Odontogenic osteomyelitis of the jaw
What is odontogenic osteomyelitis?
Odontogenic osteomyelitis of the jaw is an infectious lesion of the jaw bone tissue. It accounts for about 70% of all reported cases. It has been noticed that the male part of the population suffers from manifestations of this ailment much more often than the female half. Perhaps this is due to an untimely visit to doctors in the event of diseases that trigger the onset of osteomyelitis.
Most of the odontogenic osteomyelitis is the lower jaw, about 85% of all cases. The upper jaw is damaged less often - up to 15%. The main peak incidence occurs at the age of 7 to 15 years in childhood and from 30 to 35 years in a mature state. In childhood, the development of the disease is most often associated with carious damage to dental tissues.
The terminological concept "osteomyelitis" was first used in the 19th century. At its core, the name of this disease does not fully reflect the processes taking place in the body. Contrary to the term for bone marrow damage, inflammation affects all structural components of the bone, and also causes damage to the surrounding soft tissue.
- Causes of odontogenic osteomyelitis
- Forms of odontogenic osteomyelitis and symptomatic characteristics
- Diagnosis of odontogenic osteomyelitis
- Treatment of odontogenic osteomyelitis
- Possible complications
- Prevention of odontogenic osteomyelitis
- Disease prognosis
Causes of odontogenic osteomyelitis
In the vast majority of cases, the disease is caused by pathogenic bacteria that enter the bone through the circulatory system of the infected tooth. Most often, Staphylococcus aureus becomes the culprit, less often streptococcus, Klebsiella, Pseudomonas aeruginosa and some species of E. coli. Sometimes pathogenic fungi play a leading role.
The following routes of infection are distinguished:
- an infected tooth (periodontitis);
- blood flow;
- chronic infections and their exacerbations (tonsillitis, sinusitis, sinusitis);
- acute infectious diseases (scarlet fever, diphtheria, tonsillitis).
And based on the way pathogens enter the tooth cavity, osteomyelitis of the jaw can be divided into the following types:
- odontogenic osteomyelitis, which accounts for about 75% of cases. The causative agent of the disease through carious neglected formations enters the pulp of the tooth, then goes to the root, and from there it moves with the help of channels and lymphatic messages into the bone tissue and causes an inflammatory process.
- hematogenous osteomyelitis, which occurs due to the presence of chronic diseases and their exacerbations. First, the infection spreads to the bone tissue adjacent to the focus, then moves to the teeth, from where it enters the cavity.
- traumatic osteomyelitis that occurs after fractures, dislocations of the jaw. In this case, pathogenic microorganisms can enter from the outside (for example, from the surface of the skin), but bacteria living in the body can also be activated. The most rare type of osteomyelitis.
Specialists are still unclear about the mechanisms of odontogenic osteomyelitis of the jaw and osteomyelitis in honesty. But it is known that there are a number of conditions that predispose to the disease and trigger it, which, in combination, give an impetus to the development of pathology.
The category of predisposing phenomena includes:
- latent infections;
- allergic manifestations;
- decreased immunity due to illness or long-term treatment with aggressive drugs;
- physical and nervous exhaustion.
The reasons giving the command to "start" odontogenic osteomyelitis:
- diseases of the oral cavity;
- periodontitis, pulpitis and other dental lesions;
- frequent SARS;
- chronic diseases in the acute stage;
- stress, vivid negative emotions and experiences.
Forms of odontogenic osteomyelitis and symptomatic characteristics
Clinical manifestations, which are expressed in patient complaints, depend on the type of osteomyelitis, the course of the disease and the degree of tissue damage:
The acute form, in which the symptoms are pronounced, the body actively reacts to infection, resists "on all fronts."
Symptoms of the disease in this form are local and general:
- Pain syndrome in the area of the damaged tooth, aggravated by palpation (feeling, light pressure) of the jaw and soft adjacent tissues. Percussion tests (tapping) also increase pain. Moreover, most often the pain increases in adjacent areas, and subsides in the directly infected tooth.
- There is a pronounced swelling of the muscle tissue around the affected area, redness and swelling.
- An infected tooth, immobile at the onset of the disease, begins to loosen gradually. There is a syndrome of "keys" when the teeth adjacent to the focus also acquire mobility.
- Enlargement of the cervical and submandibular lymph nodes, accompanied by pain.
- In some cases, there may be a violation of the sensitivity of the lips and taste.
- Blood and urine test results indicate obvious inflammation.
- headaches, especially in the temples;
- weakness syndrome;
- an increase in body temperature up to 39–40 ° C;
- sleep disturbance;
A subacute form that develops after an acute one. At this stage, a fistula forms, through which purulent discharge and inflammatory fluid come out. As the pressure decreases, the pain subsides, but the site of infection remains in place. Moreover, the inflammatory process can grow and cause the formation of dead areas - sequesters.
Symptoms of the subacute form:
- elevated body temperature remains;
- pain syndrome becomes less pronounced;
- purulent fluid is released from the damaged tooth;
- general malaise is growing.
In the absence of adequate treatment, it is possible to develop a generalized form of osteomyelitis, which, in the absence of medical care, can lead to death.
A chronic form that lasts from several months to several years. It is characterized by periodic repetitions of relapses (exacerbations) and remissions (extinctions) of the disease. With chronic course fistulas, sequesters are formed. The teeth become mobile. In the area of the focus of infection, a thickening of the jaw is observed.
In some cases of acute and chronic odontogenic osteomyelitis, severe symptoms may be absent, and symptoms can be interpreted as manifestations of completely different diseases.
Diagnosis of odontogenic osteomyelitis
- To make the correct diagnosis, a combination of different diagnostic methods is used: the clinical picture and patient complaints are correlated with laboratory and instrumental research methods.
- Laboratory methods are represented primarily by a general blood test. An increase in the number of leukocytes indicates the presence of an inflammatory process, and the characteristics of the forms of leukocytes indicate the nature of the disease. The infectious nature of the disease is also indicated by the ESR indicator and a decrease in the level of platelets.
In cases of an incomprehensible clinical picture, a biochemical blood test, urine analysis is used.
- Of the instrumental diagnostic methods, X-ray of the jaw is used, which clearly shows the place of occurrence of the disease according to the changed bone structure - the inner part of the bone thickens, and the outer one becomes thinner.
- The most informative and accurate is the study using computed tomography. This method allows not only to determine the focus of infection, but also the severity of inflammation, duration, nature. CT scan reveals large and small formations, single and group, and also shows the area of the disease. The fistulography method is often used, which consists in performing CT with a contrast agent.
- Another method is infrared radiation, through which the temperature is estimated and areas with higher values are indicated.
- With some concomitant diseases, for example, tuberculosis, diagnosis is difficult, and the situation requires a detailed study.
Treatment of odontogenic osteomyelitis
Modern medical practice assumes an integrated approach to the treatment of odontogenic osteomyelitis of the jaw. It includes surgery and drug therapy. Isolated surgical manipulations or drug exposure will not bring results; moreover, they can lead to complications.
Treatment is carried out in stationary conditions and depends on the form of the disease and its stage.
- Acute osteomyelitis of the jaw implies immediate disposal of the damaged tooth. After removal, the cavity is rinsed with antibiotic solutions for disinfection and elimination of pus. In the future, it is necessary to regularly cleanse the wound with the help of antiseptic agents, the introduction of antibacterial drugs to extinguish the focus of infection, to prevent its spread. Regenerating and vitamin courses are also used.
- The subacute form of odontogenic osteomyelitis needs to contain the infection. The main task is to prevent inflammation from spreading to adjacent areas and infecting healthy tissues. For this, antibacterial and anti-inflammatory drugs are introduced, drainage of purulent foci is used. Follow-up therapy includes antibiotics, vitamin infusions, detoxification courses. Physiotherapy methods are used.
- Chronic odontogenic osteomyelitis with formed fistulas and sequesters requires opening the foci, removing dead areas and purulent formations. Antibiotic therapy is aimed at extinguishing infectious inflammation and containing disease within the affected area. A complete sanitation of the damaged area and the entire oral cavity is performed. The patient receives anti-inflammatory, detoxification and vitamin infusion (intravenous) infusions.
For all types of odontogenic osteomyelitis, general strengthening therapy is prescribed, aimed at increasing the body's resistance.
Launched odontogenic osteomyelitis, as well as concomitant diseases that aggravate the course of the disease, can cause serious complications:
- sepsis, which is often fatal;
- inflammation with a spill of purulent fluid (phlegmon) of the soft facial and cervical tissues;
- the formation of abscesses of various localization;
- deformities of the jaw, the formation of false bones;
- pathological fractures of the jaw.
- In addition, damage to the upper jaw can lead to diseases of the nasopharynx and thrombophlebitis. Damage to the mandibular region - to limitation of mobility.
Prevention of odontogenic osteomyelitis
Unfortunately, there are no methods that 100 percent protect people from developing odontogenic osteomyelitis. But hygiene, caution and timely access to doctors greatly reduces the risk of disease. The following preventive actions can be distinguished:
- regular, at least once a year, visits to the dentist;
- thoroughly brushing your teeth twice a day, removing food debris after eating;
- avoidance of injuries, blows, jaw dislocations;
- increasing the state of immunity with adequate physical activity, spending time in the fresh air, proper nutrition;
- timely prosthetics and dental treatment.
It is possible to make statements about the prognosis of the course of odontogenic osteomyelitis of the jaw only after the diagnosis and assessment of the severity of the condition. The earlier a disease is detected, the faster and easier it can be dealt with. Therefore, you should never ignore visits to the dentist, especially if you experience unusual sensations, pain, fever of unknown origin and without other specific symptoms.
In time, unnoticed acute osteomyelitis threatens with the transition of the lesion to the chronic stage. Regular dental check-ups, preventive blood tests can determine the initial stage even without the appearance of warning signs.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.