Osteomyelitis of the jaw - causes, symptoms, diagnosis and treatment

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.

Causes

The main reason for the development of osteomyelitis of the jaw is the penetration of highly pathogenic microorganisms into the bone tissue. Infection can occur in several ways:

Odontogenic way, when the source of the infectious agent is a tooth affected by caries. In this case, microorganisms first enter the pulp tissue, after which they spread through small lymphatic vessels or dental tubules to the bone tissue.
Hematogenously, when pathogenic microorganisms spread to the maxillofacial area through blood vessels from the primary source of infection. This role can be played by any infectious focus present in the body: acute or chronic tonsillitis, erysipelas or furunculosis. In addition, some specific infections can provoke osteomyelitis: typhus, scarlet fever or even the common flu.
Traumatically, when osteomyelitis occurs against the background of infection after a fracture or surgery on the jaw. It is most rarely seen in dentistry.

With the odontogenic route, the lower jaw is most often affected, and with the hematogenous route, the upper jaw is most often affected. If the infection occurs hematogenously, then the localization of the purulent focus will be deep in the bone tissue, and the phenomenon of periostitis will be minimal.

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.

Prevention

Preventive measures are not only the key to preventing the development of osteomyelitis, but also a factor that reduces the risk of complications and shortens the recovery period if the disease cannot be avoided:

Timely treatment of caries, even if it has no clinical manifestations.
Maintaining normal immune status through regular physical activity, rational and nutritious nutrition.
Sanitation of all chronic foci of infection in the body.
In case of injury, in the postoperative period or after tooth extraction, compliance with all preventive medical prescriptions.

In conclusion, it should be noted that, despite all the achievements of modern medicine, osteomyelitis of the jaw in adults and children does not lose its relevance. Timely detection of its signs and adequate treatment increase the patient’s chances of a full recovery and maintaining a high quality of life.
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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.

Classification of pathology

Depending on the method of infection, the following types are distinguished:

Hematogenous - bacteria spread through the circulatory system from other infectious foci. This path is typical for secondary osteomyelitis of the upper jaw, which develops against the background of another disease. This could be scarlet fever, purulent otitis media, tonsillitis, or diseases of the larynx. First, the infection affects the bone tissue of the jaw, and then only the teeth and gums.

Odontogenic – external route of infection. The cause is an infected pulp or tooth root. Predisposing factors include advanced dental diseases. These are pulpitis, periodontitis, the presence of cystic formations, alveolitis.
Traumatic – fractures and injuries of the jaw joint with damage to soft tissues and the presence of fragments of the dentition. Often occurs due to late seeking medical help.

According to the course and nature of the manifestation of symptoms, the pathology can be acute, subacute and chronic. Based on the area of distribution, local (limited) and diffuse (diffuse) forms are distinguished.

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.

Osteomyelitis of the upper jaw: symptoms and diagnosis

The disease develops slowly. The first symptom of a sluggish chronic inflammatory process is pain in the area of the damaged tooth.

The following manifestations are added:

as the infection spreads, the pain intensifies and covers the area of several teeth or the entire jaw;
swelling and redness of the gums;
tooth mobility;
local pain in the temple area, in the ear;
numbness of the chin;
difficulty swallowing and chewing;
speech disturbances due to numbness or burning of the jaw;
putrid odor from the mouth;
enlarged lymph nodes as a reaction to severe inflammation;
change in the shape of the face (swelling due to the pathological process).

Symptoms arise gradually in a chronic course.

Acute osteomyelitis of the lower jaw develops sharply. Accompanied by high body temperature and chills. If the outflow of purulent contents is disrupted, then purulent abscesses are formed, and the formation of perimaxillary phlegmon is possible. Such formations are dangerous and require surgical intervention. This dental pathology is often confused with another acute infectious disease - mumps (mumps).

Important! If your health suddenly deteriorates, you must call an ambulance.

On average, the acute period lasts 7–14 days. Then the symptoms subside and the subacute period begins. It occurs after the formation of a fistula to release pus from the source of infection. During this phase, the general condition improves, the pain becomes tolerable. But tooth mobility not only remains, but also gets worse. This leads to problems with chewing food and becomes a risk factor for the development of gastrointestinal diseases.

The subacute form often becomes chronic with a sluggish course that can last several months. The outcome is the rejection of all necrotic areas of bone tissue with the formation of sequesters (fragments of dead tissue). They are removed through the resulting fistula. This is a favorable outcome, which still requires examination and treatment by a specialist. However, the outflow of purulent contents is often difficult, which leads to damage to soft tissues, deformation of the jaw and the spread of the purulent process.

Which doctor should I contact: diagnosis of the disease

If you experience toothache of an unclear nature, as well as pathological changes in periodontal tissue, you should contact a dentist.

If necessary, he will refer you to a specialist - an orthodontist, surgeon or orthopedist.

The initial stage of the pathology may not yet be visualized using x-ray diagnostic methods. Therefore, collection and study of anamnesis and external examination are used.

The doctor pays attention to the following points:

Degree of tooth mobility.
Condition of the oral mucosa and gums.
The presence of a painful syndrome when tapping.

Since osteomyelitis is a purulent infectious process that affects many processes in the body, it is advisable to prescribe laboratory general blood and urine tests. Also, to accurately determine the type of pathogenic pathogen, bacterial culture of the purulent contents is carried out.

In advanced forms of the disease (chronic or subacute stage), changes in bone tissue are already significant and noticeable, so an X-ray or computed tomography of the jaw is recommended. Such methods help to see the formed areas of dead tissue (sequestra), as well as to understand how deeply the inflammatory process has spread.

If there is a fistula tract with purulent contents, biomaterial is taken for laboratory testing. This is necessary to exclude actinomycosis of the maxillofacial area.

Important! The acute form of osteomyelitis must be differentiated from similar pathologies: purulent periostitis, festering cyst, acute periodontitis. Therefore, the experience and professionalism of the doctor is important here.

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:

Undergo an initial examination of the jaw by a dentist. With osteomyelitis, tapping and palpating the affected areas will be painful.
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.
Take a general urine and blood test, a biochemical blood test, and bacteriological culture to identify the type of pathogenic microorganisms.
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.

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.

Consequences and rehabilitation after osteomyelitis of the jaw

The consequences of acute or chronic osteomyelitis of the jaw bone can be quite serious and significantly worsen a person’s quality of life.

Often, during the surgical treatment of such a pathology, it becomes necessary to remove not only the causative tooth, but also several others. This leads to the fact that in the future the person will need orthodontic treatment and prosthetics.
Extensive bone tissue defects can lead to jaw deformities, which is not only a cosmetic defect, but also significantly disrupts the normal functioning of the maxillofacial apparatus.
Damage to soft tissues often leads to scar deformation, which is also a serious cosmetic problem that needs to be solved with plastic surgery.
The spread of infection to the joint can provoke inflammation (arthritis) or arthrosis, which subsequently causes the development of ankylosis and a sharp limitation of jaw mobility.
The consequences of septic conditions against the background of osteomyelitis may also include disruption of the functioning of internal organs, hematopoietic processes and the functioning of the immune system.
Osteomyelitis affecting the upper jaw can spread to the zygomatic bone and even the orbit with the development of an abscess or phlegmon of the eyeball. This leads to complete loss of vision without the possibility of recovery.

Rehabilitation after suffering purulent inflammation of the oblique jaw sometimes continues for several years. All patients are subject to dispensary registration, from which they are removed only after correction of all violations that have arisen.

Rehabilitation measures include:

use of physiotherapeutic techniques;
if necessary, prosthetics for lost teeth;
repeated surgery for cosmetic or medical reasons;
prevention of recurrence of such pathology.