What is dental periostitis – symptoms, treatment, and causes

Dental periostitis is a painful and serious inflammatory condition that affects the periosteum—the thin membrane surrounding the jawbone or maxilla. The periosteum plays a key role in dental and bone health as it is responsible for blood supply, nerve endings, and bone regeneration. When this membrane becomes inflamed, symptoms can be intense and include pain, swelling, and even fever. If left untreated, dental periostitis can lead to severe complications, such as the spread of infection or sepsis. In this article, we’ll explore its causes, symptoms, treatment methods, and the consequences of neglecting this condition.

What is the periosteum and what is its function?

The periosteum is a thin yet vital membrane that covers bones, including the bones of the jaw. It consists of two layers:

• Outer layer – rich in blood vessels and collagen fibers, which supply nutrients to the bone;
• Inner layer – contains osteoblasts, the bone-forming cells responsible for regeneration and healing.

This membrane is highly sensitive due to numerous nerve endings, making periosteal inflammation extremely painful. While teeth themselves don’t have periosteum, it surrounds the bone structures that support them and is essential in dental recovery and healing.

What is dental periostitis?

Dental periostitis refers to inflammation of the periosteum around the bones of the jaw or maxilla, usually triggered by bacterial infection or trauma. In dentistry, it is most commonly associated with infected teeth.

There are two types of dental periostitis:

• Acute periostitis – characterized by sudden, intense pain and rapid onset of symptoms;
• Chronic periostitis – involves milder, persistent inflammation, potentially causing permanent changes to the bone.

Periostitis in the jaw typically results from bacterial infection, but can also be linked to mechanical trauma or complications following dental procedures.

Causes of dental periostitis

The most common cause of periostitis is bacterial infection, often stemming from untreated dental problems. The main triggers include:

Bacterial infections

Bacteria from tooth decay, pulpitis, or periodontal disease can spread from the tooth to surrounding tissues, including the periosteum.

Untreated tooth decay

Advanced decay that reaches the pulp can cause tissue necrosis and the spread of infection to the periosteum, resulting in inflammation.

Pulpitis

Inflammation of the dental pulp, when left untreated, can develop into periostitis if the infection continues unchecked.

Post-extraction complications

Tooth extractions can sometimes lead to periosteal inflammation, particularly if the extraction site becomes infected. Poor oral hygiene or improper healing may worsen the condition, requiring antibiotics and cold compresses.

Mechanical injuries

Jaw fractures, trauma, or forceful impact may damage the periosteum, increasing the risk of inflammation.

Systemic diseases

Conditions such as diabetes, weakened immune systems, or sinus infections can predispose individuals to periosteal inflammation.

READ MORE: Ameloblastoma

Symptoms of dental periostitis

Symptoms can vary depending on whether the condition is acute or chronic. The most characteristic symptom is a throbbing toothache that worsens with pressure or while eating. Additional symptoms may include fever and pain radiating toward the temples or neck.

Acute periostitis symptoms:

• Intense, throbbing pain near the affected tooth
• Swelling of the face and gums in the inflamed area
• Red, sensitive gums
• Fever, fatigue, general malaise
• Swollen lymph nodes in the jaw or neck area
• Difficulty chewing or opening the mouth

Chronic periostitis symptoms:

• Persistent, dull pain
• Thickening and deformation of the periosteum
• Possible formation of fistulas (draining pus channels)

Diagnosing dental periostitis

Accurate diagnosis is crucial for effective treatment. A dentist will assess oral health, perform imaging tests, and review the patient’s symptom history. The diagnostic process includes:

• Medical interview – assessing symptom duration, pain intensity, and dental history
• Clinical examination – checking the oral cavity, gums, lymph nodes, and facial swelling
• Imaging – X-rays to evaluate bone and periosteum condition; CT scans (CBCT) may be used in complex cases
• Lab tests – blood tests may be required to measure infection markers

How to treat dental periostitis

Treatment focuses on eliminating the source of infection and relieving symptoms. A comprehensive approach usually includes medication and dental procedures.

Causal treatment:

• Root canal therapy – to remove infected pulp and save the tooth
• Tooth extraction – if the tooth is beyond repair

The type of treatment depends on the severity and extent of the infection. In some cases, surgical drainage or removal of necrotic tissue may be necessary.

Pharmacological treatment:

• Antibiotics – such as amoxicillin or clindamycin to combat bacterial infection
• Painkillers and anti-inflammatory medications – e.g., ibuprofen to reduce swelling and discomfort
• Antibacterial mouth rinses – chlorhexidine-based products for topical disinfection

In cases where an abscess forms, surgical incision and drainage may be needed to remove pus. In advanced stages, dead tissue or infected bone may have to be surgically cleaned.

Consequences of untreated dental periostitis

If left untreated, periostitis can lead to dangerous complications. These include:

• Development of a subperiosteal abscess
• Destruction of jaw or maxillary bone
• Spread of infection to sinuses or facial tissues
• Sepsis – a life-threatening systemic infection
• Meningitis – inflammation of the membranes surrounding the brain

Advanced periostitis can damage surrounding bone and tissue, spreading infection throughout the body and potentially becoming life-threatening.

Preventing dental periostitis

Preventive steps include:

• Brushing and flossing teeth regularly
• Visiting the dentist at least twice a year
• Treating cavities and other oral issues early
• Avoiding facial trauma
• Maintaining a healthy, immune-supporting diet

Summary

Dental periostitis is a serious condition that requires immediate attention. It is often caused by bacterial infections resulting from untreated decay or pulpitis. Early symptoms such as pain, swelling, or fever should prompt an urgent dental visit. With proper diagnosis and timely treatment—including antibiotics, root canal therapy, or extraction—complications can be avoided. Maintaining good oral hygiene and scheduling regular dental check-ups are key to preventing periosteal inflammation and protecting your oral health.