Periostitis

Question 1

How do we get periostits ?

Answer 1

When inflammation products or ABCESS pass through Haversian system and volkmann’s canals to periosteum and elevate it
Stem cells in osteogenic layer start to polifirate into osteoblasts and new bone lying down .

purulent exudate from the periodontal tissue extends to the periosteum:
-through the Haversian and Volkmann’s canals
-through the small foramens in a compact plate
- by lymphatic vessels
-rarely through the medullary spaces

Question 2

Which parts are more likely to get periostitis ?

Answer 2

Vestibular then , lingual , palatal

Question 3

Which symptoms are present in acute serous stage and not purulent ?

Answer 3

No fluctuation , no x-ray changes , infiltrated , painful , red mucogingival fold ,
Painful in chewing , edematous swelling of cheek and alveolar
Causal teeth periodontitis
Initial signs of inflammation ( night sleep distribution)

Question 4

Which signs present in acute purulent stage ?

Answer 4

Facial assymetry , limit mouth opening (edema) and painful swallowing, high temp
Mucogingival fold is filled in causal tooth and the adjacent 1-2 , flattened , swelled , obliteated
Fluctuation
Causual tooth destroyed , mobile
Regional lymphadentitis painful palpation
Pulsation , radiate pain
Subperisoteal abcess

Question 5

In which one we observe blood changes , leukocytosis , increase sedemintation of erythrocytes

Answer 5

Acute purulent

Question 6

What’s the treatment of acute serous periostitis?

Answer 6

-drilling or removing the causitive tooth
-Anti-inflammatory medication
-Physiotherapy

Question 7

Does the pain in serous stages relieve innediately after extraction ?

Answer 7

Not always
Periostomy and drainage for 3-4 days .
Periostomy decrease the pressure of tissue in inflammation site

Question 8

What’s purulent acute periostitis therapy ?

Answer 8

• Intraoral incision and dranage of subperiosteal abscess
• Opening or removing the causitive tooth
  -Anti-inflammatory medication

Question 9

What’s the outcome of acute forms ?

Answer 9

Recovery
Going into a chronic form
Development of secondary cortical osteomyelitis
Development of acute osteomyelitis of the jaw
Development of maxillary abscesses and phlegmon

Question 10

Acute purulent periostitis is differentiated with:

Answer 10

acute and exacerbated chronic apical Periodontitis
acute osteomyelitis
abscesses and phlegmons
acute sialadenitis

Question 11

If the pus has spread from the molars,

Answer 11

the cheek, , parotid region swell, sometimes the lower eyelid.

Question 12

What’s the patient complains about chronic periostitis ?

Answer 12

Unpainful or slight pain
Previous experience with acute form Symptoms

Question 13

What’s clinical signs of chronic form ?

Answer 13

Changes in facial configurations due to certain enlargement of jaw
Skin : not hypermic, no swelling
Lymphadenopathy , painless or slight in palpation
Mucosa : painless or slight in palpation and bone thickening
Cyanotic , hypermic in bone thickening areas

Question 14

How do we treat the chronic forms

Answer 14

Surgical incision of the infiltrate should be performed to the bone in the area of
enlarged periosteum;
- The wound should be drainage ( 5-7 days) and irrigated with antiseptics;
- Physiotherapeutic procedures;
- Surgical leveling of the enlarged part of the bone when ossifying form is present;
- Extraction or treatment of the “causal” tooth;
- Symptomatic therapy.

Question 15

How does chronic forms react with treatment?

Answer 15

Simple : easily treated , ostoid tissue undergo regression ( if not treated transfer into ossifying )
Ossifying : hyperosteosis

Question 16

How do we prevent chronic form

Answer 16

Chronic odontogenic foci removal
Immune system correction

Question 17

From which diseases we should deffirintiate the chronic form?

Answer 17

Chronic osteomyelitis
Tumors
Tumor like formation

Question 18

From which disease we differentiate the acute form ?

Answer 18

acute and exacerbated chronic apical Periodontitis
acute osteomyelitis
abscesses and phlegmons
acute sialadenitis

Question 19

A 50-year-old female patient complains of pain in the upper left
jaw, high fever up to 38, 5o C, worsening of her general condition. The disease onset was 3 days ago. Objecti- vely: the face is asymmetrical due to swelling of the right cheek soft tissues, palpation is painful, the skin is hyperemic. The crown of the 16th tooth is destroyed completely; percussion sensitivity is positive. There is hyperemia and edema of the alveolar process soft tissues in the area of the 15th, 16th and 17th teeth vestibular surface. What is the most probable diagnosis?

Answer 19

A. Acute odontogenic maxillary periostitis in the area of the 16th tooth

Question 20

region, the mouth can be opened by 1,5 cm, further opening is difficult,
body temperature is 37, 6oC, mucogingival fold is vestibularly flattened, hyperaemic and swollen. The 84 and 85 teeth have fillings, their percussi- on is painless. The 84 tooth exhibits I degree mobility. What is the most likely diagnosis?

Answer 20

A. Acute odontogenic periostitis

Question 21

A 32-year-old patient complains about pain and swelling in the region of his mandible and left cheek. He has been suffering from this for 2 days. Objecti-vely: his general condition is satisfactory. Body temperature is 37,
5oC. There is an edema of soft tissues in the left buccalregion. Submandibular lymph nodes are bilaterally enlarged, painful on palpati- on. Crown of the 37 tooth is partially decayed, the tooth is immobile, percussi- on is slightly painful. Mucogingival fold in the region of the 37 tooth is edematic, hyperaemic, flattened, its palpation causes acute pain. What is the most likely diagnosis?

Answer 21

Acute purulent periostitis of mandible beginning from the 37 tooth

Question 22

A 40-year-old patient complains of constant intense throbbing pain in the 23 tooth lasting for 3 days. This problem hasn’t bothered him before. Vertical and horizontal percussion is positive, the tooth is mobile, mucous membrane around the 26 tooth is hyperemic and edematous. Palpation of the mucogingival fold in the root apex projection is painful. What is the most likely diagnosis?

Answer 22

A. Acute purulent periodontitis of the 26 tooth

Question 23

A 23-year-old patient complains of pain and swelling in the region of a central incisor which was injured some time ago. After clinical and radiographic exami- nation the patient has been diagnosed with acute purulent periostitis of the upper jawmaxilla extending from the 11 tooth; radiograph shows a slight wideni- ng of periodontal ligament space of the 11 tooth. Choose the best method of treatment:

Answer 23

A. Subperiosteal abscess opening, endodontic treatment of the 11 tooth

Question 24

45. A 50-year-old female patient complains of pain in the upper left
    jaw, high fever up to 38, 5o C, worsening of her general condition. The disease onset was 3 days ago. Objecti- vely: the face is asymmetrical due to swelling of the right cheek soft tissues, palpation is painful, the skin is hyperemic. The crown of the 16th tooth is destroyed completely; percussion sensitivity is positive. There is hyperemia and edema of the alveolar process soft tissues in the area of the 15th, 16th and 17th teeth vestibular surface. What is the most probable diagnosis?

Answer 24

Acute odontogenic maxillary periostitis in the area of the 16th tooth

Question 25

How can we get periostitis ?

Answer 25

Acute and chronic exacerbated periapical inflammation
Perio disease
Impacted and semi-impacted teeth
Purulent radicular cyst
Alveolitis (dry socket )

Question 26

Intralveolar abcess

Answer 26

Pus in alveolar bone periapical
Can spread through PDL to periosteum

Question 27

A 30-year-old male patient consulted a dentist about a swelling in the region of his upper lip. Objectively: the face is asymmetric because of upper lip edema, nasolabial fold is smoothed. Mucogingival fold of the upper jaw vestibular surface in the region of the 11, 12, 21 teeth is smoothed, hyperemic. Palpation is painful. Fluctuation is present. The patient was diagnosed with acute purulent periostitis of the upper jaw satrting from the 21 tooth. Choose the treatment tactics:

Answer 27

Preservation of the 21 tooth, periosteotomy, anti-inflammatory therapy

Question 28

A 40-year-old patient with mandible fracture consulted a doctor 3 weeks after immobilization of fragments because of pain and body temperature rise. Objectively: a slight swelling in the mental region, mucous membrane of alveolar process in the area of the 21|12 teeth is hyperaemic, edematic, palpatory painful. Overtooth splint on 54321|12345 teeth is in satisfactory condition, no occlusion abnormalities were detected. The patient was diagnosed with acute purulent periostitis of mandible. What surgical action is indicated?

Answer 28

A. Lancing of abscess to the bone

Question 29

A 23-year-old patient complains of pain and swelling in the region of a central incisor which was injured some time ago. After clinical and radiographic exami- nation the patient has been diagnosed with acute purulent periostitis of the upper jawmaxilla extending from the 11 tooth; radiograph shows a slight wideni- ng of periodontal ligament space of the 11 tooth. Choose the best method of treatment:

Answer 29

Subperiosteal abscess opening, endodontic treatment of the 11 tooth