Flux is a common, non-medical name for a whole group of diseases that require immediate, and in some cases, emergency care. One of the main manifestations of flux is a violation of the shape of the face associated with a complication in an inflamed tooth.
The main groups of diseases that are commonly called flux: periodontitis, periostitis, osteomyelitis, abscess and phlegmon, lymphadenitis, odontogenic sinusitis.
Periodontitis
- inflammation of the tissues of the apical part of the tooth.
Periostitis
– inflammation of the periosteum in the area of the teeth.
Osteomyelitis
– inflammation of the jaw bone, which necessarily ends with necrosis (death) of the affected area of the bone.
Abscess
- This is a limited purulent inflammation of fatty tissue.
Phlegmon
- This is a diffuse purulent inflammation of fatty tissue.
Under the skin, under the mucous membrane, under and between the muscles there is fatty tissue. With an exacerbation of odontogenic infection, pus spreads under the periosteum, axillary and intermuscular spaces, causing inflammatory and edematous-infiltrative changes in the soft tissues of the face and neck.
Inflammatory diseases of the maxillofacial area (flux, abscess, phlegmon) and neck are divided into two main groups according to localization. The first is abscesses and phlegmons located near the upper jaw. The second is abscesses and phlegmons located near the lower jaw.
Lymphadenitis
– inflammation of the lymph node (group of lymph nodes) adjacent to the odontogenic (dental) focus of infection. Odontogenic sinusitis is often an inflammation of the maxillary (maxillary) sinus (sinusitis), caused by the anatomical features of the position of the roots of the maxillary teeth involved in the pathological process, in which the roots of the teeth either stand in the lumen of the maxillary sinus, or are located close to the bottom of the maxillary sinus. In this case, infection of the mucous membrane of the maxillary sinus occurs with the subsequent development of sinusitis.
Causes
Inflammatory (infectious-inflammatory) diseases of the maxillofacial area are caused by microbial microorganisms, which are usually part of the normal microflora of the oral cavity. Microbial pathogens are staphylococci, streptococci, enterococci, diplococci, gram-positive and gram-negative bacilli (intestinal, protea, etc.). In addition, during flux, fungi, mycoplasmas, treponema, and protozoa from the Trichomonas family are found in foci of odontogenic infection. According to various authors who analyzed the microbial flora in foci of odontogenic infection (flux), the microflora is represented by a monoculture of staphylococcus (aurus and epidermal) or streptococcus of groups D, F and G. Associations of the above microorganisms are often identified.
The question arises of how non-pathogenic or opportunistic microorganisms trigger the initiation of an infectious-inflammatory process (flux). For the occurrence of a disease, the presence of only non-pathogenic or pathogenic microorganisms is not enough. The answer to this question is given by the so-called Arthus-Sakharov phenomenon. According to the infectious-allergic theory, its essence boils down to the following: under the influence of a foreign serum protein, which has antigenic properties, antibodies are produced, which leads to sensitization of the body. Sensitization of the body is the acquisition by the body of increased sensitivity to foreign substances (proteins) - allergens. Against this background, repeated introduction of the protein into the vascular bed causes the formation of antigen + antibody complexes, which are fixed on the membranes of blood vessels and turn into target cells. Then the cell membrane is damaged, enzymes are released, mediators (from the Latin mediator - mediator) of inflammation are released. This is accompanied by activation of the third platelet factor and can cause intravascular coagulation, which leads to impaired microcirculation and necrosis (death) of tissue. This immunopathological reaction is also involved in odontogenic infection, leading to the occurrence of gumboil. The waste products of microbes participate in the role of antigen. This explains why in many patients non-pathogenic microorganisms are found at the site of inflammation.
The dynamic balance between the focus of chronic odontogenic infection and the body is ensured by the connective tissue capsule surrounding the focus. It limits the penetration of microbes into the tissues and vascular bed adjacent to the lesion, and limits the effect of immune factors on the infectious focus. The balance is also maintained by the fact that part of the waste products of microorganisms and tissue decay through the root canal of the tooth, fistula or periodontal fissure is released from the infectious focus into the oral cavity.
An imbalance can be caused by a disruption in the outflow of exudate from the lesion through the root canal due to food masses entering the carious cavity or when filling a carious cavity by a dentist. In the infectious focus, the concentration of microbes, their toxins, and waste products, which penetrate through the connective tissue capsule into the surrounding tissues, increases. Here their direct damaging effect on tissue can occur, and upon penetration into the vascular bed, the mechanism of the Arthus-Sakharov phenomenon is triggered. Clinically, this is manifested by an exacerbation of a chronic focus of odontogenic infection and the occurrence of gumboil.
Another mechanism of imbalance between the focus of chronic infection and the human body is associated with damage to the connective tissue capsule itself. This can happen when a tooth is removed, when there is increased load on the tooth while chewing hard food, etc. Damage to the capsule leads to the spread of microorganisms (their toxins, waste products) beyond the infectious focus, which in a sensitized organism leads to the occurrence of the Arthus-Sakharov phenomenon. These are the reasons and the main mechanism of exacerbation of odontogenic infection, leading to the development of gumboil.
Why is a dental cyst dangerous?
Despite the fact that being the result of a positive struggle of the body and a reaction to negative processes, reduced immunity, a dental cyst can lead to serious side effects and cause complications. The most dangerous and common of them:
- Flux is the concentration of a purulent process in the periosteal jaw area under the gum. A type of complex disease externally manifests itself in the form of a tumor, and a sharp throbbing pain is felt.
- Periodontitis is an advanced form of a purulent cyst that provokes the spread of infection to bone tissue.
- Tooth loss. A side effect that occurs extremely rarely, but occurs if the patient does not consult a dentist in a timely manner and does not receive drug treatment. The damaging effect extends to nearby hard areas of bone tissue, and there is a danger of losing several adjacent teeth.
Possible more complex exacerbations and consequences:
- inflammation of the lymph nodes;
- purulent abscess;
- fracture of the jaw due to decay of bone tissue and its complete destruction in a certain area;
- sepsis and osteomyelitis.
Even with minor signs of a dental cyst, treatment should be started. The sooner you see a dentist with a problem, the greater the chance of a complete recovery. While maintaining oral hygiene, make regular appointments with your dentist, and do not neglect the importance of medical examinations. You will not have to deal with the consequences of a dental cyst, since a qualified doctor will be able to recognize it at the initial stage. Take good care of your mouth at home and follow your dentist's advice.
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Symptoms
The main manifestations of gumboil disease are pain in the area of the causative tooth and the appearance of swelling in the soft tissues of the face. If at the beginning of the disease the swelling is mild, then as the process progresses the swelling increases and can spread to the eye area, scalp or neck. As the symptoms of flux increase, pus from under the periosteum can spread through the fatty spaces closer to the skin - this is manifested by the fact that the skin turns red, becomes dense and hot to the touch. Further, the skin in the center of the flux softens, becomes thinner, and a fistula with purulent discharge may appear. In this case, pain may decrease somewhat, which is associated with a decrease in pressure in the flux cavity during the formation of a fistula tract.
In addition to pain, symptoms such as limited mouth opening or inability to open the mouth, and pain when swallowing may occur. If the flux is located deeply, facial swelling may be mild or not expressed at all, and the main manifestations will be limitations in mouth opening, pain in the flux area and pain when swallowing.
What is flux?
Purulent inflammation of the tooth root is called gumboil. It is formed as a result of advanced caries or its complications, dental injuries or an inflamed pocket between the gum and tooth. A damaged tooth accumulates food debris that is not easily removed by regular brushing with a toothbrush. Under the influence of microorganisms they begin to rot. The accumulated pus seeks a way out and spreads through the dental canal. An obstacle in its path may be the periosteum or the lower jaw. As a result of stagnation, it collects in one place, forming an inflammatory process in this localization. Patients complain of significant swelling in the mouth and face, pain, and also note an increase in body temperature.
It is strictly prohibited to treat flux yourself at home, since the purulent focus can burst and form a fistula. Pus can enter the meninges or blood, which can lead to the development of sepsis. Treatment of this disease should be carried out by a dentist after examination and diagnosis. Only a qualified specialist can choose the most optimal method.
Diagnostics
To diagnose flux, methods such as questioning, examination, and additional research methods are used: radiography, ultrasound, computed tomography, magnetic resonance imaging, blood test data, culture of exudate, etc. An experienced maxillofacial surgeon who treats patients with flux, can, based on the patient’s complaints and examination, carry out an accurate topical diagnosis of the disease (localization of pus) and select the optimal surgical approach to ensure sanitation of the purulent focus and adequate drainage.
Why does swelling occur after dental implantation?
In general, swelling is a completely normal reaction of the body to injuries. All this is nothing more than an influx of lymph to damaged tissues (i.e., accumulation of fluid in a certain area). This way the body’s natural defenses are activated. Swelling forms within 2-3 days - it reaches its peak on the third day after surgery. After this, the swelling of the tissues should gradually decrease and disappear completely within a week.
When installing classic two-piece implants, when the flap method with gum peeling is used, the likelihood of tissue swelling is much higher. Patients with pathologies of the cardiovascular system and diabetes mellitus are also at risk.
Treatment
Treatment for flux can be boiled down to a catchphrase in Latin: “Ubi pus, ibi incision,” which translates as “Where there is pus, there is an incision.” Treatment of flux begins with eliminating the cause that caused the flux. That is, from the removal of the causative tooth. Next, they begin to drain (empty) the purulent focus by opening (incision) in the area of the flux. The abscess is emptied, the abscess cavity is washed with antiseptic solutions, and drainage is installed through which pus will be released. Regardless of the type of flux, the principle of treatment remains the same: opening the lesion, drainage.
In the postoperative period, daily antiseptic treatment (washing) with antiseptic solutions is carried out. There is a peculiarity in the treatment of these diseases (flux, periostitis, phlegmon, etc.), which is that immediately after surgery and up to 1-2 days, facial swelling (flux) may increase. This should not be taken as a worsening of the disease. The fact is that any surgical intervention is perceived by the body as an injury, and the body responds to this by increasing tissue swelling in the area of injury. This may be accompanied by increased swelling of the eyelids, cheeks, etc. Painful sensations decrease and subsequently decline as acute inflammatory phenomena subside. As a rule, antibacterial drugs, antihistamines and painkillers are prescribed after surgery.
If there is an advanced case of flux, which is accompanied by a violation of the function of external respiration (the patient may suffocate), then hormonal drugs are prescribed, and even an operation is performed - a tracheotomy. The operation consists of making an incision in the area of the tracheal rings and installing a tube. As the swelling of the upper respiratory tract (pharynx, larynx) decreases, when the threat of asphyxia (suffocation) has passed, the tube is removed from the trachea, and the patient breathes through the natural airways. The duration of prescription of drugs is determined by the attending physician. The drainage in the wound is periodically changed, and the wound is removed when cleansed. The duration of drainage in the wound is also determined by the attending physician, based on the clinical picture of the disease. The drainage can remain in the wound for an average of 3 to 10 days.
If the incision for flux was made through the oral mucosa, then additional suturing of the wound is not required in the future. The wound in the oral cavity will heal on its own (by secondary intention). If the incisions were on the skin side, then after the acute inflammatory processes have subsided, the wound can be sutured. After suturing the wound (and this can be 2-4 weeks after surgery), the patient is also prescribed antibacterial drugs and painkillers, and the wound is drained.
With inadequate treatment, as well as in advanced cases of flux, complications such as suffocation, penetration of infection into the cranial cavity, onto the membranes of the brain, into the neck and into the mediastinum (part of the chest cavity where vital organs are located), penetration into the orbital cavity with damage to the optic nerve and the occurrence of a systemic inflammatory reaction (sepsis), which leads to multiple organ failure and even death.
Soft tissue incisions, which are used in the surgical treatment of flux, must ensure complete sanitation of the purulent focus and adequate drainage. Surgical treatment should not be replaced by the prescription of strong antibacterial drugs. Waiting tactics, delays in performing surgery, and small incisions that do not provide adequate drainage of the purulent focus are unacceptable. We must not forget that surgery for a purulent process in the maxillofacial area and neck is often an operation to save the patient’s life. The occurrence of complications is more likely when the patient has concomitant chronic diseases: diabetes mellitus, coronary heart disease, anemia, diabetes mellitus and others. Elderly and senile age are also factors that can aggravate the course of this disease.
Types of dental cysts
A molar cyst is distinguished by several characteristics:
- depending on the reasons for the appearance;
- according to location.
Distributing according to the reasons that provoke the appearance of a dental cyst, the following varieties are distinguished:
- A keratocyst appears on the lower jaw. Older people are susceptible to the disease. It can turn into a malignant form - it grows deeply into the body and destroys the bone.
- Odontogenic or radicular dental cyst is the most common type. After periapical inflammation and necrosis of the pulp, a granuloma of the dental root is formed in the upper part. The size of the purulent focus ranges from 3 mm to 3 cm. The process does not affect bone tissue and does not provoke tooth displacement.
- A cyst that forms at the site of teething is a retention cyst. It appears during the period of replacement of milk teeth with molars. A purulent fistula with bloody contents looks like a dark blue abscess. Education is formed if the process of eruption is slow. The purulent contents of the abscess should be opened and cleaned out.
- A calcifying odontogenic tumor occurs in the area of the support of the lower jaw. Experts do not have a consensus on the reasons for its formation - they have not yet been fully studied.
- A residual formation with pus occurs after tooth extraction as a result of careless work by the doctor. If a piece of root or a fragment of a tooth remains in the wound, a granuloma forms.
- A follicular cyst forms in place of soft tissues that resist the eruption of a new tooth. A cyst grows around a tooth hidden by the gum, enlarges and can spread to other teeth. The result of the development of a cyst can be tilting, tooth displacement or root resorption.
- A lateral periodontal cyst looks like a small formation, most often found on the lateral part of the root.
Depending on the location of the purulent tumor, there are:
- A cyst is formed on a tooth root. Three location options: basal, inter-root or peri-root zones. When a purulent capsule forms, the disease manifests itself well.
- The purulent focus is located in the maxillary sinus. Making a diagnosis is extremely complicated - you cannot do without an image of a certain area. In the advanced phase, the cyst provokes the appearance of sinusitis.
- At the initial stage, a cyst on the gum is asymptomatic. At the moment of filling with purulent contents, the bubble begins to grow rapidly. In treatment, medications are used, and they are also fought by puncturing the capsule, treating with saline solution and cleaning until complete healing.
- The formation of a cyst under the tooth crown occurs after unsuccessful disinfection during its installation after treatment. As a result of a loose fit, food debris gets under the crown, rots and creates a favorable environment for cyst growth. To treat it, you need to remove the crown.
- A cyst on the front teeth has practically no room for development and localization. It comes out at the initial stage of development.
- A wisdom tooth cyst forms at the site of a long-erupting “figure eight.” As a treatment for this category of teeth, a proven effective method is recommended - removal of the cyst and wisdom tooth together.
