Dental Infection And Abscess

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Your mouth is of course a portal to the inside of your body, it is however, in spite of this, a relatively strong safeguard against infection. Your mouth and teeth are bathed in a constant wash of saliva which is strong enough to trap and deal with most incoming infections and rarely does invading bacteria that is breathed in manage to get hold of your teeth or gums. However, it is true that your teeth are packed with nerves and delicate fibres, which is why, a dental negligence, while only affecting a small area of the mouth, is very painful and can be debilitating. 

Dental infection and abscess though are frequently occurring infectious processes. The fate of the infection, it can be said is very much dependant upon the following factors; first, the virulence of the bacteria, then the hosts resistance factors, and finally the relative health of the individuals local anatomy (local that is to the site of infection). Acute dental abscess is what microbiologists refer to as a polymicrobial infection, meaning that it rarely is one sort of bacteria but a host of organisms that have different functions. Anaerobes, such as anaerobic cocci, Prevotella, Fusobacterium species, thrive in environments where there is no oxygen available, in some of these organisms may actually die off if oxygen is present (or introduced). There are also, what scientists would call facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group. These creatures take whatever oxygen may be present and use it to construct a product called ATP. ATP is foodstuff which other bacteria may then feed on. Also various and numerous organisms have been identified as potential pathogens in a list too long to produce here.  

A dental infection then is not an overnight creation, the assembly of the various factors that are necessary to make the conditions right for the infection to thrive may take months and months to develop. To you though, as a patient this slow growth is usually completely unnoticeable. Typically, it begins with poor oral hygiene but it doesn’t have too, a small caries (decay) in the tooth or other dental problem may be an enabler for the infection to take hold . Ultimately tiny gaps between the tooth and the gum can allow collected food debris to invade and penetrate beneath the gum, this area is protected to a degree from the body’s saliva and here the bacteria that may be present can feed in relative comfort on this food debris, growing into a larger culture. 

After a while this may result in, sensitivity, or extreme pain in the areas where the infection occurs. It is worth noting that when speaking to dental professionals about the infection it is true that that they don’t expect you to be able to name each tooth by its scientific name or by its dental label. However, it is worth at least labelling your mouth upper left, upper right, lower left, lower right. This may well be of significant value not just because it demonstrates some common sense but also acts a secondary safeguard to wrongful extraction. 

What are the Early Signs and Symptoms of Dental Infections. 

As stated, pain or an area of sensitivity is one of the first signs of a problem. Left without treatment, what may have been an uncomplicated dental problem such as a small filling or a tooth impacting another, may well result in an infection that can carry with it pain, inflammation and even a high fever that indicates your body is attempting to fight the infection. 

You might also notice a foul taste in your mouth or bad breath that won’t go away with brushing or rinsing with a mouthwash. In some cases, you may have a broken or fractured tooth, but infections can often go undetected deep within the core of teeth, without any outward signs other than pain and swelling.

Some signs of infection include:

Throbbing pain in the tooth, jawbone or neck

Inflammation (swelling) of the face

Sensitivity to hot or cold fluids and foods

Teeth that are tender to bite down on or to touch

Fever / temperature or feeling generally unwell. 

Swollen lymph nodes in the neck (principally in the neck but you could have swellings anywhere including the groin and armpit). 

There can be little doubt that if you have both a fever and inflammation or swelling, or you have trouble breathing or swallowing, you should seek medical attention immediately. That really means seek dental help immediately but I you cannot get to see a dentist then see your GP. It may be that your condition warrants an urgent referral to the Dental Hospital. If you just show up at your accident and emergency department it may just result in the same referral anyway, better by far to simply see your gp or dentist. If there are issues with breathing though, or if you have doubt then by all means proceed straight to your nearest hospital or call 999.

What is the difference between an infection and an abscess?

A dental abscess is a collection of pus material that can form inside the teeth or in the surrounding gums and bone that holds the teeth in place. It’s caused by a bacterial infection. A tooth abscess is an infection inside the tooth itself, and an abscess at the end of a tooth, which is more appropriately referred to as a periapical abscess. If you think you might have a dental abscess, it’s really important to see your dentist as soon as possible, because abscesses don’t go away by themselves. Not only can they be very painful, but without prompt treatment, you could end up having to have your tooth extracted.

Where can you get a dental abscess?

Generally an abscess can affect any tooth or any area of the mouth but generally they tend to form at the very bottom of the root of the tooth. The tissue here is very complex and forms a semi dense soup of minerals and other materials which makes the tooth very vulnerable to bacterial infection that likes this area because of its protected position and propensity to have large amount of “food funds” to take from.

What are the symptoms of a dental abscess?

A dental abscess may give you symptoms such as:

An intense pain or toothache in the affected area; this may spread to other areas, like your ear (although not every abscess is painful) this cannot be underestimated, often patients will describe the pain as “the worst that they have ever suffered” or “unbearable” a typical pain score is 10/10 or even 11/10. 

You should also look out for heat, and inflammation in the affected area, sometimes the whole face can be effected. 

Just like an infection there is typically sensitivity to hot and cold food and drinks

What Should I do about my dental abscess?

Make an appointment with your dentist as soon as possible, and tell them you think you may have a dental abscess – remember, the longer you leave it the worse it will get, the condition will not fix itself or settle down, the pain will continue and requires you to take appropriate action. 

How will my abscess be treated? 

It depends on the abscess and how large it is but typically, antibiotic medication is usually the first line of attack. Expect to see a amoxicillin prescription or even a metronidazole (both general wide spectrum antibiotics) but there are literally hundreds of potential antibiotics that could be tried. 

It may be that these work to a large degree and the infection (or the pain) seems to dissipate. Be careful though, frequently these infections are far from simple and whilst you may have beaten them back with medication, they often linger – especially if there is a underlying dental problem that goes unfixed. 

A dental surgeon may also advise a root canal treatment. This essentially cleans out the roots of the tooth and replaces them with strong medicants. These kill off the remaining infection and then the roots can be backfilled with material which will further resist infection. 

Finally, if the infection is strong and the tooth is compromised beyond rescue the dentist can extract the tooth and thus remove the shelter (and the source of minerals the infection is feeding on) and this along with good oral care is usually enough to kill the infection. 

What if I am not registered with a Dentist?

Well there is no time like the present, you need to get a dentist and emergency dentists have little treatment options for you. Perhaps the best thing that can come from a dental infection or abscess is a resolution that this will never happen again. Register with a dentist and undergo regular treatment, regular check-ups and regular descaling and polishing and ensure that you prioritise your oral health brushing and flossing regularly with a good brush (electric are best). This sort of approach cannot guarantee that you will not get an infection in the future, but it will make them rare and if you do get one dealing with it will be much easier. 

In the short term though, anything that promotes the swelling to reduce is going to be useful in terms of controlling pain. NSAIDS such as Ibuprofen are very efficient but only if you have no problems taking them. Cold presses can reduce the inflammation (never hot) and can have an easing effect on the pain as well. Mouthwashes may assist a little but don’t be tempted by Homeopathic remedies to put into the tooth cavity or gum. The same applies to Internet Home Remedies, there is no substitute for proper dental care. 

What if a dentist caused this infection?

There are of course some circumstances in which an infection can be caused by negligent dental practice, fortunately this is rarely the case but for some people it will be true. However, 2 things spring from this, 1 you still need to get your condition under control. This is number 1 on your to-do list, there is no point talking to a lawyer while your face is blown up and you are in so much pain you cannot think or speak clearly and No 2 on the list is contact a lawyer on after you have sorted yourself out. That way at least the full picture can be known. If in doubt contact me at www.law-med.co.uk or on 0800-009-6312. 

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