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VERIFIED CONTENTAuthor: lek. dent. Krzysztof Górowski

Tooth gangrene is a colloquial term for pulp gangrene. Tooth gangrene is a disease of the tooth pulp (inflammation of the tooth pulp), which not only causes troublesome pain, but can also be a serious he alth hazard. What are the causes and symptoms of tooth gangrene? How is the treatment going?

pulp gangrene( tooth pulp inflammation ), or colloquiallytooth gangrenerequires quick diagnosis and implementation of the correct treatment.Gangrenethis is the state of decay of tissues in a living organism. Decay is conditioned by the presence of bacteria.

Dead tissue is an excellent place for the development of microorganisms, especially those that do not require oxygen for their development. The factors necessary for the formation of the decay process are the presence of dead tissue, appropriate humidity and temperature, as well as the presence of bacteria responsible for the decay of dead tissues. Gangrene can develop in any location of the human body that has contact with the outside world, e.g. in the skin (e.g. in the course of a diabetic foot), in the intestines or lungs.

Causes of tooth gangrene

The hard tissues of the teeth, such as enamel and dentin, protect the living tissue inside the tooth, the so-called pulp. Despite this protection, pulp necrosis occurs in some cases. This condition may be caused by pathological stimuli affecting the tooth.

Most oftenpulp necrosisdevelops as a result of tooth decay. Caries is a bacterial disease in which mineralized tooth tissues are destroyed by acids produced in the metabolic processes of microorganisms. Initially, when the carious lesion is small, bacterial toxins penetrate towards the pulp, causing its irritation and development of inflammation. In the initial phase, it is a reversible phenomenon, which disappears after the irritating stimulus is removed (in this case, after the preparation and filling of the carious cavity).

Teeth with dead pulp are a frequent site of gangrene development.

Inflammation gradually becomes irreversible if not treated quickly enough, and then becomes irreversible.necrosis of the pulp. In the environment of the oral cavity (high humidity, appropriate temperature) the dead tissue is quickly infected with putrefying bacteria. The pulp quickly loses its normal appearance and becomes a gray-brown, amorphous mass with a very unpleasant odor. In the metabolic processes of bacteria and during the breakdown of tissues, many highly toxic chemical compounds are produced that have a harmful effect on the human body (including cadaverine, putrescine, neuridine).

The main group of bacteria responsible for the formation of gangrene of the tooth are G (-) anaerobic bacteria. Initially, gangrene may cover only a part of the pulp, e.g. the pulp located in one of the root canals. In such a situation, the pulp not affected by the decay of gangrene may remain alive, but it is in a state of irreversible inflammation.

What are the symptoms of gangrene of the tooth?

Pulp gangrene can develop in the tooth without any obvious symptoms . The asymptomatic course is especially characterized by gangrene in which the tooth chamber remains wide open. This allows the free flow of toxic compounds into the mouth.

The situation changes dramatically when tooth gangrene develops when the chamber is closed or the chamber is closed for some reason, e.g. due to residual food debris. The increasing pressure in the tooth cavity causes pain. Pain is described by patients as spontaneous, sharp, pulsating, often radiating towards the ear or temple. The pain is diffuse, often the patient does not have to indicate which tooth is the cause of the ailment.

A tooth with a defect reaching the pulp may be visible in the mouth. Gray-brown masses are visible in the defect. In many cases, the causal tooth differs in color from the rest of the dentition. It becomes darker, becomes gray or brown.

Gangrene is accompanied by an unpleasant, unpleasant smell from the mouth. Often, patients also report an unpleasant taste in the mouth. In the course of pulp gangrene, the inflammation almost always affects the tissues around the apex of the root.

It causes the feeling of the tooth being blown out of the socket, the feeling of the tooth being too high, as well as peripheral pain examined by the dentist. The X-ray image taken in the dentist's office may show an extensive defect reaching the pulp. In the case of advanced inflammation of the periapical tissues or a forming periapical abscess, the radiograph will show a brightening in this area.

In the course of tooth gangrene, general symptoms such as raised body temperature or bad ones may appearwell-being.

Gangrene of the pulp - treatment and prevention

In the case of diagnosis of pulp gangrene, it is necessary to implement appropriate treatment. If the tooth is suitable for conservative treatment, it is subject to endodontic treatment. It is a multi-stage and time-consuming treatment. In the initial stage, the infected tooth pulp is removed and the root canal system is thoroughly cleaned and disinfected.

You may need to apply a root canal dressing for a while. After this stage, properly prepared tooth canals are filled with a special material (most often gutta-percha is used for this purpose). If the tooth canal system has been properly filled, the tooth crown damaged by caries should be rebuilt.

Depending on the damage to the tooth, conservative or prosthetic hard tissue reconstruction is required. Unfortunately, endodontic treatment of adults is reimbursed by the National He alth Fund only in the anterior region (i.e. from canine to canine), the remaining teeth must be treated at your own expense. In the event that endodontic treatment cannot be performed for some reason or the remaining amount of tooth tissue is not sufficient to rebuild it properly, a surgical procedure is indicated. Most often the tooth is removed completely. Hemisection or radisection surgery may also be considered.

In the course of pulp gangrene, the administration of an antibiotic may turn out. However, it will not replace the treatment of the causal tooth, which must be performed.

Dental gangrene prevention is based on early diagnosis and treatment of pulp inflammation. Undoubtedly, the prevention of caries, control visits to the dentist and early treatment of cavities will avoid serious complications.

Tooth gangrene - complications

Tooth gangreneis caused by a bacterial infection. Microorganisms from the gangrenous pulp enter the body through the apical opening, causing many threats. In the course of pulp gangrene, abscesses may form, initially they are located within the so-called bone area. periapical abscesses.

With time, it spreads to adjacent tissues, creating odontogenic abscesses, sometimes of considerable size. Such abscesses pose a threat to he alth and even life.

Bacterial infection spreads through the blood, affecting the entire body. Many diseases, such as infective endocarditis, rheumatoid arthritis and glomerulonephritis, have been linked to pathogens of dental origin.

People preparing for non-dental surgical procedures should also be examinedby a dentist in order to exclude odontogenic foci of infection that may cause further complications.

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Dentistry and Orthodontics