Complications of periodontitis

Progression of periodontitis into acute inflammatory processes

Acute inflammatory processes of the maxillofacial region are often odontogenic in origin. If periodontitis is not treated in time or managed inadequately, the inflammation spreads beyond the root canal and periodontal ligament space, causing acute purulent periostitis and odontogenic osteomyelitis of the jaw.

The clinical picture of such conditions includes:

• Spontaneous pain, often throbbing in nature.
• Pronounced tissue edema and swelling.
• Discoloration of the skin and redness (hyperemia).
• Local temperature increase.
• Impaired swallowing, breathing, and speech (if the process is localized in the floor of the mouth, tongue, pharynx, or soft palate).

Clinical manifestations of odontogenic osteomyelitis

With the development of acute osteomyelitis of the jaws, specific symptoms are observed involving the teeth, oral cavity, and extraoral region:

1. "Multiple periodontitis" symptom: painful percussion is detected in several teeth simultaneously, including intact ones, whereas percussion of the causal tooth itself becomes less painful.
2. "Key" symptom: at the onset of the disease, the causal tooth is immobile, but soon loosens along with adjacent teeth.
3. Grade I–II inflammatory contracture: limitation of mouth opening due to involvement of the masticatory or temporal muscles.
4. Gingival changes: the mucous membrane is hyperemic and edematous; by the 3rd–4th day, it becomes cyanotic and pasty near the causal tooth. Due to the destruction of the circular ligament, the marginal gingiva detaches, and pus is discharged.
5. Bilateral periostitis symptom: cuff-like thickening of the alveolar part or process due to soft tissue edema from both the vestibular and oral sides.

Reaction of the lymphatic system: lymphadenitis and lymphangitis

Infection spreads from the inflammatory focus via lymphatic pathways to lymph nodes and vessels.

• Etiology of lymphadenitis: acute odontogenic lymphadenitis in adults depends on the port of entry of the infection and is frequently caused by periodontitis, alveolitis, periostitis, osteomyelitis, or infected cysts. Most commonly affected are the submandibular, submental, buccal, mandibular, parotid, and cervical lymph nodes.
• Acute serous lymphadenitis: accompanied by deterioration of general condition, body temperature rise to 37.3–38.0 °C, and swelling in the node area. The overlying skin is unchanged and can be easily pinched into a fold.
• Lymphangitis: inflammation of vessels in the presence of highly virulent flora. In acute deep (truncal) lymphangitis, bright red, broad streaks appear on the skin extending from the focus to the lymph node (e.g., along the facial vein over the masseter muscle). In perilymphangitis, the process spreads to the surrounding tissues with increasing edema and tenderness.

Class and exam questions

What else to study on this topic

• Features of diffuse acute osteomyelitis of the maxilla and anatomical reasons for lesser destruction
• Classification of lymphangitis by course and depth of lesion
• Non-odontogenic and primary lymphadenitis of the maxillofacial region
• Clinical picture of eruption cysts and follicular cysts during exacerbation
• Complications associated with suppuration of a follicle during difficult tooth eruption

Other topics in the "Additional Topics" section

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