How inflammation develops
Most often, the infection enters the bone through the apex of the tooth root in which the pulp has died. Pus accumulates at the root, then spreads through the bone marrow spaces, disrupts the nutrition of the bone area, and it dies. The dead fragment is called sequester - the body gradually separates it from healthy tissue. The lower jaw is affected more often than the upper jaw, because its bone is denser and less well supplied with blood, and inflammation is more easily confined inside. At the same time, the periosteum and surrounding soft tissues become inflamed, resulting in pronounced swelling of the face.
- Odontogenic - from a diseased tooth, the most common option
- Traumatic - after a jaw fracture
- Hematogenous - with blood flow, more often in children
- Acute, subacute and chronic stages
- Formation of sequesters during chronic course
- Drug-induced osteonecrosis as a separate condition
Symptoms
Acute osteomyelitis begins rapidly. The pain changes from local to diffuse, spreading to the ear, temple and neck, the temperature rises to 38–39 °C, weakness and chills appear. The face swells on the affected side, the lymph nodes under the jaw become enlarged and painful. There is an unpleasant odor from the mouth, the gums around the causative tooth turn red and swell on both sides, and the teeth in the lesion become mobile. A characteristic sign of damage to the lower jaw is numbness of the lower lip and chin due to compression of the nerve. Opening the mouth becomes painful and limited.
- Severe diffuse pain in the jaw
- High temperature, weakness, chills
- Facial swelling and enlarged lymph nodes
- Mobility of several teeth
- Purulent discharge from the gums, bad breath
- Numbness of the lower lip
- Limitation of mouth opening
Diagnostics
The diagnosis is made by a dental surgeon based on the clinical picture and examination data. A targeted X-ray and X-ray of the jaw may look almost normal in the first days: X-ray changes in the bone do not appear immediately, so a normal X-ray does not exclude the diagnosis. Over time, areas of bone loss are visible, and in chronic cases, sequestration. CT shows the extent of the lesion more accurately and helps plan surgery. A blood test reveals an increase in leukocytes and ESR. The discharge is sent for culture to determine sensitivity to antibiotics.
- Examination by a dental surgeon
- Sight image of the causative tooth
- X-ray of the jaw
- CT for planning surgery and chronic course
- General blood test
- Culture of pus for flora and sensitivity
- Blood glucose to detect diabetes
Treatment
The main principle is to remove the source of infection and ensure the drainage of pus. The causative tooth is most often removed, the abscess is opened and drained, and if necessary, incisions are made for drainage from the soft tissues. At the same time, antibiotics are prescribed, selected by the doctor taking into account the culture, painkillers and detoxification therapy. In severe cases, treatment is carried out in a hospital. In case of chronic osteomyelitis, sequestrectomy is performed - removal of dead areas of bone. Home treatment with rinsing and heating is not only useless, but also dangerous: heat accelerates the spread of pus.
- Removal of the causative tooth
- Opening and draining a purulent lesion
- Antibiotic therapy as prescribed by a doctor
- Pain management and infusion therapy
- Hospital treatment for severe cases
- Sequestrectomy for chronic form
- Categorical refusal of warming up and compresses
Complications and prevention
Untreated osteomyelitis can lead to phlegmon of the face and neck, inflammation in the floor of the mouth with a threat to breathing, spread of infection into the orbit and cranial cavity, sepsis, and with a long course - to a pathological fracture of the jaw and permanent deformity. In children, there may be disturbances in the growth of the jaw and the buds of permanent teeth. Prevention is simple and reliable: do not start caries, treat periodontitis, and do not wait until the tooth stops hurting, get examined by a dentist twice a year and compensate for diabetes.
- Cellulitis of the face and neck
- Spread to the orbit and cranial cavity
- Sepsis
- Pathological fracture of the jaw
- Chronic fistula and deformity
- Prevention: timely treatment of caries and examinations twice a year
