When a localized area of pus, called an abscess, develops in or around the root of a tooth, this provides the opportunity for bacteria to enter nearby blood vessels. This can lead to a potentially life-threatening blood infection, especially in people with an impaired immune system. Good oral care is the key to keeping your teeth and gums healthy and free of abscesses.
Tooth Abscesses Develop
It is estimated that there are about 700 different types of bacteria that make up the over 6 billion bacteria living in your mouth, according to an article published in "Clinical Microbiology Reviews" in January 2009. A tooth abscess most often results from a crack in the tooth or a cavity caused by tooth decay. This exposes an inner layer of the tooth called dentin. Bacteria can then infiltrate microscopic tunnels in the dentin and enter the root canal in the center of the tooth. The canal contains a tissue called pulp, which includes cells, nerves and blood vessels. When bacteria enter the pulp, they can set up a localized infection, forming an abscess. This infection starts in the root of the tooth but can extend into the surrounding area. Less commonly, severe gum disease can also result in a tooth abscess.
Bacteria Enter the Blood
As bacteria from an abscess travel into blood vessels, they enter the general bloodstream -- a condition known as bacteremia. When bacteria enter the blood, they are usually rapidly destroyed by the body's immune system. But in some people, especially older individuals, people with immune systems impaired by HIV or chemotherapy or those with diabetes, the immune response is unable to adequately destroy the bacteria. Sometimes, the bacteria will travel through the blood to set up an infection primarily in a certain area of the body, such as the lungs -- causing pneumonia -- or the brain -- producing meningitis. At other times, the bacteria will cause a more generalized blood infection.
When Blood Infection Occurs
When bacteria produce a generalized infection in the blood, this is known as sepsis or blood poisoning. Sepsis produces a massive, full-body response by the immune system in an attempt to fight the infection. Low blood pressure, poor blood flow and excessive blood clotting can occur, which produce dysfunction or even complete failure of multiple organs in the body. The kidneys, liver and lungs are examples of organs that are often affected.
The number of people who develop sepsis from a tooth abscess is not known. However, it has been estimated that severe sepsis impacts over 750,000 individuals yearly in the United States and up to 19 million worldwide, according to an article in the August 2013 issue of "The New England Journal of Medicine." Death occurs in up to 30 percent of people with severe sepsis.
Recognizing a Tooth Abscess or Sepsis
A tooth abscess typically causes a severe toothache. The tooth is often extremely sensitive to hot or cold temperatures and any pressure on the tooth, as occurs when chewing. Other symptoms can include swelling and redness around the tooth, swelling extending into the face or neck, swollen lymph nodes in the neck and a bad taste or smell in the mouth. Difficulty breathing or swallowing may occur if the infection spreads into the throat. A mild to moderate fever may occur with a tooth abscess, although a high fever suggests that a blood infection may be present. Sepsis may also be recognized by the presence of chills, a fast heart rate, nausea or vomiting. When severe, sepsis typically produces a low blood pressure, lightheadedness, confusion, loss of consciousness and difficulty breathing.
Prevention Is the Key
At the beginning of the 20th century, 10 to 40 percent of individuals who developed dental infections died, according to an article published in "Journal of Medical Microbiology" in February 2009. With the discovery of antibiotics and advances in dentistry, deaths have been significantly reduced. But what has not changed is the potential for oral bacteria to cause cavities, gum infections, dental abscesses, bacteremia and sepsis. These conditions can now be prevented with regular oral home care -- brushing and flossing -- and addressing dental problems as soon as they develop.
When to Seek Treatment
See your dentist if you have a severe toothache or any other symptoms suggestive of a tooth abscess. Treatment will likely include antibiotics. Depending on the severity of your abscess, you may also require a dental procedure, such as drainage of the abscess, a root canal treatment or removal of the tooth. Early treatment is important to prevent the development of serious complications like a blood infection. Seek immediate medical care if you have a high fever, difficulty breathing or swallowing, confusion, lightheadedness or loss of consciousness.
- Journal of Medical Microbiology: The Microbiology of the Acute Dental Abscess
- The New England Journal of Medicine: Severe Sepsis and Septic Shock
- Clinical Oral Investigations: Hospital Admissions for Pneumonia More Likely with Concomitant Dental Infections
- Clinical Microbiology Reviews: Microbiology of Odontogenic Bacteremia: Beyond Endocarditis