DISEASES OF THE TEETH AND ALVEOLAR PROCESS : THE TEETHING TROUBLE OF THE TEETH (DENTITIO DIFFICILIS). And PERICORONITIS - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Infection, sometimes the wrong location prorezawategosa of the tooth or adjacent teeth.
The pathogenesis. Shortness of teething occurs mainly during the eruption of wisdom teeth, manifesting itself in the form of the retromolar periostitis. Periostitis develops due to infection under the gum cover, lying on the chewing surfaces partially prorezawategosa tooth. Usually first erupt front bumps, and, thus, the posterior tubercles remain covered by a flap of mucous membrane in the form of a hood.
Symptoms. Subjective phenomena - painful mouth opening, increasing trismus, pain in the jaw and submandibular region. With the spread of edema in peripharyngeal area the patient complains of painful swallowing (angina dentaria). When viewed objectively the oral cavity is found acutely inflamed ulcerated flap of the mucous membrane covering the posterior tubercles of the wisdom tooth. Swelling of mucous in circumference, quite often the pus from the gum pockets. Depending on the stage of the disease detected some degree of trismus until full details of the jaw, preventing inspection of the site of the lesion. On external examination and study notes collateral swelling of the cheek, painful and enlarged submandibular lymph glands. General condition of the patient in the acute stages indicates varying degrees of intoxication.
Course and complications. Retromolar periostitis, beginning with a slight inflammation of the mucous membrane and periosteum, gradually, sometimes rapidly increases, giving a sharp bursting pain, soon becoming complicated by lockjaw. In fact not only proizvodite tooth, but also partially impacted or standing incorrectly can create a picture of the "difficulty of eruption". Consequently, relapses of the disease, the frequent repetition of which forces you to remove the tooth (cold period). Serious complications, it is important to keep in mind the possibility of the development of osteomyelitis and phlegmons in the submandibular triangle (parotid, parapharyngeal). In protracted cases, and lack of maintenance (mechanotherapy) trismus may be in the form of long-term complications.
The recognition is based on detection of the characteristic swollen hood of the mucous membrane covering the crown of the tooth, and phenomena of periostitis in the area of the tooth wisdom. Trismus often complicates the examination of the oral cavity. In such cases, the radiograph facilitates the ability to eliminate other inflammation in the teeth. In addition, recognition should be borne in mind inflammation colosseu cancer.
Prediction, in view of the frequent complications acute and sometimes protracted nature of periodontitis at the difficult cutting of a wisdom tooth, serious. Possible, although rare fatal due to further development of phlegmonous inflammation (sepsis).
Treatment in uncomplicated cases: after kochanezycie mucosa by smearing (injection is contraindicated) hanging over the chewing surface of the tooth hood cut with scissors or a knife in the direction from front to back so that the entire chewing surface of the tooth was released from the mucosa. Then through an incision of the mucosa behind the molars on the distal surface having a narrow (1 cm) strip of iodoform gauze. Good effect is the burning the hood hanging over the crown of the tooth, with the help of cautery. When expressed phenomena of abscess, it is recommended to make the incision in transition folds. In addition, prescribed heat in the form of rinses and warmer, blue light, Solux and painkillers. Extraction of the tooth in the acute period is not recommended because of fears of infection of the extraction wound and the possibility of generalization of infection.
In the presence of trismus the primary intervention is sometimes impossible, and in these cases you have to limit incisions in the mucosa close to the bone lesion. In cases of cellulitis shown the autopsy hearth abscess lesions, sulfanilamide, penicillin.