Surgical treatment of periostitis. Periostitis of the jaw: what is it and how to treat it

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Dentistry defines odontogenic periostitis as acute inflammation of the periosteum of the alveolar process of the upper jaw or the alveolar part of the lower jaw. The disease is of odontogenic origin, that is, it is caused by a diseased tooth. As a rule, periostitis is a complication of periodontitis not treated in time. Less commonly, the infection enters the jaws through blood vessels from other areas of inflammation. Odontogenic periostitis has unpleasant symptoms (one of them is severe toothache), the elimination of which requires surgical treatment.

Usually the disease begins in the inner or outer layer of the periosteum, but due to the close connection between it and the jaw bone, the inflammatory process easily passes from one tissue to another, causing osteoperiostitis. There are acute periostitis, which in turn is divided into serous, purulent and chronic. The inflammatory process can be either limited or diffuse purulent, when the inflammation spreads to the body of the jaw.

Acute serous periostitis

The development of periostitis in the acute serous form occurs within 1 to 3 days and is manifested by swelling of the soft tissues. Its localization depends on the location of the causative tooth, and its size depends on the structure of the vessels of the periosteum. This form of the disease can develop after a bruise or fracture (traumatic, post-traumatic periostitis). The inflammatory process, as a rule, quickly subsides, but sometimes it can lead to fibrous growths or the deposition of calcium salts and new bone formation (ossifying periostitis).

Acute purulent periostitis

Acute purulent periostitis is manifested by severe and sometimes throbbing pain. Pain can spread to the ear, temple and eye. It is also worth noting that heat intensifies toothache, and cold, on the contrary, soothes. Swelling and redness of the mucous membrane occurs. The disease may be accompanied by elevated temperature (38 – 38.5 0 C). As pus accumulates, the symptoms of acute purulent periostitis intensify. The causes of the disease, in addition to dental problems, can be open fractures and other injuries.

Diffuse acute periostitis

Diffuse acute periostitis is manifested by severe toothache and symptoms of general intoxication. The body temperature rises to 37 - 38 0 C, the person feels general malaise and loses appetite. Moreover, periostitis of the lower jaw is more complicated than periostitis of the upper jaw. The localization of the inflammatory process depends on the affected tooth:

Upper incisors – the upper lip and part of the nose swell.
Upper canines and premolars - pus accumulates in the periosteum.
Molars - inflammation occurs in the upper part of the cheek closer to the cheekbones and ears.
Premolars – swelling is located in the lower part of the cheek.

Chronic periostitis

This form of periostitis is less common than others. Chronic periostitis most often develops in the periosteum of the lower jaw and is characterized by a local inflammatory reaction in the form of dense edema, which does not significantly change facial features. At the site of inflammation, the bone thickens and the lymph nodes enlarge. At the same time, the oral mucosa may become swollen and red. Chronic periostitis does not go away for a long time and can develop over 4–8 months, and sometimes several years, making itself felt with periodic exacerbations.

How to treat periostitis?

Odontogenic periostitis involves various treatments, the type of which depends on the severity of the disease and the process of its progression. In the case of acute serous periostitis, it is enough to remove the nerve of the tooth and wash the opened wound with solutions of antiseptics and antibiotics. If there is acute purulent periostitis, treatment is supplemented with physiotherapy. In cases where periostitis requires active anti-inflammatory therapy, the patient is prescribed antibiotics. In case of chronic periostitis, the diseased tooth is usually removed.

General treatment of periostitis involves the prescription of antibacterial and anti-allergic drugs, as well as strengthening agents in the form of calcium and vitamins. With timely treatment, recovery occurs within 3–5 days. Without medical assistance, periostitis can provoke the formation of a fistula on the gum or the penetration of pus into the surrounding tissues with the development of an abscess or phlegmon, which is most dangerous for the patient.

Periostitis is a dangerous disease that threatens with serious consequences not only for your teeth and gums, but also for the entire body. At the first signs of periostitis, you should immediately contact a dental clinic and begin treatment. To prevent the disease, maintain oral hygiene and visit the dentist regularly.

Periostitis (flux)– inflammation developing in the periosteum of the alveolar process. The disease is infectious in nature and is a complication of caries, pulpitis, periodontitis, periodontitis.

Briefly about the disease

To learn more about the pathology of periostitis, you need to get acquainted with anatomical features dentofacial apparatus.

The crown of the tooth has protective hard tissues - enamel and dentin. The outer shell reliably protects the internal vulnerable fibers from aggressive environmental factors and pathogenic microorganisms.

Caries leads to the destruction of enamel and dentin, weakening natural protective mechanisms. When infection penetrates the neurovascular fiber located in the root canals, acute pulpitis occurs. Without timely treatment, the nerve dies, decay products remain in the root canal. The pathological process involves the membranes of the roots of the tooth and adjacent tissues, and acute periodontitis is formed.

The penetration of infection into the periosteum and the development of an acute process in it causes periostitis. The inflammatory focus is located in closed space, has no contact with the environment. As they reproduce anaerobic bacteria and disintegration of the affected tissues, inflammation increases, and swelling of the gums appears. Within a few hours the swelling may spread to soft fabrics face (lips, nose, cheeks, neck) causing facial asymmetry.

Causes of periostitis

Toothache of any intensity indicates the presence of an inflammatory process. Often, people ignore discomfort in the oral cavity and put off visiting the dentist. As a result, minor inflammation increases and leads to dangerous complications.

Periostitis is a consequence of one of the dental diseases:

Caries– damage to hard dental tissues. There are several stages of the disease. At the initial stages, the enamel is destroyed, followed by dentin. Primary symptoms of pathology: change in enamel color, appearance of pigmentation, roughness, lack of shine and smoothness of the tooth. With medium and deep caries, dentin is involved in the pathological process, a cavity is formed, and pain symptoms appear. Treatment of initial and intermediate caries is carried out in 1 visit and is not a very expensive procedure. Detection of the disease at the stage of formation, and timely treatment helps prevent the development of more serious pathologies, allows the patient to maintain health and budget;
Pulpitis– inflammation of the neurovascular bundle of the tooth. Occurs with medium and deep caries, with damage to enamel and dentin. The diagnosis is established on the basis of a visual examination (probing, caries test, percussion, cold test), x-rays. Great importance is given to interviewing the patient. A person complains of pain in the area of the affected tooth, which intensifies in the evening and at night. The unpleasant sensations are constant and do not depend on external influences. After taking analgesics, the pain is dulled for a short time. With chronic pulpitis, pain is periodic and of moderate intensity.
Treatment of pulpitis consists of removing the affected tissue, antiseptic treatment of the dental canals, and their high-quality filling. After endodontic intervention, the tooth crown is restored with filling material. If healthy tissue is severely damaged, the issue of orthopedic treatment is decided (installation of an inlay, pin, crown);
Periodontitis– inflammation of the tooth root membrane and surrounding tissues. The disease is a complication of caries or pulpitis, and can occur as a result of injury. Poorly performed dental treatment can also lead to the development of inflammation. The symptoms of periodontitis and periostitis are similar: pain when biting, increasing intensity, swelling in the area of the affected tooth, disturbance in general well-being.
Treatment of the disease consists of removing tissues affected by caries, opening infected root canals, and treating them with antiseptic. After eliminating the source of infection, the root canals are filled with medicinal paste. If the dynamics are positive, the canals are permanently filled and the tooth crown is formed;
Periodontitis– inflammation of periodontal tissues. In advanced forms of the disease, deep gum pockets form. Bacterial contents accumulate in the cavities, contributing to the occurrence of purulent-inflammatory processes.
Periodontitis is treated by a periodontist. At the initial stage of the fight against the disease, professional hygienic teeth cleaning is carried out, and the issue of surgical intervention is decided. After removing soft and hard plaque, the patient is treated with antibiotics, rinses his mouth with antiseptic solutions, and treats the mucous membranes with wound-healing preparations.

Periostitis can occur as a result of injury or previous infectious disease(lymphogenous, hematogenous route), after removal of a diseased tooth.

You can learn about the causes and symptoms of periostitis from the video:

Endodontic treatment of pulpitis, periodontitis and periostitis should be carried out by an experienced dentist. Diagnoses are made on the basis of x-rays. After therapy, a control x-ray is required. During treatment, sterility is maintained and a special cofferdam is used. The doctor is assisted in his work by modern equipment – a dental microscope.

Symptoms

Periostitis rarely appears suddenly; most often it is preceded by one of the dental diseases. When questioned, patients confirm that they knew about the presence of a deep carious cavity, but could not find the time to treat it.

The asymmetry of the face with flux can be seen in the photo:

The main symptoms of periostitis:

Pain when biting or tapping of varying intensity. At the initial stage of the disease, people experience minor discomfort. As inflammation increases, the pain becomes constant and unbearable.
Tissue swelling, facial asymmetry. Initially, a slight swelling appears on the gum. Gradually, the pathological formation increases in size. If the cause of the development of periostitis is a tooth in the lower jaw, the lower lip, cheek, and neck swell. With the development of inflammation in the upper jaw, the upper lip, cheek, and wings of the nose swell.
Numbness of the tongue, jaw, lips, wings of the nose.
Having a diseased tooth. Upon examination, carious tissue damage is detected, or the patient indicates that endodontic treatment of an incisor, canine or molar was carried out in the past.
Decreased general health. There is an increase in body temperature, weakness, lack of appetite, sleep disturbance, and headaches.
Enlarged cervical lymph nodes.
The formation of a fistula (exit hole in the gum) is not a mandatory symptom.

The nasal sinuses are located on the upper jaw. In the absence of timely treatment, flux can be complicated by acute sinusitis.

Classification of the disease

Depending on the duration of the course, acute and chronic periostitis are distinguished. An acute disease develops over several hours and is accompanied by severe symptoms. Chronic flux occurs over a long period of time, has phases of remission and complications, contributes to the deterioration of the overall health of the body, and can lead to the development of osteomyelitis of the jaw.

Types of flux:

odontogenic – the infection penetrates the periosteum through the diseased tooth;
traumatic – inflammation occurs as a result of a previous injury;
hematogenous - bacteria enter the periosteum through the bloodstream;
lymphogenous - the infection penetrates the periosteum through the lymphatic tract.

The infection can be limited and diffuse (spread to the tissues of the entire jaw). Depending on the component of the exudate, purulent and serous periostitis are distinguished.

The diagnosis of periostitis is established based on a number of components:

External examination of the oral cavity. Percussion, probing, cold test, caries test.
Detection of swelling of the gums and soft tissues.
Interviewing the patient, taking a history of the disease.
X-ray images. The images reveal signs of granulating periodontitis and radicular cysts.

If necessary, the doctor prescribes laboratory blood tests.

Flux must be differentiated from acute or chronic periodontitis, osteomyelitis, jaw abscess, malignant or benign neoplasms.

Treatment

The main task of the doctor during periostitis is to open the infectious focus and release the accumulated exudate.

General tactics of a dental therapist for odontogenic periostitis:

anesthesia with local anesthetic;
elimination of affected tissues;
root canal cleaning;
antiseptic treatment of cavities.

After the manipulations, the tooth remains open. If there is severe swelling, the dental surgeon will open the source of infection and install a special drainage.

Treatment of dental periostitis surgically can be seen in the video:

For 5-10 days, as prescribed by the doctor, the patient takes antibiotics and performs antiseptic rinses. The effectiveness of treatment is assessed based on the patient’s well-being, the dynamics of external manifestations, and x-rays.

Question answer

At what age can flux occur?

Periostitis affects men and women with equal frequency. Children and the elderly are at risk because they have a reactive course of the disease.

Is it possible to get rid of flux yourself?

No. Dental diseases should be treated by a doctor. Independent use medications and attempts to eliminate the disease will not lead to success, but will end in sad complications.

Periostitis is commonly called an infectious-inflammatory process of the jaw, which entails severe inflammation of the periosteum. Periostitis of the jaw is far from a rare phenomenon, and as dentistry says, it occurs in approximately 5% of people who are undergoing treatment, and in 90% of cases these are people with a strong inflammatory process, and the remaining 5% are patients with a chronic course of the disease.

Due to the accumulation of pus between the bone and periosteum, periostitis causes severe pain, fever, weakness, disrupts sleep, and is also accompanied by swelling.

Initially, periostitis forms at the root of the tooth, affecting the pulp, while the person may not even feel pain, which is the most dangerous thing about this disease. A person begins to experience serious inflammation and, accordingly, severe pain when pus accumulates under the periosteum itself. If you do not consult a doctor in time, periostitis begins to cover the soft tissues, causing inflammation of the gums, and as a result, gumboil is formed. In addition, this disease can lead to blood poisoning and other dangerous complications.

It must be remembered that self-medication for periostitis is prohibited; only dentistry can help with this disease.

Periostitis of the upper jaw, as well as mandibular periostitis, is characterized by pain that can suddenly appear and then disappear again.

Oddly enough, dentistry calls common reasons diseases: human hypothermia, stress and early existing diseases and injuries.

Diagnosis of periostitis

To diagnose and determine treatment methods for periostitis, doctors prescribe x-rays of problem areas of the jaw, which helps assess the condition of the tooth roots. In addition, dentistry will prescribe an in-depth analysis of the oral cavity to determine an accurate diagnosis, since along with periostitis there are a number of other inflammatory diseases that are similar in their symptoms.

Periostitis of the jaw is divided into the following types:

Acute periostitis of the jaw, characterized by sharp, acute pain and the formation of pus. Acute periostitis, in turn, happens:

serous periostitis, the development of which is promoted by apical periostitis. It manifests itself as moderate pain and a slight rise in temperature. It can also be recognized by the gums turning red;
purulent periostitis, in which the patient feels severe throbbing pain, requiring immediate attention to the dentist. Purulent periostitis can be recognized due to severe swelling of the face, accompanied by high temperature and general malaise.

Chronic periostitis has periodic symptoms with temporary outbreaks of exacerbation.

Infectious periostitis, which appears due to the influence of microorganisms.

Traumatic periodontitis occurs due to dental trauma, surgery, jaw fractures, etc.

Periostitis is also classified based on its location in the periosteum:

Odontogenic periostitis, characterized by a disease of a specific tooth.
Hematogenous periostitis is characterized by infection through entry into the blood vessels.
Lymphogenic periostitis accordingly characterizes the spread to the lymph nodes.
Traumatic periostitis is damage to the periosteum due to injury.

Symptoms of periostitis are:

Signs of periostitis vary according to the forms of the disease. The development of this disease may be influenced by previous diseases of the dental cavity, condition immune system person, etc.

Periostitis of the lower jaw

Periostitis is common. Swollen soft tissues, pain, fever - all these are symptoms of this disease. With periostitis of the lower jaw, pain does not occur immediately; it has, so to speak, a cumulative nature. The pain may gradually begin to radiate to the temporal lobe or ear.
Periostitis in children is mainly a consequence of caries or pulpitis. Infection in children occurs through the lymphatic or circulatory systems. Among the signs of periostitis in children, dentistry also includes swelling of soft tissues and constantly increasing headache. If prompt medical assistance is not provided, purulent periostitis may form on the neck or in the area of the eyes and teeth. In addition, toothache gets worse and worse, and pain-free intervals get shorter.

Periostitis can appear in both adults and children. In children, this process occurs less frequently, since in adults the inflammatory process is a consequence of periodontitis, the treatment of which was untimely.

Purulent periostitis in children in most cases is formed due to advanced caries, which is widespread among them. Caries is dangerous because it can form on invisible areas of the teeth with no pain until the bacteria enter the pulp.
You need to understand the danger of such an inflammatory process as periostitis, since children tolerate pain much worse than adults, which is why symptoms appear faster. At the first symptoms, it is necessary to promptly take the child to the dentist, because periostitis is a serious inflammatory process that cannot be treated at home. An infection that is not eliminated in time can enter the child’s blood, muscle and bone tissues, disrupting his immune system.
Do not self-medicate under any circumstances! In addition, remember that during periostitis, it is prohibited to apply warm compresses, since warming only enhances the process of spreading bacteria, which can lead to infection in new, not yet infected areas.
It is also important to set an example for your children and teach them to properly care for their oral cavity: brush their teeth twice a day, use rinses, dental floss, and visit the dentist every six months so that he can eliminate any problems that have arisen.

Treatment of periostitis will vary depending on the forms and severity of the disease. When treating acute serous periostitis, you will most likely be asked to remove the nerve and do an antibiotic flush. When treating acute purulent periostitis, doctors often prescribe physiotherapy followed by antibiotics. If the disease is chronic, the tooth may have to be removed.
If you visit your doctor in a timely manner, you may be prescribed medications that contain calcium and vitamins. In this case, treatment will not take more than four or five days. If medical care is delayed, the pus can spread and develop into an abscess or other serious diseases. For purulent periostitis, dentistry mainly resorts to surgical intervention. The operation is performed under local anesthesia. In addition, during the postoperative period, doctors recommend taking antibiotics, diet, rinsing, etc.

When treating periostitis of the lower jaw during surgical intervention, dissection of the periosteum is used, which is carried out in the following way:

To exclude infection of healthy teeth, based on the results of the x-ray, the doctor decides on the advisability of saving the tooth.

Physiotherapy

Doctors often prescribe physical therapy, which helps relieve pain and prevents infections from spreading to nearby soft tissues.

A course of physical therapy is usually prescribed the day after surgery.

Main types of physiotherapy:

Periostitis is not a simple disease, so in order to avoid complications it is necessary to consult a doctor in a timely manner.

However, with the help folk remedies You can remove one or another symptom for a while:

a solution of salt and soda. Rinsing with a solution of salt and soda will help you relieve swelling a little and dull the pain;
chamomile, calendula, sage will cope perfectly with inflammatory processes;
A compress (cold) can also help eliminate swelling and relieve pain for a short time.

In order not to harm the body, it is prohibited to use drugs without a doctor’s instructions, especially antibiotics.

The lack of comprehensive treatment for periostitis of the lower jaw can lead to diseases such as sepsis, abscess, and osteomyelitis.

Prevention of periostitis of the lower jaw

As is already known, periostitis is a serious disease that cannot be delayed, since it can develop into more complex diseases, the treatment of which will require additional time and nerves.

Therefore, I propose to consider measures to prevent periostitis of the lower jaw:

need to be implemented daily care behind the oral cavity;
You need to brush your teeth twice a day;
for bleeding gums, use various types of rinses;
visit the dentist at least twice a year, taking into account compliance with all rules and recommendations;
promptly remove tartar, treat caries and eliminate other dental problems;
categorically refuse self-medication for serious illnesses.

To summarize, we can emphasize that periostitis of the jaw is a fairly common disease, and in most cases it appears due to infectious diseases.

With proper and, most importantly, timely treatment, the patient will be healthy within five days. If this type of disease is neglected and appropriate measures are not taken, purulent periostitis may form, and then surgical intervention cannot be avoided.

To prevent disease, experts strongly recommend spending more time on oral hygiene, treating various diseases in a timely manner, preventing them from becoming chronic.

Serious dental diseases that remain untreated lead to the onset and development of an inflammatory process in the periosteum. A new disease arises, which is called periostitis or popularly.

Periostitis occurs in the periosteum, the very thin connective tissue that covers the surface of the bone. Under the influence of the inflammatory process, the named tissue thickens and then peels off. A space forms between the bone and the periosteum in which serous fluid or pus accumulates. The disease torments with its severe, completely unbearable pain, poor health and high body temperature (more than 39°).

The infection enters the tooth cavity through the apex of its root, entering the periodontal tissue. Then inflammation affects the periosteum.

Periostitis may appear due to:

The beginning of purulent processes in the roots of the teeth.
Infection occurs in the inner layers.
Bacteria enter the tissue through a wound, which often appears after tooth extraction.

What can you notice right away? Periostitis can be identified by swelling of the cheek. Swelling occurs due to pus that has accumulated inside. Cheek swelling itself can exist in different ways, regardless of which jaw it develops on.

On the face you can see swelling of the lower edge of the eye, the wing of the nose and the cheek. This is how maxillary periostitis manifests itself. This type of disease is very dangerous due to the transition of the inflammatory process to the sinuses of the bone.

But periostitis is more common in the lower jaw. Under its influence, swelling of the jaw angle or the space under the jaw is formed.

Note that periostitis is not an independent disease. It appears due to untreated less severe diseases.

A pathogenic infection is unlikely to penetrate through healthy tissue. Infection occurs due to lack of hygiene. And also if a microscopic wound appears in the oral cavity, microbes quickly enter it and begin to infect the tissue.

This dangerous disease can occur at any age. However, children are least susceptible to it. Since periostitis often becomes a subsequent complication after periodontitis, which was not cured on time.

The disease is provoked by:

Poor nutrition.
Drinking alcohol.
Lack of regular hygiene.
A bad habit is smoking.
Chronic diseases that a person does not intend to treat.
Herpes infection.

Symptoms of the disease

Periostitis is indicated at the very beginning by the appearance of a tumor.

The pain radiates to the temple, eye and ear.
The more swelling becomes, the more pain is felt.
Gradually the body temperature rises.
If the disease develops in the upper jaw, noticeable swelling appears under the eye.
If the inflammatory process takes place on the lower jaw, then under it.
In case of an abscess, the cheek and lips swell.

In a complicated situation, a fistula tract may form through which pus penetrates. The serous substance itself spreads very quickly throughout the tissue.

How not to confuse periostitis with other diseases

Similar symptoms appear when:

Periodontitis. It also causes inflammation of the tooth root. The inflammatory process begins to progress even more over time. At the stage of exacerbation, pus breaks out through the fistulous tract.
Osteomyelitis. The disease causes general intoxication. The person feels lethargic and tired. body temperature is far from normal. The patient constantly feels a headache. The named disease is usually a consequence of periostitis, which was not treated in time.
Diseases that are accompanied by dense formations. Periostitis softens the mucous membrane and causes swelling of the face.
. Here the infection itself comes not from the diseased tooth, but from the salivary passages.

Causes of the disease

Periostitis does not appear out of nowhere. The disease is a consequence of other dental diseases:

Periodontitis.
Jaw cyst with pus.
Periodontitis.
Inflammatory process in wisdom teeth.

The appearance of the disease is facilitated by:

Injuries suffered.
Infections of soft facial tissues.
Poor quality surgical interventions.
Open jaw fractures.

Dentists say that the disease occurs against the background of:

Purulent wounds that lead to the rapid spread of infection.
An inflammatory process in the teeth that remains untreated for a long time.

In children, periostitis occurs against the background of diseases:

Tonsillitis.
Scarlet fever.
Measles.
Angina
Flu.
ARVI.

Classification of periostitis

Depending on the nature of the flow, it can be:

Spicy.
Chronic.

Acute is purulent or serous, and chronic is ossifying and simple.

Acute serous is obtained as a result of infiltration of the periosteum and accumulation of serous exudate in a small amount at the site. This flux occurs along with a subperiosteal abscess and formed fistulas.

The chronic form occurs after experiencing an acute one. In it, all processes begin to proceed rather sluggishly. Typically, in such a situation, young tissue forms on the surface of the jawbone. Simple form chronic periostitis indicates that the process of bone tissue formation is reversible. But with ossifying periostitis, hyperostosis and ossification begin quite quickly.

Depending on how the infection penetrates into the periosteum area, periostitis occurs:

Odontogenic: occurs due to dental disease.
Traumatic: Occurs when the periosteum is damaged by trauma.
Lymphogenic: occurs when the infectious process travels through the lymphatic tract.
Hematogenous: Occurs when a dangerous infection spreads through the blood.

Depending on the area of distribution, periostitis can be:

Limited (distributed in the area of one or several teeth).
Diffuse (spreads over the entire jaw).

Depending on the direct factors of the disease, periostitis occurs:

Toxic (when an infection gets into the mouth).
Specific (when periostitis appears due to severe pathological processes).
Inflammatory (when the disease arose against the background of dental pathologies).
Traumatic (when gumboil was the result of injury).

Diagnostics

With odontogenic periostitis, you can see a destroyed tooth crown in the mouth, which serves as a source of inflammation. It usually contains a carious cavity and canals that are filled with decay products. If you bite this place, the patient will feel pain.

X-rays cannot show the acute form of the disease. However, it will provide information about the exact disease in periodontitis, cyst formation, etc.

Treatment

At the very beginning of the disease (at the serous stage), you can get rid of periostitis without surgical intervention. To do this, the canals are cleaned of pus. You may also need drainage, which will allow the purulent contents to spontaneously drain.

In case of serious indications, complete removal of the diseased tooth will be required. It is impossible to carry out such treatment without anesthesia.

The gums are numbed, then the medicine is injected orally. In this case, it should go along the line of the incision itself and not get into the area where the pus is located. After the abscess is opened, the doctor tells the patient that it is necessary to rinse the mouth with the prepared bicarbonate solution or manganese solution.

Sequence of periosteum dissection

First, anesthesia is administered. This is anesthesia of the inflamed area with the help of drugs and articaine. In case of severe suppuration, the anesthetic does not act at full power, since the lesion contains an acidic environment, which neutralizes the active substance of the anesthetic drug.
Periostotomy is an incision along the transitional fold. It allows you to capture the periosteum, from which pus will then flow out.
Drainage. At the time of this procedure, a glove band is placed in the inflamed area, with the help of which the outflow of pus is carried out.

The decision to permanently remove the tooth, of course, is made only by the doctor. He looks at the indications, functionality of the tooth and its aesthetics. If a decision was suddenly made to save a tooth, it will definitely require careful treatment to remove accumulated pus and be of good quality.

If the pus has been removed, then on the second day it would be good to carry out physiotherapeutic procedures. These include: laser therapy, light-thermal treatment, rinsing with antiseptics, applying sea buckthorn oil dressings and fluctuarization.

Preserving a tooth during periostitis is not always advisable.

Affected baby teeth must be removed.
Severely damaged teeth should also be removed.
If the teeth have retained their functionality, then they should be saved.

Antibacterial drugs for the treatment of periostitis

Sulfonamides. These include norsulfazole and sulfadimethoxine.
Nitrofurans. This is furazolidone or furadonin.
Antihistamines. Here you can list three drugs: diphenhydramine, diazolin, suprastin.

The first group is increasingly being replaced by broad-spectrum antibacterial drugs. They actively suppress painful microflora. As a result, the source of infection is stopped and is not transmitted to neighboring tissues.

Read also: The chewing muscles of the face, which ensure the movements of the jaw apparatus, may suddenly undergo spasm - this is what it is.

In treatment, taking vitamins and agents that strengthen bone tissue is of particular importance. If treatment is carried out in a timely manner, complete recovery will occur within a few days.

If painful sensations come unexpectedly, the following methods and recipes will help:

Rinse with a solution of baking soda and salt. This product is good at removing swelling and relieving pain.
Use a cold compress. To relieve pain and reduce swelling, cold ice is applied to the tooth.
Rinse your mouth with the following decoctions: chamomile, calendula,...

Treatment of periostitis of the lower jaw

In the lower jaw, periostitis most often affects the molars, or rather the large teeth and wisdom teeth. It is not so often necessary to treat second teeth (meaning small and large molars) and the very first small molars. The inflammatory process can also occur from fangs and incisors.

For treatment, the area of suppuration is initially opened. If there are indications, the diseased tooth is removed. Next, the patient is prescribed antibiotics and treatment of the resulting wound with antiseptic solutions.

Periostitis of the lower jaw must be treated with the help of a surgeon. The doctor performs the intervention under local anesthesia. During the operation, he tries to ensure that there is a free outflow of pus. If an abscess is suddenly observed, then the single-osseous area is cut right down to the bone. Next, using a parser, they move to the lower jaw in the corner. At this time, you should work carefully so as not to touch the masticatory muscles. After dissection, a drainage procedure is performed. The quality of its implementation will be known only the next day.

Finally, the wound is washed with antiseptic agents. At the same time, doctors may prescribe antibiotics and special ointments with oil. If physical treatment is used together, recovery will occur on the third day.

Treatment of periostitis of the upper jaw

In the upper jaw, the disease affects the first large molars, the first small molars and the second small molars, also molars. Rarely, incisors, canines and wisdom teeth suffer from inflammation.

There are subtleties in the treatment:

The operation is performed in the molar area.
The gum is cut along the upper tuberosity.
The movements are carried out backwards and inwards.
If inflammation has spread to the lingual surface, then the gum is cut in place largest accumulation pus.
In the case of an abscess, after the wound is incised, it is drained using a thin elastic band.

If suddenly the treatment performed does not produce results on the second day, then the patient must be admitted to a hospital.

Prevention

If inflammation of this form is not treated, the pus will gradually reach other soft tissues and bone structures. As a result, the person will get osteomyelitis and blood poisoning (in other words, sepsis). In addition to treatment, everyone needs to take preventive measures:

Take proper, regular, timely care of your mouth.
When caring, use herbal rinses, dental floss and other products depending on the existing problems.
Go to the dentist twice a year (if there are no problems).
Correct any dental problems promptly.
If braces and other structures are installed, carefully monitor their condition and clean them regularly.
Be sure to correct crooked teeth.
Correct malocclusion.
Do not treat at home.
At the first signs of periostitis, you should rush to see a dentist.

Prognosis and risk of complications

If treatment is performed on time, serious and dangerous complications can be avoided. Note that here we're talking about not about the loss of teeth, but about the threat to life. Less dangerous disease is an acute serous periostitis. More dangerous is a purulent disease. The latter requires immediate surgical intervention.

Periostitis with a palatal abscess cannot open on its own. If left untreated, bone necrosis and osteomyelitis can occur.

Conclusion

No reason can justify ignoring periostitis. One cannot fail to understand the seriousness of the situation. The absence of pronounced pain should not be a reason not to consult a doctor. If suddenly her symptoms began to manifest themselves less clearly, it means that they simply turned into a more serious and dangerous form, chronic.

Acute or aggravated chronic periodontitis, in the absence of self-resolution or adequate treatment, can lead to the spread of the inflammatory process into the periosteum of the alveolar process of the upper or lower jaw and the adjacent soft tissues with the formation of acute periostitis of the jaw.
The share of patients with periostitis of the jaw accounts for 7% of the total number of patients who applied for treatment to clinics, and 20-23% of patients who were hospitalized. inpatient treatment. IN acute form Periostitis occurs in 94-95% of cases, in chronic cases - in 5-6%. On the lower jaw, periostitis occurs in 61% of patients, on the upper jaw - in 39%. Periostitis, as a rule, develops on one side of the jaw, most often affecting it from the vestibular surface (93% of patients).

Acute periostitis of the jaw

Etiology

The cause of acute periostitis can be acute and chronic periodontitis, periodontitis, acute or exacerbation of chronic sinusitis, pericoronitis, suppurating jaw cysts, benign and malignant tumors. Acute periostitis can develop after tooth extraction surgery as a complication of alveolitis. Surgical intervention in in this case serves as a trigger for the disease, disrupting the immunobiological balance between the infectious principle and factors of local and general defense of the body, thus provoking an exacerbation and development of the inflammatory process.

The acute form of the inflammatory reaction during periostitis is usually divided into two stages: serous and purulent.

The serous stage of periostitis occurs in 41% of patients. It is a reactive inflammatory process in the periosteum, accompanying acute or aggravated chronic periodontitis.
In the purulent stage (59% of patients), exudate from the affected periodontium penetrates into the periosteum through the system of Haversian and Volkmann canals or through a previously formed usura in the wall of the socket, and through the blood-lymphatic circulation system into the surrounding soft tissues.
The morphological picture is characterized by swelling and loosening of the periosteum. Its leukocyte infiltration develops and increases, and microcirculatory disorders develop. The inner layer of the periosteum melts, and serous, then serous-purulent, and subsequently purulent exudate accumulates between the periosteum and the bone. The accumulating mass of exudate exfoliates the periosteum, disrupting the blood supply in it, which contributes to the development of deeper pathological changes. Dystrophic changes occur in bone tissue: lacunar resorption of bone substance, fusion of Haversian canals and medullary spaces. As a result of these processes, significant thinning occurs, and in some areas, the disappearance of the cortical layer of bone and adjacent bone beams. At the same time, penetration of purulent exudate from under the periosteum into the Haversian canals and its transition to the peripheral areas of the bone marrow spaces is noted.

Clinical picture

It is varied and depends on the gender and age of the patient, the localization of the inflammatory process, the state of general and local reactivity of the body, the type and virulence of the microflora, the type of inflammatory reaction (Fig. 8-13).

In most cases, it is possible to establish a connection between the occurrence of periostitis and such previous provoking factors as hypothermia, overheating, physical or emotional stress. For patients with acute periostitis, the pain in the causative tooth subsides, but at the same time it begins to take on a diffuse character, becomes constant, aching, often acquires a pulsating character, radiates along the branches of the trigeminal nerve to the ear, temple, and spreads to the entire half of the head. Depending on the location of the inflammatory process, there may be complaints of limited, painful opening of the mouth (inflammatory contracture of the I-II degree), minor pain and discomfort when swallowing, moving the tongue, and chewing. Swelling of the soft tissues appears in the area of the upper and lower jaw, which can be expressed to varying degrees. The localization of edema is usually quite typical and depends on the location of the causative tooth.
When examining the oral cavity in the area of the causative tooth, hyperemia and swelling of the mucous membrane, smoothness of the transitional fold and the alveolar process of the jaw are detected (Fig. 8-14).

More often this is typical for the serous stage. When the process passes into a purulent form, a roller-like protrusion is formed along the transitional fold - a subperiodic abscess. If the pus melts the periosteum and spreads under the mucous membrane, a submucosal abscess is formed. In this case, self-resolution of the process may occur through the breakthrough of pus from under the gingival margin. The causative tooth becomes mobile, its crown may be partially or completely destroyed, the carious cavity and root canals are filled with putrid masses. Sometimes this tooth is filled. Pain during percussion of the causative tooth of varying intensity is observed in 85% of patients. There may be pain on percussion of adjacent teeth, numbness of the lower lip (Vincent's symptom) is observed only in patients with an inflammatory process localized in the area of premolars and molars of the lower jaw. In most patients, regional lymph nodes are slightly painful, enlarged, have a dense elastic consistency, but retain mobility. The patients' well-being does not suffer much. Symptoms of intoxication (weakness, malaise, sleep disturbance, appetite, etc.) are mild or moderate. As a rule, a disturbance in general well-being is associated with fatigue from pain, bad sleep and appetite. During an objective examination, the general condition is often assessed as satisfactory. Body temperature is kept within subfebrile levels, rarely rising to +38 °C and above. The described clinical picture is characteristic of periostitis, characterized by the formation of a normergic type of reactive response. With hyperergy everything clinical symptoms more pronounced. Intoxication develops rapidly, the process becomes widespread and within a short time (about a day) can spread to surrounding tissues, contributing to the occurrence of abscesses and phlegmon of the perimaxillary areas. In patients with reduced body reactivity, the disease develops more slowly, according to the hypoergic type. This process is especially often observed in elderly and senile people, as well as in the presence of concomitant diseases, such as diabetes, circulatory disorders II-III degree, chronic diseases of the cardiovascular and digestive systems. With the hypoergic type of inflammatory reaction, the clinical symptoms are mild. Such patients rarely go to the doctor, while the subperiosteal abscess opens spontaneously with necrosis of the periosteum and mucous membrane, acute inflammation is stopped, and the process most often becomes chronic.
In many ways, the clinical picture of acute odontogenic periostitis depends on the location of the causative tooth. When an inflammatory process occurs in the upper jaw, in the area of the incisors, there is significant swelling of the upper lip and wing of the nose, which can spread to the bottom of the lower nasal passage. In some cases, purulent exudate can penetrate under the periosteum of the anterior part of the bottom of the nasal cavity with the formation of an abscess, especially with a low alveolar process.

When purulent exudate spreads from the incisors towards the hard palate in the area of its anterior section, a palatal abscess is formed. When the causative tooth is the upper canine, the swelling spreads to the infraorbital and part of the cheek area, the corner of the mouth, the wing of the nose, the lower and even the upper eyelid. The source of inflammation is most often located on the vestibular surface of the alveolar process of the upper jaw. If the sources of infection are the premolars of the upper jaw, then collateral edema spreads to the infraorbital, buccal and zygomatic areas, often to the lower and upper eyelids. The nasolabial fold smoothes out and the corner of the mouth drops, indicating an inflammatory lesion of the terminal branches of the buccal branch of the facial nerve. When purulent exudate from the palatal roots of the first upper premolars spreads to the palatal surface, a palatal abscess can form in the middle part of the hard palate. Acute periostitis, developing from the upper molars, is characterized by edema covering the zygomatic, buccal and top part parotid-masticatory area, rarely on the lower eyelid, can reach the auricle. A few days after the development of the process, the edema begins to shift downward, which can create a false impression that the pathological focus comes from the small and large molars of the lower jaw.
When the inflammatory process spreads from the palatal roots of the upper molars towards the palate, swelling of the soft tissues of the face is not observed. Detachment of the dense periosteum in this area causes severe aching and then throbbing pain in the area of the hard palate. Due to the absence of a submucosal layer on the hard palate, the swelling is insignificant. Spontaneous opening of the abscess can occur on the 6-7th day, which leads to the development of cortical osteomyelitis.

For purulent periostitis developing from the lower incisors, characterized by the presence of edema in the area of the lower lip and chin. At the same time, the chin-labial furrow is smoothed out. When the inflammatory process spreads from the lower canine and premolars, the edema affects the lower or middle part of the buccal region, the corner of the mouth and spreads to the submandibular region. If the source of infection is the molars of the lower jaw, then collateral edema affects the lower and middle parts of the buccal region, the parotid-masticatory and submandibular regions. When the inflammatory process spreads to the periosteum in the area of the angle and branch of the lower jaw, the swelling is not pronounced, but has a significant area. It should be noted that in the lower jaw, the inner bone wall in the area of the molars is thinner than the outer one, so the clinical manifestations of periostitis can be localized on the lingual surface. In this area, there is hyperemia, swelling and bulging of the mucous membrane, spreading to the sublingual area.

Diagnosis of acute periostitis can be confirmed by laboratory blood tests. At the same time, a slight increase in leukocytes is observed - up to 10-11x109/l, due to a slight increase in the number of neutrophils (70-78%). ESR increases slightly, rarely exceeding 12-15 mm/h.
During radiographic examination of the jaws there are no changes in the bone structure. As a rule, only changes characteristic of granulating or granulomatous periodontitis, radicular cysts, semi-impacted teeth, etc. are detected.

Differential diagnosis

Many clinical signs of acute odontogenic periostitis of the jaws are also found in other acute inflammatory diseases.
Acute periostitis is differentiated from acute or exacerbation of chronic periodontitis, acute osteomyelitis, abscesses, exacerbation of chronic sialadenitis, inflamed jaw cysts, benign and malignant neoplasms of the jaws.

Acute periostitis differs from acute or aggravated chronic periodontitis in the localization of the inflammatory focus and the severity of the inflammatory reaction. In periodontitis, inflammation is localized in the projection of the apex of the root of the causative tooth; in periostitis, inflammation spreads under the periosteum. With periodontitis, a slight reactive edema can be detected in the area of the periosteum and soft tissues from the vestibule of the oral cavity, and with periostitis, an inflammatory infiltrate is localized in this area and a subperiosteal abscess is formed. In acute osteomyelitis, in contrast to periostitis, the inflammatory infiltrate is localized on both sides of the alveolar process, covering it in a muff-like manner (bilateral periostitis). With osteomyelitis, the mobility of several teeth located in the affected area is determined, and Vincent's symptom develops. Acute osteomyelitis is accompanied by more severe general intoxication of the body and pain.

Acute odontogenic periostitis should be differentiated with sialadenitis of the sublingual and submandibular salivary glands. It should be remembered that with periostitis, the salivary glands are not involved in the inflammatory process. In the case of sialadenitis, when massaging the salivary gland, cloudy or purulent-streaked saliva is released from the mouth of the duct. In these cases, in patients with calculous sialadenitis, salivary stones can be detected using radiography of the floor of the mouth.
Acute periostitis has similar features to suppurating jaw cysts, benign and malignant tumors. These diseases are sometimes accompanied by the development of inflammation of the periosteum. With festering cysts and tumors, the signs of inflammation are less pronounced. Radiography allows you to identify a pathological focus. It should be remembered that in all cases where adequate surgical intervention and drainage is carried out, anti-inflammatory therapy is carried out, but there is no effect of treatment or tissue infiltration increases, it is necessary to think about malignant tumor and purposefully look for it.

Treatment

Treatment of acute periostitis should be comprehensive . In surgical terms, the question of the advisability of removing or preserving the causative tooth should be decided. Usually, single-rooted teeth with a well-passable root canal that can be filled are preserved. If there is a focus of bone destruction near the root apex, it is recommended to perform resection of the root apex after complete relief of acute inflammatory phenomena. The issue of preserving multi-rooted teeth is the subject of debate, but most authors insist on their removal. Moreover, if tooth extraction is associated with significant trauma during surgery (impacted, dystopic tooth, etc.), then removal is postponed until complete elimination inflammatory reactions, usually for 7-10 days.
When making incisions to open subperiosteal abscesses, the localization of the inflammatory process should be taken into account. The operation is performed under local anesthesia with premedication. In cases where it is necessary to simultaneously remove a tooth and open an abscess, the intervention begins with opening the abscess and then removing the tooth. When opening an abscess, the scalpel blade is positioned strictly perpendicular to the bone and guided along the transitional fold, i.e. along the border of the mobile and immobile mucous membrane of the gums (Fig. 8-16). If this border cannot be determined, then the incision is made, retreating from the gingival margin by 0.5-1.0 cm through the thickness of the infiltrate. You should not approach the gingival margin, as this may cause further gingival necrosis in this area. Also, you should not move away towards the mucous membrane of the cheek, where you can damage fairly large blood vessels and cause severe bleeding. The length of the incision should correspond to or slightly exceed the length of the inflammatory infiltrate. The mucous membrane and periosteum are dissected down to the bone, then the periosteum is peeled off in all directions from the cut by at least 1 cm, thereby fully opening the purulent focus. Through the incision, subperiosteally, a strip of glove rubber is inserted for drainage.

With periostitis, localized in the area of the last molars of the upper jaw, the inflammatory process tends to spread to the tubercle of the upper jaw. Therefore, when exfoliating the periosteum, you should purposefully move a blunt instrument to the tubercle by 0.5-1.0 cm, introducing drainage mainly in this direction.
When the inflammatory process is localized in the area of the second and especially third molar of the mandible on the vestibular side, it can spread to the lower sections under the masticatory muscle itself, which is clinically accompanied by severe inflammatory contracture of degree II-III. In this case, the incision should start from the retromolar triangle, downwards, reaching the transitional fold. When the periosteum is detached, one should penetrate to the lower parts of the masticatory muscle itself and under it, installing drainage there.
If the inflammatory process is located in the area of the lower molars on the lingual side, it can spread under the lower parts of the medial pterygoid muscle, which is clinically determined by infiltration of this area and severe inflammatory contracture of degree II-III. In these cases, the incision also starts from the retromolar triangle and leads down to the lingual surface of the alveolar part of the lower jaw, and then parallel to the gingival edge, 0.7 cm away from it. When the periosteum is detached, a blunt instrument is used to penetrate downwards, posteriorly and inwardly in the direction under lower parts of the medial pterygoid muscle. Drainage is also introduced in this direction.
When opening a subperiosteal abscess localized in the area of the premolars of the lower jaw, it should be taken into account that the mental foramen with its neurovascular bundle is located in this area. To avoid injury, an arcuate incision should be made, with the apex facing upward and closer to the gingival margin. When detaching the periosteum, you should work carefully to avoid injury to the neurovascular bundle. When opening an inflammatory process localized in the frontal part of the upper or lower jaw, you should avoid crossing the frenulum of the upper or lower lip, which can lead to scarring and shortening. In those rare cases when the infiltrate is located exactly in the center and intersection of the frenulum is inevitable, two incisions should be made, respectively to the right and left of it. When opening a subperiosteal abscess on the hard palate, triangular-shaped soft tissue is excised with a cut side of up to 1 cm. In this case, the edges of the wound do not stick together, its reliable drainage is ensured, and the development of osteomyelitis of the hard palate is prevented. Subsequently, the wound surface is covered with granulation tissue, followed by epithelization.
Treatment of the patient in postoperative period carried out in compliance general principles therapy of purulent wounds. Warm intraoral rinses with various antiseptics are prescribed locally, which can be alternated or combined. The wound is dressed daily until the discharge of pus stops.
General treatment is in the prescription of antibacterial, analgesic, desensitizing and sulfa drugs and vitamin therapy. Of the modern drugs with anti-inflammatory, analgesic, desensitizing and vasoactive properties, from the NSAID group, diclofenac (rapten rapid*) is used, which can be successfully used in the treatment of periostitis.
The next day after opening the abscess, it is necessary to prescribe UHF therapy in an athermic dose, flucturization or GNL therapy.

Complications

The most common complication in the postoperative period is the progression of the inflammatory process and its spread to surrounding tissues. They arise due to untimely tooth extraction, insufficient opening, emptying and drainage of the purulent focus. Treatment consists of prescribing full complex drug and physiotherapeutic treatment. If the treatment package is insufficient, it needs to be expanded in compliance with all requirements.

Rehabilitation

Acute odontogenic periostitis is a fairly serious disease, and non-compliance with outpatient or inpatient treatment can lead to serious complications. The patient is disabled for a period of 5-7 days. In the first 2-3 days after surgery, bed rest is recommended. Patients are allowed to work after complete elimination of inflammatory phenomena. Subsequently, for 2-3 weeks he is freed from heavy physical activity. If this exemption contradicts working conditions, then the certificate of temporary incapacity for work is extended for this period.

Chronic periostitis of the jaw

It occurs in 5-6% of adults and children and, as a rule, is the outcome of an acute inflammatory process. However, in children and adolescents, chronic periostitis sometimes develops primarily, and therefore it should be classified as a primary chronic disease. The development of chronic periostitis is facilitated by the preservation of a focus of prolonged sensitization. This occurs in the presence of a chronic focus of infection: an affected tooth, chronic sinusitis, with insufficient sanitation of a purulent focus, with repeated exacerbations of chronic periodontitis without a pronounced inflammatory reaction and characteristic clinical manifestations, as well as as a result of trauma caused by removable and fixed dentures. Decreased immunity plays a big role.
There are simple, ossifying and rarefying forms of chronic periostitis. In the simple form, the newly formed osteoid tissue undergoes reverse development after treatment. In the ossifying form, bone ossification develops in the early stages of the disease and most often ends with the formation of hyperostosis. Referential periostitis is characterized by pronounced resorptive phenomena and restructuring of bone structures.

Upon morphological examination, the affected area of the periosteum has the appearance of spongy bone tissue. The network of interwoven bone trabeculae has varying degrees of maturity - from osteoid beams and primitive coarse-fibrous trabeculae to mature lamellar bone tissue. The bone tissue found in these layers is also at different stages of maturation. Chronic proliferative inflammatory changes in the periosteum are difficult to reverse or cannot be reversed at all. The process is most often localized on the lower jaw.

Clinical picture

Patients usually do not make any complaints or complain of a feeling of discomfort and stiffness in the corresponding half of the jaw, of an externally determined deformation of the face. Some of them have a history of an acute stage of the disease. The configuration of the face can be changed due to slight protrusion of the soft tissues due to the thickening of the jaw. The long-term existence of an inflammatory focus leads to enlargement and hardening of regional lymph nodes, which can be painless or slightly painful. Refractive periostitis occurs most often in the frontal region of the lower jaw, and is usually caused by trauma. As a result of the injury, a hematoma is formed, and its organization leads to compaction of the periosteum. When examining the oral cavity, a thickening of the jaw in the vestibular direction is determined (dense, painless or slightly painful). Edema of the mucous membrane is not detected, or it is mild; the mucous membrane is slightly hyperemic, cyanotic, and a vascular pattern may be pronounced. Radiologically, the shadow of periosteal thickening of the jaw is determined. With the long-term existence of the inflammatory process, ossification of the periosteum is visible. At longer periods, vertical striations and a layered structure of the periosteum (onion pattern) are noted.

Differential diagnosis

Chronic periostitis is differentiated from chronic odontogenic osteomyelitis of the jaw. Chronic osteomyelitis is preceded by a more pronounced acute stage, thickening of the jaw occurs both in the vestibular and oral directions, fistulas are formed, and Vincent's symptom is determined. In addition, chronic osteomyelitis is characterized by a certain x-ray picture with pronounced bone destruction.
In case of specific inflammatory processes (actinomycosis, tuberculosis, syphilis), there is no acute stage of the disease, the lymph nodes change, the data of specific studies are positive (skin test, Wasserman reaction, etc.).
Chronic periostitis is similar to some bone tumors and tumor-like diseases. Diagnosis is aided by medical history (history of acute inflammation), the presence of a causative factor, an x-ray pattern characteristic of neoplasms, and the results of morphological studies.

Treatment

In the early stages of the disease, it is enough to remove the causative factor and sanitize the inflammatory focus, which leads to the reverse development of the inflammatory process. In later
During the period, removal of ossification is carried out in a hospital setting. Treatment of rarefied periostitis consists of conducting a revision of the pathological focus after peeling off the trapezoidal mucoperiosteal flap and removing the encysted hematoma. At the same time, the proliferatively changed part of the periosteum is excised, and the newly formed bone tissue is removed with bone cutters or a chisel. After removal of excess bone formation, areas of softening are found on the underlying cortical bone. The postoperative wound is sutured tightly. Intact teeth are preserved. The flap is placed in place and secured with sutures. Antibacterial, desensitizing, immunostimulating and restorative drugs are prescribed. Good results in the treatment of chronic periostitis are obtained by using electrophoresis of a 1-2% potassium iodide solution. Treatment of periostitis in older people is not much different from that in young people. You should pay attention to the prescription of physiotherapeutic procedures. They must be done with caution and taking into account concomitant diseases (hypertension, atherosclerosis, etc.).

Materials used: Surgical dentistry: textbook (Afanasyev V.V. et al.); under general ed. V. V. Afanasyeva. - M.: GEOTAR-Media, 2010

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