Local Complications After Tooth Extraction - Tooth Socket Osteomyelitis And Neuritis • OHI-S

Clinical picture of osteomyelitis of the tooth socket

The clinical picture of osteomyelitis of the tooth socket is characterized by complaints of acute throbbing pain both in the area of the socket and in the area of neighboring teeth. General symptoms such as weakness, hyperthermia, headache, chills, impaired performance and sleep are also observed. Swelling of the perimandibular soft tissues develops, the submandibular lymph nodes are enlarged, dense, painful on palpation.

With osteomyelitis of the socket of only one molar of the lower jaw, the inflammatory process can spread to the area of the masseter or medial pterygoid muscle, which, in turn, can cause difficulty opening the mouth. When examining the oral cavity, the doctor may detect a dirty gray coating on the bottom and walls of the socket. You can also smell a specific smell. Percussion of adjacent teeth is painful.

The mucous membrane in the area of the transitional fold is hyperemic and swollen. Palpation of the alveolar process from the buccal and oral sides is sharply painful both in the area of the socket and adjacent teeth.

The acute phase of inflammation lasts about 6–8 days, sometimes 10 days. Then the inflammatory phenomena decrease, the process becomes chronic. The general condition improves, body temperature decreases. Swelling and hyperemia of the mucous membranes also decrease, and then pain on palpation of the alveolar process, swelling of facial tissues and submandibular lymphadenitis disappear. After 12–15 days, the tooth socket is filled with loose, pathological granulation tissue, sometimes bulges out of the socket, and pus can be released when pressure is applied.

On the x-ray we see fuzzy blurred contours of the compact lamina of the alveoli; osteoporosis and bone destruction in the alveolar region are pronounced. In rare cases, after 20–25 days from the beginning of the acute period, it is possible to identify small sequesters.

Causes of limited osteomyelitis of the socket

1. as a complication of alveolitis. 2. as a result of decreased immunity

Treatment of socket osteomyelitis

In the acute stage of the disease, therapy begins with revision of the hole. Under conduction or infiltration anesthesia, the tooth socket is cleaned of remnants of a blood clot, food and pathological tissue. Then the well is washed from a syringe with a weak antiseptic solution or a biologically active drug. The following drugs are used: staphylococcal and streptococcal bacteriophage, proteolytic enzymes, lysozyme. After this, a bandage with Alvogyl is applied to the wound.

To reduce inflammation and pain, dissection of the infiltrated area of the mucous membrane and periosteum is performed. An incision is made along the transitional fold 1.5–2 cm long, as well as an incision on the inside of the alveolar process. Drug therapy is prescribed: antibiotics, sulfa and antihistamines, analgesics, physical therapy (UHF, ultrasound, helium-neon laser). To increase specific immunological reactivity, phagocytosis stimulants are prescribed: pentoxyl, methyluracil, milife, lemongrass.

After relief of acute inflammation, treatment with multivitamins and stimulants of nonspecific resistance of the body is continued (methyluracil 0.5 g or pentoxyl 0.2 g 3-4 times a day, sodium nucleinate 0.2 g 3 times a day, milife 0.2 G). Concomitant ultrasound or laser therapy of the inflammation focus is necessary. Approximately 20 days from the onset of the acute inflammatory process, if the wound has not healed and sequesters are found on the radiograph, pathological granulations and small sequesters are removed with a surgical spoon, the walls and bottom of the hole are scraped out. The wound is washed with an antiseptic solution, dried and loosely packed with gauze soaked in iodoform liquid.

Dressings (treating the hole with an antiseptic solution and changing the iodoform gauze in it) are done every 2-3 days until young granulation tissue forms on the walls and bottom of the hole.

Prevention of socket osteomyelitis is the same as for alveolitis.

Before the intervention, professional oral hygiene is necessary
the doctor must inspect the socket and perform hemostasis by compression
if more than two teeth are removed, apply sutures
After tooth extraction, it is necessary to give clear recommendations to the patient

If, nevertheless, the appearance of alveolitis could not be avoided, and the patient complained of pain, it is necessary to stop the process as quickly as possible. Therefore, the patient must be informed about possible complications and motivated not to delay visiting the dentist if he experiences pain.

The relationship between ENT organs and dental health

30.10.2017

Author: Dentist-periodontist Tamara Valerievna Kudzieva

Often, patients are faced with a situation where doctors have difficulty making a diagnosis due to the proximity of certain organs, and the patient is forced to turn to related specialists in order to avoid an inaccurate diagnosis.

Dental science is no exception. The diagnosis, etiology, i.e. is quite common. The cause of which dentists sometimes find it difficult to determine. Namely, inflammation of the maxillary (maxillary) sinus - sinusitis. Or a diagnosis whose name is more familiar - sinusitis. Patients are often confused about which doctor to see, a dentist or an ENT specialist.

Let's figure out why often an ENT doctor and a dentist cannot share this diagnosis.

First, let's give a definition and understand what the maxillary sinus is:

The maxillary sinus is a cavity formation in the upper jaw, lined with mucous membrane.

The function of the maxillary sinus is to warm and purify inhaled air. When an infection penetrates, one way or another, the mucous membrane of the sinus becomes inflamed, this process is called sinusitis (sinusitis). The patient usually complains of a feeling of nasal congestion, the presence of purulent exudate (discharged fluid), headaches, fever, pain in the projection of the sinus when tilting the head and palpation.

The reasons for the development of sinusitis can be odontogenic (due to the tooth) and non-odontogenic.

Non-odontogenic causes are most often associated with complications of colds or viral diseases, rhinitis. A specialist in ENT diseases works directly with this diagnosis.

We will dwell in more detail on the odontogenic cause of sinusitis:

As noted above, the cause of the development of this type of inflammation is an infected tooth.

This is due to the anatomical features of the structure of the upper jaw, since the roots of the teeth are located close to the sinus or even directly in it:

Thus, in the presence of a chronic inflammatory process in the canals of the teeth of the upper jaw, this infection spreads to the mucous membrane of the sinus, causing its inflammation. If there is an odontogenic cause for the development of sinusitis, it is not advisable to treat only the sinus by an ENT doctor, since this treatment will not give a long-term effect. It is necessary to eliminate the cause of inflammation - an infected tooth. And often, such unpleasant manipulations as punctures, rinsing, and prescribing antibacterial agents do not bring the desired result.

And therefore, competent ENT specialists, before starting treatment, must refer the patient to a dentist to exclude an odontogenic cause for the development of sinusitis.

If the inflammation is caused by a tooth, the dentist first needs to assess the feasibility of treating and preserving the tooth. If the prospect of treatment is assessed as favorable, then the endodontist performs high-quality root canal treatment to eliminate the infection. Before permanent filling of the canals, you may need to temporarily fill them with agents that have an antiseptic effect. And then, having seen the positive dynamics, seal the tooth hermetically. If the tooth is severely damaged, or there is no possibility of passage of the canals (sclerosis, severe curvature, root perforation, false passage, broken instrument), then such a tooth must be removed.

After eliminating the cause, after a couple of months, a control CT scan is performed to make sure that the sinus has begun to recover.

It is important to note that all sinuses communicate with each other; therefore, an infection from the maxillary sinus, in the absence of proper treatment, can spread throughout the entire sinus system, which greatly complicates treatment.

Thus, a competent approach to treatment and timely redirection to a suitable specialist will prevent an incorrect diagnosis and, as a result, incorrect treatment tactics. And therefore, save the patient’s time and finances.

Trigeminal neuritis

Today, traumatic neuritis of the trigeminal nerve is considered one of the most common causes of pain syndromes in the maxillofacial area.

As a complication, it occurs during the removal of permanent molars of the lower jaw, due to damage to the lower alveolar nerve in the mandibular canal. The apices of the roots of the lower molars are in close proximity to the mandibular canal and in some cases may be located in the canal itself. Sometimes, due to chronic apical periodontitis, the bone between the root apex and the wall of the mandibular canal is resorbed. When a tooth is loosened by an elevator, the lower alveolar nerve can be injured, which will lead to partial or complete disruption of the functions of the third branch of the trigeminal nerve. The result is pain in the jaw, numbness of the lower lip and chin, decreased or absent sensitivity of the gums, decreased electrical excitability of the dental pulp on the affected side. Usually all these phenomena gradually disappear after a few weeks.

Electroodontometry

Electroodontometry is the most effective method for assessing the functional state of the trigeminal nerve when it is damaged. EDI is based on a study of the reaction of the teeth of the lower jaw to electrical stimulation. The method is performed on all teeth of the lower jaw, with preserved pulp both in the affected area and on the opposite healthy side.

S.N. scale Fedotova (1997) to assess the severity of damage to the inferior alveolar nerve based on electrical odontometry data:

mild degree - reaction of teeth with preserved pulp on the side of nerve damage within 20-40 μA;
moderate severity – reaction of teeth to currents from 40 to 100 µA;
severe degree - complete loss of pain sensitivity, reaction of teeth to currents above 100 μA

The use of EDI to diagnose traumatic injuries of the inferior alveolar nerve is impossible if:

lower jaw teeth endodontically treated
lower jaw teeth are covered with orthopedic structures
metal elements of splinting structures are fixed on the teeth
missing teeth

Locations for measuring electrical excitability of facial skin

Assessment of the area of paresthesia in traumatic neuritis of the inferior alveolar nerve

The zone of paresthesia is identified - impaired sensitivity of the skin based on a tactile test, photographed, followed by an assessment of the area of the paresthesia zone: points are drawn on the border of areas of normal sensitivity of the skin, the red border of the lips and the paresthesia zone, which are then connected by a continuous line. Zones of hyper-, hypo- and anesthesia were marked with different colors.

I - vertical lines:

midline,
a line passing through the outer edge of the philtrum,
a line passing through the outer edge of the wing of the nose,
pupil line;

II - horizontal lines:

lip line,
a line running along the lower edge of the red border of the lips,
the border line between the chin and lower lip,
a line drawn along the most protruding part of the chin,
line of the border of the chin and submental areas.

Schematic representation of the areas for measuring facial skin paresthesia.
Each of the 12 resulting squares was assigned a score depending on the nature of the sensitivity disorder:

0-sensitivity is not impaired;

1-skin hyperesthesia

2-hypoesthesia of the skin;

3-anesthesia of the skin.

Next, the sum of points was calculated and divided by 12 (quadrants).

With the results:

3.0-2.1 – severe sensitivity impairment was diagnosed;

2.0–1.1 – moderate severity;

less than 1.0 – mild severity of the pathology being studied

"Dental" sinusitis

Surely everyone has heard that you need to visit the dentist at least twice a year, otherwise fleeting preventive meetings with the dentist can turn into long and painful therapeutic appointments for both parties.

Moreover, often an otolaryngologist also joins this idyll. “What does he have to do with it?” - you ask. The answer is simple: an ENT doctor treats odontogenic or, more simply put, “dental” sinusitis, which quite often occurs as a complication of dental diseases.

How are bad teeth and sinusitis related?

And the connection here is purely anatomical. Sinusitis itself is an inflammation of the mucous membrane of the air sinus, which is located in the thickness of the upper jaw. The bottom or lower wall of this sinus is a layer of bone that separates the sinus from the roots of the upper teeth (molars and premolars, sometimes canines).

Treatment of neuritis

Treatment of neuritis in traumatic injuries must be timely and wait-and-see tactics are unacceptable. For mild damage to the inferior alveolar nerve, decongestant therapy (prednisolone, veroshpirone) is sufficient. In case of moderate severity of damage, drugs that improve the conductivity of the nerve trunk (neuromedin) are added to decongestant therapy. In case of severe damage to the nerve trunk, in the absence of positive dynamics in the restoration of sensitivity within 4 months, the patient should be referred for a consultation with a neurosurgeon in order to resolve the issue of the possibility of restoring the anatomical integrity of the nerve trunk.

Various reflexotherapy methods are widely used in the complex treatment of diseases of the peripheral nervous system. In the complex treatment of diseases of the peripheral nervous system, reflexology methods such as electroacupuncture and transcutaneous electrical neurostimulation are widely used.

Prevention of neuritis

Prevention of neuritis of the inferior alveolar nerve is the correct technique for removing teeth, correct diagnosis and correct reading of the radiograph, and a gentle technique for dislocating the roots of teeth in the lower jaw with an elevator.

Abscess after tooth extraction

An abscess after tooth extraction is a long-term complication of a tooth extraction operation that occurs as a result of contamination of the wound surface with microorganisms. When teeth are removed, not only the tissues surrounding the tooth can be injured, but also the mucous membranes of the mouth and cheeks. A fresh wound is a favorable environment and entry point for microorganisms. Therefore, under appropriate circumstances, an abscess may form in the soft tissues or in the hole, which over time and without treatment can “spill” with the formation of phlegmon in several areas.

Causes of abscess

The cause of an abscess may be failure to comply with the rules of asepsis and antisepsis directly during the tooth extraction operation. As a result of incorrect actions by the doctor, infection occurs in the tooth socket and subsequent suppuration. Also, infection of the socket and soft tissues can occur due to the fault of the patient himself if he does not follow all the dentist’s recommendations. The patient must strictly follow the prescribed procedures, otherwise repeated surgery cannot be avoided.

Prevention and treatment of tooth abscess

Prevention of the appearance of an abscess after tooth extraction is basic regular oral hygiene and following all the recommendations of the dentist. Also, preventive measures include visiting the dentist if you experience pain within a few days after tooth extraction. Treatment of an abscess consists of opening and cleaning the abscess cavity, removing purulent formations and prescribing anti-inflammatory therapy. Sometimes the abscess opens on its own, and the pain disappears. But this does not mean that the process has been stopped, so further treatment by a dentist is necessary. Otherwise, the infection may spread to contact areas and intensify the process.

What to look for

The most serious consequences that can occur after wisdom tooth removal:

Alveolitis. This is an acute inflammatory process. It begins in the tooth socket and gradually spreads to other gum tissues. The most common reason for the development of alveolitis is improper care after removal.
Paresthesia. Develops when the root of the jaw nerve is damaged or irritated. Manifested by a feeling of tingling, burning, numbness.

To avoid developing serious problems, monitor your oral health. The first symptoms are not difficult to replace:

Bleeding from the socket. This is not always a sign of complications. Immediately after removal this is a normal reaction of the body. In the first minutes after tooth extraction, bleeding will be slightly heavier. The dentist treats the wound with antiseptics and packs it. After some time, the bleeding stops. Slight bleeding persists for 2-3 hours. This is also normal. You should pay attention to bleeding if it is profuse and begins several hours after removal. In this case, contact a specialist immediately.
Swelling and pain. This is also a natural reaction. Pain occurs as the anesthetic wears off. Normally it lasts 2-3 days. At the same time, the gums swell slightly. You should sound the alarm if the swelling transfers to the cheek. In complex cases, the tumor can be very large. Severe swelling is one of the symptoms of alveolitis.
Fever. On the first day after removal, the temperature rises to 37 degrees. Such an increase is within normal limits, especially if the operation was complicated. When the temperature lasts more than a day or rises strongly, this is a symptom of inflammation. To prevent the inflammatory process from spreading to neighboring tissues, visit a dental clinic.
Suppuration. The inflammatory process, accompanied by suppuration, has pronounced symptoms. Suppuration is indicated by a putrid odor from the mouth and an unpleasant taste. When examining the tooth socket, you may notice gray plaque or white purulent contents. In this case, you need to go to the dentist immediately.
Headache. Immediately after wisdom tooth removal, headache is normal. It is caused by stress and anesthetic drugs. If the headache is severe and is accompanied by fever, swollen lymph nodes, and weakness, we recommend visiting a doctor.

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