DESCRIPTION

A dental infection is an inflammatory response of the dental pulp (pulpitis) secondary to caries lesions, periodontal pathology, and/or a history of dental trauma/dental treatment. Oral bacteria invade the pulp causing pulpitis, which can be acute (reversible pulpitis) or chronic (irreversible pulpitis) in nature. If left untreated, complete necrosis of the pulp tissue occurs, causing a collection of pus to form at the apex of the root (abscess).

EPIDEMIOLOGY

Dental abscesses account for 47% of all dental-related attendances at pediatric emergency rooms in the United States.

RISK FACTORS

• Social/biologic
  • Primary caregiver has active dental caries.
  • Primary caregiver has economic insecurity and low health literacy.
  • Frequent exposure (>3 times per day) between meal, sugar-containing snacks, or beverages per day
• Clinical
  • Visible caries, missing teeth, fillings
  • Visible plaque on teeth
• Protective
  • Lack of fluoride toothpaste
  • Lack of dental home/regular dental care

PATHOPHYSIOLOGY

• Most dental infections in primary and permanent teeth are a result of the advancement of dental caries into the pulp (nerve) tissue of the tooth.
  • Advancement through the separate layers of the tooth occurs due to production of lactic acid by a group of cariogenic oral bacteria (Streptococcus mutans) that metabolize sugar from diet and a lack proper oral hygiene.
  • As more lactic acid is created, the Ph of the oral cavity falls below the critical threshold of 5.5, which further enhances the production of cariogenic bacteria and continues the cycle.
  • If not appropriately addressed by nutritional/hygiene counseling, the mouth remains in an acidic environment, causing the demineralization of the separate tooth layers (enamel/dentin), until invasion of the pulp tissue occurs, causing an acute (reversible) or a chronic (irreversible) inflammatory response (pulpitis).
  • Reversible pulpitis is the diagnosis of a pulp tissue capable of healing with proper dental treatment (restorations) and/or pulpal therapy (partial or complete root canal therapy)
  • Irreversible pulpitis is the diagnosis of a pulp tissue that is incapable of healing, requiring advanced dental treatment (complete root canal) or extraction of the tooth.
  • If left untreated, necrosis of the nerve tissue occurs, ending in deposition of an abscess at the apex (root) of the tooth.
• Dental abscesses often remain localized and are “self-draining” through the development of a sinus tract or can spread locally to vestibular/gingival tissue, causing an intraoral swelling surrounding the offending tooth.
• Further spread of the dental abscess may also occur through cutaneous and subcutaneous soft tissue planes of the head and neck region, causing a diffuse extraoral swelling commonly referred to as facial cellulitis.
  • In these children, dehydration is a significant consideration; prompt treatment of the source of infection is imperative.
  • With infections involving the upper portion of the face, patients complain of pain, fever, and malaise, whereas infections of the lower face involve pain, swelling, and trismus (limited mandibular opening).
  • Most dental infections occur in the upper face; however, infections in the mandibular region are most frequent in older children.