Osteomyelitis of the jaw: how to recognize a deadly enemy?

Osteomyelitis of the jaw is a dangerous inflammatory disease that is caused by infection. A purulent-necrotic process develops on the tooth bone - most often on the lower jaw. Next, the inflammation affects the bone tissue of the head and spreads to soft tissues - gums, salivary glands, skin, chewing and facial muscles. In severe cases, pus forms and necrosis of bone tissue occurs.

If the process turns into purulent inflammation of the soft tissues of the face, the patient suffers not only from local inflammation of the bone, but also from general intoxication.

Inflammatory processes in the mouth do not always develop into osteomyelitis. This disease most often affects people with weakened immune systems.

General information

Osteomyelitis of the mandible is more common, more severe and has more complications. With chronic osteomyelitis of the lower jaw, the bone is affected deeper, which can lead to jaw fractures. Inflammation affects a dangerous area - the jaw processes. Acute osteomyelitis of the lower jaw easily turns into subacute and then chronic.

Osteomyelitis of the upper jaw develops more rapidly and can lead to inflammation of the maxillary sinuses. However, since the bone tissue here is less dense, abscesses and phlegmons develop less often with osteomyelitis of the upper jaw, and the disease itself is easier.

The entry point for infection is a diseased tooth, and the causative agents of inflammation are Staphylococcus aureus and Staphylococcus alba, pneumococci, Escherichia coli and typhoid bacilli. This microflora is usually located in areas of chronic infection of the tissues surrounding the tooth.

Inflammation in osteomyelitis does not occur suddenly; initially, a chronic infection develops in the gum for a long time - for example, in periodontitis or periodontitis. Then, if the outflow of waste products from the infection is disrupted, the microflora from the lesion spreads to the surrounding tissue.

Osteomyelitis of other parts of the skeletal system is caused by only one type of pathogen - staphylococcus (streptococcus), which penetrates the tissue through the bloodstream. Since osteomyelitis of the jaw can be caused by different pathogens, the course of the disease has much more distinctive features than with ordinary osteomyelitis.

Complications

Osteomyelitis of the jaw can cause complications that cause great harm to human health. sepsis and inflammation of the soft tissues of the face and neck ( phlegmon may develop . Osteomyelitis can also result in deformation or fracture of the jaw. If the purulent process spreads to the facial area, this can lead to the development of dural sinuses and phlebitis of the facial veins. meningitis and brain abscess may develop . Sometimes complications lead to disability of the patient, and in especially severe cases – to death.

Classification

Osteomyelitis of the jaws (photo) is classified according to several parameters.

Osteomyelitis may be caused by:

• Infectious

a) Single-gene. It is a consequence of dental disease - caries, stomatitis. The most common type of pathology accounts for 75% of all cases of osteomyelitis.

c) Non-odontogenic (hematogenous). The pathogen enters the bloodstream from other foci of infection. May be a consequence of chronic tonsillitis, diphtheria, scarlet fever.

• Non-infectious (traumatic). The result of mechanical damage to the jaw or a wound through which infection enters. Osteomyelitis can occur under the influence of a growing malignant tumor or become a complication after dental surgery. For example, if the nerve tissue is not carefully removed from the tooth socket.

According to the course of the disease, osteomyelitis of the jaw occurs:

• Spicy. It lasts 7–14 days, then passes into the subacute stage - when a fistula forms at the site of inflammation and exudate flows out from the site of inflammation.
• Chronic. Lasts from a week to several months. It ends with the rejection of dead bone areas through the fistulous tract. Treatment at this stage is mandatory.
• Subacute. The transitional form between acute and chronic disease lasts 4–8 days. The painful signs subside, but the infection is actively spreading.

According to the location of the pathology:

• Osteomyelitis of the upper jaw.
• Osteomyelitis of the lower jaw.

By coverage:

• Limited. The inflammation covers the alveolar process or the area of ​​2–4 teeth of the jaw.
• Diffuse. The pathology covers most or all of the jaw.

According to clinical and radiological forms, chronic odontogenic osteomyelitis is:

• productive. During the healing process, it does not form sequesters (dead bone areas);
• destructive. Upon recovery, it forms sequesters.
• destructive-productive.

Why does it occur

Most often, doctors deal with odontogenic disorders. It can develop against the background of:

• advanced caries;
• pulpitis;
• pericoronitis;
• periodontitis;
• tooth root fracture;
• granulomas;
• dental cyst.

The infection first spreads in the pulp, then passes through the root and reaches the jaw.

The hematogenous form of the disease is a consequence of the ingress of bacteria from boils and carbuncles of the jaw area. This type of osteomyelitis can also be caused by:

• sepsis;
• otitis;
• sinusitis;
• tonsillitis;
• scarlet fever;
• diphtheria.

A hematogenous disorder always follows this scenario - first the jaw bone becomes inflamed, and only then some of the teeth begin to hurt.

Jaw osteomyelitis of a traumatic nature is the result of fractures, bruises, injuries, and wounds. In all these cases, pathogens enter deep bone tissue from the environment.

If you take a sample of the causative agent of dental osteomyelitis for study, you can get unexpected results. It turns out that the culprits of the disease may be:

• staphylococci;
• streptococci;
• coli;
• proteas;
• Pseudomonas aeruginosa;
• Klebsiella, etc.

How quickly the disease progresses depends on the state of a person’s general and local immunity. It is tolerated worse by people who have concomitant pathologies such as:

• oncology;
• diabetes;
• rheumatism;
• hepatitis;
• polyarthritis;
• blood poisoning.

Causes of osteomyelitis of the jaw

Odontogenic osteomyelitis is caused by advanced diseases of the oral cavity. The infection penetrates into the bone tissue through the affected pulp or tooth root. Among the most common gates of infection are:

• caries;
• pulpitis;
• periodontitis;
• pericoronitis;
• alveolitis;
• granuloma or dental cyst.

With hematogenous osteomyelitis, infection through the bloodstream can come from abscesses on the neck or face (boils, carbuncles) or result from:

• purulent otitis;
• tonsillitis;
• umbilical cord infections in infants;
• inflammatory foci in diphtheria and scarlet fever.

With traumatic osteomyelitis, the infection from the external environment enters the open wound, then into the bone tissue. This may happen:

• with a gunshot wound;
• jaw fracture;
• damage to the nasal mucosa.

If a person has good immunity, his body successfully resists the invasion of pathogenic bacteria and in 60% of cases can prevent the development of the disease. If the patient suffers from chronic ailments - diseases of the blood, liver, kidneys, endocrine system, arthritis and polyarthritis, he will most likely develop osteomyelitis of the jaw.

List of sources

• Shargorodsky A.G. Inflammatory diseases of the maxillofacial region and neck / A.G. Shargorodsky. - M.: GEOTAR-MED, 2002;
• Tsarev V.N., Ushakov R.V. Antimicrobial therapy in dentistry: Guide. - M.: Medical Information Agency, 2004;
• Robustova T. G. Odontogenic osteomyelitis of the jaws // Surgical dentistry and maxillofacial surgery. National leadership / Ed. A. A. Kulakova. T. G. Robustova, A. I. Nerobeeva. - M.: GEOTAR-Media, 2010;
• Afanasyev V.V. Traumatology of the maxillofacial region. M.: GEOTAR-Media, 2010.

Symptoms of osteomyelitis of the jaw

At the initial stage, osteomyelitis of the jaw has no characteristic signs. The person feels unwell, as with most inflammatory diseases. Unaware of the real cause of poor health, the patient may assume another disease and self-medicate. Not only will this not help, but it will also delay the moment of recovery. Therefore, if you feel unwell, it is important to consult a doctor.

External symptoms of maxillary osteomyelitis:

• General weakness, sweating, headache. The person is depressed, he sleeps poorly, refuses to eat.
• Depending on the type of infection and the patient’s immunity, the body temperature rises to 38 or higher or remains normal. If there is no temperature, then the body is not fighting the infection.
• In the acute form of odontogenic osteomyelitis, the tooth affected by the infection hurts. The pain intensifies with pressure and is not relieved by taking painkillers. The tissue around the tooth is swollen and has a reddish tint. Not only the diseased tooth moves, but also those nearby.
• Sometimes an abscess develops on the periosteum of the tooth root. Inflammation affects neighboring teeth, and acute pain shoots into the ear, temple and eye area.
• With osteomyelitis of the lower jaw, the lower lip, mouth and chin become numb. When inflammation invades the jaw tissue, pain spreads throughout the face and neck. The submandibular and cervical lymph nodes become enlarged and painful.
• A periodontal pocket filled with pus forms in the space between the tooth and gum.

Symptoms of acute osteomyelitis of the jaw:

• it hurts to chew;
• at the site where the infection develops, the skin turns pale and becomes covered with plaque;
• the sclera of the eyes turn yellow;
• blood pressure surges;
• with osteomyelitis of the lower jaw, part of the lower lip becomes numb and stops moving, this is due to the fact that the source of inflammation compresses the alveolar nerve.

In subacute osteomyelitis, the inflammatory process continues and sequestration is formed. The teeth in the affected jaw retain and even increase mobility.

With chronic osteomyelitis, the patient feels satisfactory. During remission, the pain subsides. However, the following warning signs remain:

• lack of appetite;
• poor sleep;
• soreness of the facial skin;
• lymph nodes are enlarged;
• fistulas in the mouth do not heal, pus is regularly discharged from them;
• the mucous membranes of the mouth are swollen;
• The teeth on the affected jaw are mobile, and their mobility increases over time.

During an exacerbation, the patient again feels pain spread throughout the jaw and cannot always accurately indicate the location of its localization.

Infants and young children can also develop osteomyelitis of the jaw (usually the upper jaw). The disease develops against the background of sepsis or becomes a complication of ARVI. The symptoms of osteomyelitis in children are pronounced; the disease progresses rapidly and can lead to severe complications, including pneumonia and meningitis. Therefore, it is important to consult a doctor as soon as possible and begin treatment if your baby has the following symptoms:

• high temperature that cannot be reduced with antipyretic drugs;
• cheeks, eyes, lips swell, facial asymmetry appears, it is difficult for the child to open his eyes, and the swelling of the nose makes it difficult to breathe. If you do not see a doctor, the swelling spreads to the neck;
• lymph nodes enlarge;
• purulent foci are noticeable on the gums, and over time infiltrates and fistulas open;
• pain in the eye area.

Consequences of the disease and methods of recovery

Suffered purulent inflammation of the jaw in acute or chronic form often has serious consequences that negatively affect the quality of life.

• Often, surgical intervention during the treatment of a disease is accompanied by the removal of one or more elements of the dentition. As a result, the patient has to subsequently contact an orthodontist and undergo prosthetics.
• In many cases, infection of soft tissues causes scar deformation. This complex cosmetic problem can be corrected using plastic surgery methods.
• Septic conditions, which can develop against the background of the underlying pathology, can disrupt the full functioning of internal organs and negatively affect the functioning of the immune system and hematopoiesis.
• Severe bone lesions can change the natural shape of the jaw. This is not only a cosmetic problem, but also negatively affects the efficiency of the maxillofacial apparatus.
• Infection of a joint can lead to arthritis or arthrosis. This often leads to the formation of ankylosis and significant impairment of jaw mobility.
• Damage to the pathology of the upper jaw can affect the zygomatic bone and orbit with the further appearance of phlegmon or an abscess of the eyeball. Ultimately, the patient loses vision and it is no longer possible to restore it.

In some cases, the recovery period after osteomyelitis of the jaw is several years. All patients are monitored at the dispensary until all emerging violations are eliminated.

Rehabilitation involves the following procedures:

• application of physiotherapy methods;
• performing surgery for medical or cosmetic reasons;
• prosthetics of removed elements of the dentition (if necessary);
• preventive measures to avoid recurrence of the problem.

Diagnostics

Osteomyelitis cannot go away on its own; without medical help, the patient’s condition will worsen.

Periodontitis, cysts and tumors of the jaw, as well as lesions of oral tissue due to syphilis, tuberculosis, and fungal skin infections have similar symptoms. Therefore, self-diagnosis is highly not recommended.

When visiting the clinic you must:

1. Undergo an initial examination of the jaw by a dentist. With osteomyelitis, tapping and palpating the affected areas will be painful.
2. Take an x-ray. In the acute form, it is not very informative, but in subacute and chronic pathology, areas of change in bone density and areas of dead bone tissue will be noticeable.
3. Take a general urine and blood test, a biochemical blood test, and bacteriological culture to identify the type of pathogenic microorganisms.
4. Get a CT scan.

Treatment of osteomyelitis of the jaw

Treatment of osteomyelitis of the jaw is complex and consists of surgery, drug treatment and restorative therapy, which promotes tissue regeneration.

During surgery:

• the surgeon removes the affected tooth;
• treats fistulas and boils in the oral cavity;
• drains pus;
• removes dead (sequestered) areas of bone;
• fills hollow areas with bone materials;
• strengthens mobile teeth with splints.

At the same time, drug treatment is carried out:

• antibiotics;
• immunostimulants;
• vitamin complexes.

To consolidate the result, you must undergo a course of physical procedures:

• UHF;
• magnetic therapy;
• ultrasound therapy.

During the treatment process, the patient is prescribed plenty of fluids and a gentle diet of light, crushed and nutritious foods. It is necessary to carefully monitor oral hygiene.

Desensitization therapy

The treatment complex is supplemented with antihistamines:

• diphenhydramine;
• chloropyramine;
• fenkarol;
• diazolin.

Medicines help eliminate intoxication, activate the anti-inflammatory functions of antibiotics, minimize the permeability of the vascular wall, and fight swelling. To increase the effect, drugs containing calcium and glucose are prescribed in combination.

This treatment protocol is used for patients with diabetes, since this approach minimizes the negative impact of concomitant disorders in the foci of infection and facilitates the recovery process.

General restorative therapy

As part of a general strengthening course, the patient is prescribed vitamin complexes (groups B, C), adaptogenic drugs, and stimulants.

In severe forms of the disease, extracorporeal detoxification is performed. For this purpose, hemosorption, plasmapherosis or lymphosorption are prescribed. Courses of autohemotherapy (administration of one’s own venous blood intramuscularly) have a positive effect.

Physiotherapy

Such treatment is allowed only after acute inflammatory symptoms have reduced, so manipulations are prescribed a few days after the start of therapy. The methods may be as follows:

• hardware treatment with UV rays;
• electrophoresis using anti-inflammatory and antibacterial drugs;
• massage;
• oxygenation;
• laser irradiation of the site of the extracted tooth.

Regardless of the course of the disease, the treatment protocol is determined only by the doctor, taking into account the physiological characteristics of the body.

Forecast and prevention of osteomyelitis of the jaw

If the patient sought medical help on time, followed the doctor’s recommendations and received the correct treatment in full, osteomyelitis will be successfully cured. Incorrect treatment in combination with a weakened immune system can lead to the following complications:

• sepsis;
• acute purulent inflammation;
• general intoxication;
• the formation of multiple abscesses;
• meningitis;
• inflammation of the facial nerves;
• bone deformities;
• purulent sinusitis and destruction of the walls of the maxillary sinuses;
• infection of the orbit and formation of phlegmon;
• jaw fractures.

To prevent osteomyelitis of the jaw, it is important to:

• Have dental checkups every year.
• Properly brush your teeth, maintain oral hygiene, and use interdental floss and rinses.
• Treat teeth and gums in a timely manner.
• Protect your jaw from injury.
• Strengthen immunity.
• Do not start treatment for infectious diseases, including tonsillitis and ARVI.