Stomatolog y

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8.7 Osteitis and Osteomyelitis of the Jawbones

Although there is a little difference between these two forms of the bony tissue inflammations from the pathological anatomy point of view, for the clinical classification the term osteitis means a localized, delineated inflammation of bone, while the term osteomyelitis (inflammation of the bone marrow) is used to describe a diffuse extension of an inflammatory process to a large extent.

Osteitis originates by transfer of infection from a gangrenous tooth root into a bony tissue around the tooth apex, after an extraction or an alveolar socket inflammation. Clinical signs are identical to those of an acute periostitis or subperiosteal abscess of the alveolar ridge. It is a painful disease, alveolar mucosa around the affected tooth is swollen, a purulent discharge appears and an internal fistula is formed.

Osteomyelitis of the upper jaw is usually restricted to the alveolar ridge and its course is similar to an extensive osteitis. It is accompanied by high fevers with shivering, pronounced edema of cheeks, upper lip and lower eye lids. The danger of this disease lies at a possibility of the inflammation transfer to veins of the face and possible infection of orbits and intracranial infection of sinus cavernosus.

Osteomyelitis of the lower jaw affects adults more often than osteomyelitis of the upper jaw. An acute inflammation extends rapidly into surrounding soft tissues. High fevers with shivering, teeth loosening at an affected area and puss discharge from alveolar sockets. A diagnosis is confirmed by hypesthesia or anesthesia of the lower lip (Vincent’s sign). An X-ray examination of the lower jaw does not show any significant changes during the early stage (up to 10 days). Only after this period, an irregular dense and light areas of the bony tissue (spotted bone) and a gradual necrotization of bone together with sequestra appear. Therapy includes a combination of surgeries (incision of abscesses, sequestrectomy) and high doses of antibiotics (Lincomycin). An immobilization of jaws is employed in cases of large damage of a jaw in order to prevent a pathological fracture.

Osteomyelitis of child’s age.

This disease has usually odontogenous causes (streptococcal or staphylococcal infections). Hematogenous infections or general infectious diseases are other etiological factors. Serious complications of this disease are disorders of jaws development that can result from an inflammatory process near the growth centers. Lateral deviation of jaws, microgenia, pseudoprogenia or ankylosis of the mandibular joint can occur. Osteomyelitis of either upper or lower jawbone at infants can be caused by a tooth’s germ, infected by injured oral mucosa or by a hematogenous way. During this very serious disease, a child suffers from high fevers and refuses food. If a therapy is not started on time, the disease could be lethal in several days.

Inflammations around the jaws belong to serious stomatologic diseases. They are treated preferentially by a surgery supported by a targeted antibiotic therapy. Prevention of these diseases is based on regular and specialized stomatological examinations and treatment.

9. Diseases of Salivary Glands

9.1 Salivary Glands Functions

Salivary glands of the oral cavity are the large paired salivary glands (parotid glands, submandibular glands, and sublingual glands) and small non-paired salivary glands, scattered at the submucosal connective tissue. According to their location, they are designated as lip, cheek, palatal, lingual and gum glands. The product of salivary glands is saliva which has numerous functions, such as:

  1. ensuring a moist and smooth surface of the oral mucosa, thus enabling transport of masticated food from the mouth to the digestive tract through the esophagus,

  2. saliva is the primary digestive fluid which activates digestion of starches by the enzyme amylase,

  3. participates on neutralization of acidic environment in the mouth,

  4. takes part in maintaining an integrity of the oral mucosa by producing glycoproteins and mucoids that reduce penetration of irritant substances from food, drinks, tobacco smoke etc.

Under physiological conditions, a man produces about 1.5 liters of saliva in 24 hours. This secretion is made by the parotid glands by 26% (serous saliva), submandibular glands by 69% (sero-mucinous saliva), and the sublingual salivary gland by roughly 5%. Salivation is controlled by vegetative nerves in such manner that parasympathetic neurons induce secretion of rather thin serous saliva, in contrary to the sympathetic neurons which induce production of viscous, mucinous salivation. The vegetative neurons come to salivary gland either along blood supply vessels (especially sympathetic nerves), or by means of large nerve fibers (for instance in case of gl. parotis by means of n. auriculotemporalis).

9.2 Examinations of Sialopathies

A diagnosis of sialopathies is based on a meaningful combination of data obtained from a patient’s anamnesis and clinical examinations of a salivary gland by palpation and aspection. X-ray examination of the salivary glands area helps in diagnostics of sialolithiasis (a simple X-ray picture, e.g. at occlusal projection onto the mouth base).

Examination by sialography that uses injection of an X-ray contrast substance (Lipiodol Ultrafluid) into salivary gland ducts, shows not only changes at the ducts (obstructions of filling), but also parenchymatous modifications (e.g. in cases of chronic inflammatory states or tumors). It also informs about the functional ability of a salivary gland to extrude a contrast filling under 60 minutes.

For diagnostics of salivary glands tumors it is possible to utilize a resolution power of the computer tomography (CT), radiometric examination (scintigraphy by technetium Tc 99m), ultrasonography, thermography (contact crystal or infrared thermography).

In cases of suspect tumorous lesions, a puncture biopsy or per-operational histological examination of cryosections is performed. Sialometry (the Škach’s method) provides objective data on salivary secretion and helps to distinguish hypo-, normo- and hyper-salivation. The lower limit of a normal, physiological secretion of saliva is 10 ml in 30 minutes.

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