Understanding Tooth Infections and Why Quick Treatment Matters
Hey guys, this is Dr. Michael Hardcastle from Village Dental Care in North Dallas. I routinely get a lot of questions about various aspects of dentistry. Today I want to talk to you about a recent question that I got about tooth infections.
What is a tooth infection and how does it develop?
Generally speaking, there are two types of tooth infections. The most common is when the nerve in the tooth dies. Dead nerve tissue in a tooth is a wonderful food source for bacteria in your mouth that are just naturally occurring. They feed on that food source, creating a pus pocket in the bone at the tip of the root. That's the most common type of tooth infection.
There are other ways you can get a similar infection, like a crack in a tooth where bacteria will inhabit the crack and lead to an infection, which usually ends up killing the nerve too. The infection can spread not just from the tip of the root but up the side of the root and into the bone until it gets large enough to show on the gums. The other type of infection is related to the soft tissue or the gums around the tooth, commonly called a periodontal infection, where the gums are infected. The way we treat each of these types of infections varies based on what the actual infection is.
What are some common symptoms of a tooth infection?
First, just for full transparency, it's a misnomer. There are actually a lot of tooth infections that have no symptoms, which is one reason for routine dental visits and the routine X-rays at your hygiene visit. When you get your teeth cleaned and X-rays, we're looking for many things, including any sign of a tooth infection you wouldn't know about. If we find an infection with no symptoms, we call that a chronic infection.
If you're having pain, it's called an acute infection. Acute infections often cause symptoms like throbbing or pain when you chew. Some people think, "Oh, my tooth is really sensitive when I drink cold things," but that often means the nerve is alive, so you probably don't have a dental infection.
However, you might have a gum infection, which you'd notice by bleeding or swollen gums. Sometimes the infection from a dead nerve will grow large enough to develop a pimple on the gum, causing discomfort or a bad taste. If you see or experience these symptoms, be sure to see a dentist to find the right solution.
How does a dentist tell the difference between a cavity and an infection?
That's a great question, but it's pretty simple when we're looking at X-rays in the dental office. A cavity typically shows up as a dark spot on the X-ray in an area that shouldn't have one. Certain areas of the tooth, like where the nerve is, show up dark on the X-ray. If you see a dark spot in a part of the tooth that shouldn't have one, it's most likely a cavity. However, that doesn't mean you'd have an infection. If the cavity grows deep into the tooth and affects the nerve, causing it to die, we would see an infection as a dark spot in the bone surrounding the tooth. It depends on where the dark spots are on the X-ray.
What are the important risks you should be aware of if you leave a tooth infection untreated?
The classic example is that if somebody's in pain, they will seek treatment. But if you have a chronic infection and don't seek help because you didn't know it was there and you're not seeing a dentist routinely, that's different. The infection will continue to grow, filled with bad bacteria that can enter your bloodstream.
Once in the bloodstream, they can go anywhere in your body, potentially landing in your heart. If you have poor circulation within your heart, the bacteria can build up and lead to an infection inside your heart, commonly on a valve.
Some people know they have valve problems, others don't. You could end up with a serious condition, potentially an infected heart valve. The plaque bacteria in your arteries that build up with cardiovascular disease often originate in the mouth, adding to arterial plaque buildup, putting you at risk for cardiovascular problems.
There are many other medical problems related to poor dental health. It's very important to get these problems treated so they don't spread. Within the mouth, the infection grows, destroying more bone, causing more teeth and bone loss around that tooth, and leading to serious conditions. If you like your teeth, you don't want to affect more teeth than necessary.
Early treatment is important. From a systemic standpoint, the medical community now knows the importance of good dental health before certain surgeries. Dentists need to give clearance for heart surgery, joint replacement surgery, and other procedures to ensure no infections are present.
What are the signs or symptoms that a person might know that a dental infection has spread to other parts of the body?
Generally, that's not an easy question to answer, but there are conditions, including dental infections, that a person may recognize as general lethargy. You're tired, lacking energy, motivation, and the desire to do what you used to. That could be related to poor dental health problems, or it could be related to many other things such as hormone imbalance or systemic disease.
We have to look at the whole picture since everything is connected. If you're feeling low energy and not at the same health level as before, a dental checkup and a physical with your doctor are good starting points. Ensure you get a comprehensive evaluation. If you have dental problems, get those treated, especially infections, but don't neglect a physical with your doctor to check for other potential causes of symptoms.
Can some dental infections be life-threatening?
Yes, some dental infections can be life-threatening, particularly those related to the dental space above the shoulders. Swelling in the lower or upper face can cause your eye to swell. If swelling under your eye causes it to start swelling shut, that's a serious dental infection. There's a nerve that comes out right under your eye, and if an infection causes your eye to swell, it can force pus under pressure into the canal where the nerve came from, leading to a life-threatening brain infection.
Any swelling causing the eye to swell should immediately be treated in the emergency room. Similarly, if you have a swollen lower tooth that causes neck swelling, that becomes life-threatening as it puts pressure on your airway. In such cases of face or neck swelling, go straight to the emergency room. You can give your dentist a courtesy call, but prioritize getting to the emergency room.
What treatment options are available if you have a tooth infection?
It depends on the infection and the dentist's recommendation. If a cavity has caused an infected tooth due to a dead nerve, the treatment recommendation is a root canal and a crown, provided the tooth appears strong enough to save.
A root canal involves removing the dead nerve from the tooth's root, eliminating the bacteria's food source, sanitizing the inside of the tooth, and sealing it off. Afterward, the tooth is weaker with a hole, so a crown is placed on it to prevent breaking.
If the cavity is too large to support a crown, an extraction is recommended, followed by replacing the tooth to maintain chewing function and prevent teeth from shifting. Options for replacement include a removable partial, a fixed bridge, or a dental implant. Dental implants are popular due to their high success rate and minimal collateral damage to other teeth. They function and maintain like a natural tooth.
Do I need antibiotics for a tooth infection?
It depends on the infection, the dentist, and their practice philosophy. In my office, every infection gets antibiotics. Through practice and recommendations from various experts, I find the best healing results and most comfortable healing period occur with antibiotics. However, antibiotics without treatment are not a solution; they are an adjunct to healing the infection along with your immune system after removing the bad tooth or dead nerve.
What are the signs of an infected wisdom tooth?
Infected wisdom teeth are common in people in their late teens to mid-20s. The most common symptom bringing people in is pain, sometimes accompanied by swelling. Swollen, painful gums around the wisdom tooth are common, but symptoms vary from person to person. Some might experience facial swelling or stiffness when opening their mouth, or even an earache due to the nerve connections. If a doctor finds nothing wrong during an ear examination, they might refer you to a dentist, as they understand the connection being discussed here.
How is an infection treated when a wisdom tooth extraction is necessary?
It depends on the severity and symptoms. Sometimes, the gums over a lower wisdom tooth get infected due to chewing from the top wisdom tooth. Trauma from chewing causes the gums to become painful and infected. In such cases, I might find red, swollen, painful gums with an indentation from the top tooth and pus oozing around it.
Often, as an emergency treatment, we'll extract the top wisdom tooth, prescribe antibiotics, and schedule the more complicated lower wisdom tooth extractions or refer the patient to an oral surgeon. Not all general dentists remove wisdom teeth, but they should refer you to an oral surgeon if needed. Antibiotics, saltwater irrigation, and other measures help, but nothing replaces treatment.
What should a patient do if they're experiencing pain or a swollen jaw?
If experiencing swelling, a patient might suspect an infection. The number one thing to do is see a dentist. If you don't have one, I'd love to help, but it's essential to see a dentist somewhere. We'll take X-rays, evaluate the area, and make the best recommendation for the situation.
In my office, extraction is the last resort. If a tooth can be saved with a good prognosis, that's always the best treatment. Different dentists might have different opinions due to varying experiences, but most will recommend something similar to their colleagues. Ensure you trust the dentist and that the recommendation makes sense. Get the infection treated to avoid adverse effects.
If you’re looking for dental care you can trust, call us at (972) 992-5223 or email [email protected]. We’re here to help you have the smile you've always wanted!