of the jaw structures;
- too thin tooth plates 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 the teeth affected by various infectious diseases, as well as from other foci located in different parts of the body, as a result of pathogens entering the bloodstream and spreading throughout the circulatory system.
Types of disease
Let's look at this aspect in more detail. As such, the classification of odontogenic osteomyelitis does not exist. But doctors divide the pathology depending on the stage and intensity of the manifestation of symptoms into three types:
The main are the first and last form, and the second almost never occurs in dental practice. It is worth noting that surgery has its own classification of osteomyelitis. In this area of medicine, such varieties of it are distinguished:
- limited - the inflammatory process does not affect the entire jaw, but only a few molars;
- focal - there is a necrosis of the soft tissues of the alveolar part of the bone body;
- spilled - extensive necrosis of the entire lower or upper jaw, accompanied by the accumulation of a large number of purulent clusters.
According to statistics, most often in children and adults there is odontogenic osteomyelitis of the lower jaw. What it is connected with is still unknown, but the fact remains. If the patient does not go to the hospital on time, and 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 periodically recur and adversely affect the quality of a person’s daily life, bringing it has many inconveniences of a physical and psychological nature.
Clinical manifestations
What should you pay attention to first of all? Signs of odontogenic osteomyelitis depend on many factors, the main among which is the stage of the pathology, the severity of the jaw bone necrosis, the state of immunity and the activity of pathogens. Also, the symptoms will be more pronounced and intense, if the pathology proceeds 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, it is localized 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, 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, such local signs of acute odontogenic osteomyelitis are observed, such as:
- pain
- swelling of the gums;
- pathological loosening of teeth;
- stink from the mouth;
- discharge of pus upon palpation of the gums.
Among the main symptoms, the following can be distinguished:
- malaise and weakness throughout the body;
- fatigue and prolonged fatigue;
- decreased physical activity and ability to work;
- chills;
- lack of appetite;
- loss of sensitivity of the upper or lower lip;
- swelling and soreness of the gums and face;
- decreased mobility of the lower jaw;
- discomfort and pain while chewing;
- difficulty swallowing food;
- decreased articulation function;
- labored breathing;
- involuntary spasms of the facial muscles responsible for the performance of masticatory functions;
- enlarged lymph nodes;
- sleep disorder.
The first symptoms can occur only 24-72 hours after the onset of the inflammatory process. If the trip to the doctor was postponed for a long time, then a few months later chronic odontogenic osteomyelitis develops. With this form of pathology, body temperature rises, which can stay at 38 degrees for several days. This is because rejection of dead bone begins. The danger of this stage is that the main symptomatology of the disease disappears, and the patient experiences a marked improvement in well-being. Pain is almost completely lost, so most people simply turn a blind eye to the problem. However, further progression of odontogenic osteomyelitis continues. Lack of treatment can be dangerous, as there is a high risk of serious complications.
What consequences can pathology lead to?
This aspect is worth exploring in the first place. In young and healthy people, the immune system works well, so their complications are not observed so 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 jaw osteomyelitis is tolerated by patients much worse. The elderly suffer most of all, since they have very low regenerative processes of soft and bone tissue.
Among the most common complications, the following can be distinguished:
- Complete death and subsequent rejection of soft tissues and bones.
- Acute inflammation of the facial blood vessels and their thrombosis. This condition is very dangerous and can even cause death, so if even the slightest suspicion arises, you should immediately make an appointment with the dentist, because the longer the treatment does not begin, the more serious the consequences will be.
- Sinusitis and sinusitis. Launched 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. It is accompanied by acute pain in the temple and jaw joint that occurs during eating and talking.
- Jaw fracture. Extensive bone damage can lead to injuries even with a small 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.
- Asymmetry of the face.
- Loss of permanent molars.
- Lower retrognathia.
- Pathological change in the structure of soft tissues and scarring.
- Impaired mobility of the jaw joints.
- The formation of cavities in bone tissue.
- Inflammation of the brain and spinal cord.
- Septic shock.
- The development of cancer.
- Psychological and emotional depression.
Thus, many of the 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 and start treatment as soon as possible. It is imperative to understand that it will bring a positive result only with an integrated approach. Independently defeating an ailment at home with folk remedies will not work. Therapy should be carried out in accordance with all the instructions of the dentist.
Basic diagnostic methods
How does it happen and what is its feature? As soon as the patient comes to the hospital, the doctor conducts a complete examination and palpation of the oral cavity. In this case, a profiled specialist draws attention to the presence of the following symptoms:
- swelling of the soft tissues;
- is there tooth mobility in the area of inflammatory lesion;
- a shade of gums and mucous membranes;
- the state of the epidermis in the area of necrotic lesion;
- the presence 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 draw up 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, it is possible to detect the formation of nodules and a benign tumor. However, x-rays are not enough to make an accurate diagnosis. 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:
- a significant increase in the level of white blood cells;
- erythrocyte sedimentation rate reduction;
- a change 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 should 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 the inflammatory process in the body. As soon as an accurate diagnosis is made, the doctor sends the patient to bacteriological culture, the sampling of which is carried out from the site of necrotic lesion. This is necessary in order to establish the type and group of pathogenic microorganisms, because of which acute odontogenic osteomyelitis of the lower jaw began to develop. All these studies make it possible to obtain detailed information about the patient’s state of health and draw up a detailed clinical picture of the patient, as well as to exclude the possibility of other dental diseases having similar clinical manifestations so that the patient is not prescribed the wrong treatment. Using inappropriate drugs can complicate the course of therapy and greatly increase the healing process.
Modern Therapies
Let's dwell on this aspect in more detail. Today, for the treatment of odontogenic osteomyelitis of the jaw, many schemes are used to combat pathogenic microorganisms, stop the further development of inflammation and necrosis of soft tissues and bones, strengthen the immune system and activate regenerative processes. The treatment program should be selected only by a specialized specialist on the basis of the obtained analysis results. Only an integrated approach will achieve a positive result and minimize the risk of serious complications.
The treatment program is selected depending on the cause of development and the stage of the course 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 abscess localization and establishes a drainage that ensures the removal of purulent accumulations. In addition, in order to quickly cure odontogenic jaw osteomyelitis, a course of drug therapy is also required. In most cases, the following drugs are prescribed:
- antibiotics
- painkillers;
- medicines that reduce the permeability of the walls of blood vessels;
- vasoactive group drugs that contribute to the normalization of metabolic processes at the cellular level.
In addition to all of the above, the patient is recommended to exclude or at least minimize physical activity and try to relax as much as possible. If a person seeks medical help too late, as a result of which the disease has acquired a chronic form, then a more serious treatment of odontogenic osteomyelitis is required. The patient must also adhere to strict bed rest and take the above medications in accordance with the dosage established by the doctor. In addition, drugs that normalize blood circulation and prevent the further spread of infection are included in the treatment program. , . , . , .
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The faster the surgery is performed, the more chances there are for a successful recovery of the child without any serious or irreversible complications. Radical therapy consists in pulling out a diseased tooth, due to which the baby begins the inflammatory process. In addition to it, temporary molars involved in the formation of the bite are subject to removal. In most cases, permanent teeth can be preserved. As a rule, treatment of odontogenic osteomyelitis of the lower jaw in children does not require the installation of drainage, since purulent masses normally exit through the hole remaining after removal of the molar. But if they accumulate in the bone marrow spaces, then dentists have to work hard to perform quality cleaning.
To reduce the risk of developing abscesses, a dissection is mandatory on the periosteum, purulent formations are sanitized, and the wound is treated with antibiotics and special antiseptic agents. After being discharged home, the child should undergo a course of drug therapy based on taking drugs that have a depressing effect on the pathogenic microflora, strengthen the immune system and relieve inflammation.
If the patient has been diagnosed with chronic odontogenic osteomyelitis, then treatment can take place at home. But in this case, the patient should periodically visit the doctor so that he can monitor the patient’s health status, as well as make the necessary adjustments to the treatment 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 rehabilitation course. It will reduce the likelihood of developing various complications and accelerate the healing process. 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:
- surgical intervention;
- plastic surgery;
- with tooth loss, dentists install prostheses in their place;
- special exercises aimed at improving the mobility of the jaw joint.
Children under the age of 16 years are put on a medical examination by a doctor, which involves a dental examination at least once every 6 months.
Pathology prevention
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 can cause a person's death. If there are first suspicions of this pathology, it is recommended to contact a 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 subsequently cure it. To do this, you just need to adhere to a few tips from experienced dentists that will prevent the development of the disease. The main ones include the following:
- proper oral care;
- therapeutic measures to improve the whole body;
- regular visits to the dental office;
- strict implementation of all doctor's prescriptions;
- giving up bad foods and habits.
These very simple at first glance tips will minimize the risk of osteomyelitis. As practice shows, if a person brushes his teeth twice a day, eats properly and does not engage in any sports associated with injuries, then he will never have problems with the health of the oral cavity.
Conclusion
Despite the seriousness of osteomyelitis, due to the high level of development of modern medicine, the disease can be easily and quickly cured. According to dentists, if the patient turned to the hospital on time, when the purulent-necrotic process has not yet managed to hit vast areas of soft and bone tissues, the disease can be quickly and well treated. In this case, no serious complications that could adversely affect the quality of human life are not manifested. Therefore, if you suspect 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 faster you do this, the higher your chances of a full recovery. Do not risk your health, but immediately make an appointment with the dentist.