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VERIFIED CONTENTAuthor: Mateusz Król

What is a stereotypical visit to the dentist associated with? A specific smell and pain. What are the patients most often visiting the dentist with? Already with pain and of a very diverse nature. This is a signal that the situation has become very serious and requires decisive intervention.

The formation of subsequent pathological states of teeth is a series of reactions of the body to pathogenic bacteria penetrating through the tooth into the tissues. Everything, most often, starts with untreated caries (other causes can be periodontal disease and dental injuries). After breaking through the entire thickness of the enamel and dentin, the bacteria reach the tooth cavity in which the tooth pulp is located. The pulp is the tissue that contains the blood vessels and nerves that nourish the tooth and are responsible for the sensation within the teeth.

Someone may ask, "But other tissues can handle bacteria quite well, why not pulp?" As a result of irritation by bacteria, the pulp becomes inflamed, either reversible or irreversible.

Reversible inflammationsare characterized mainly by the fact that there is no spontaneous pain, but only prolonged provoked pain. In this state, the tooth promises to be cured with quick intervention, removal of caries and insertion of a medicine - an odontotropic material (a material that stimulates the pulp to deposit an additional layer of dentin to isolate the pulp from stimuli from the oral cavity and filling). This is called "biological treatment" that allows you to keep the tooth alive.

Failure to react quickly turns inflammation intoirreversible . This is a situation in which the pulp is inhabited by bacteria and the inflammation worsens.

One of the elements of inflammation is swelling - the pulp becomes swollen, hyperemic, and because it is closed in the hard tissues of the tooth, the pressure in the pulp increases. This results in pressure on the nerves, which is manifested in very severe pain, and pressure on the blood vessels, which leads to necrosis due to circulatory disorders. The pain grows more and more … until it stops hurting. Why? The body fought infections?

Unfortunately no, this is a signal that the pulp has died - there are no living, he althy vessels and nerves in it. On the "corpse"pulp, other bacteria begin to multiply and decompose the tissue - gangrene occurs. Pulp gangrene is one of the most foul-smelling dental conditions.

If endodontic treatment has not yet been implemented or the tooth cannot be treated with a root canal (economic, anatomical, extensive damage to the crown and many others), and the tooth has not been removed, the bacteria are preparing the next attack, beyond the tooth .

Another attack of pain and acute inflammation of the periapical tissues

Some time after the pulp dies, the bacteria begin to attack the tissues beyond the root tip with their toxins. The signal that the germs are starting to work outside the tooth is pain again. This pain is characteristic - not only does it hurt on its own, there is a feeling of the tooth sticking out of the socket, but it can be exacerbated when biting or even lying down. There is a reaction from the lymph nodes.

How does the body react in such a situation? Serum exudate (protein filtrate from blood vessels) accumulates in the apical area - then we are dealing with acute serous inflammation. Failure to treat it in this situation leads to the formation of an abscess. To understand purulent inflammation, you need to know the pus itself.

Pus is a type of exudate with a yellowish or brown color that consists of proteinaceous fluid, dead leukocytes (mostly neutrophils), other cells, and bacteria. This can be referred to as the cellular cemetery, which is formed when the enzymes of white blood cells are released. In acute purulent inflammation of the periapical tissues, pus accumulates, which forms its reservoir within the bone, i.e. the abscess.

What are the symptoms of an abscess? It depends on the type of odontogenic abscess. It is distinguished by:

  • periapical and intraosseous abscesses
  • subperiosteal abscesses
  • submucosal abscesses.

Abscesses have the ability to expand if they are not drained. In the beginning, we are dealing with a periapical abscess. The thing about abscesses is that they hurt a lot. The patient feels like a tooth is blowing up, the pain intensifies while lying down, the heat intensifies the symptoms (cold brings relief), the lymph nodes become painful, the general condition worsens (fever and malaise may appear).

When the abscess begins to "grow" and breaks through the bone beneath the periosteum, the patient will seek help even faster. The abscess begins to tear the strongly innervated periosteum from the bone until the periosteum ruptures. After puncture comes relief (less pain intensity) and severe swelling of the face. This is because pus begins to build upfrom now on in loose soft tissues. Fever and malaise may still persist.

An abscess is a condition that requires surgical intervention. The dentist must incise the abscess, release the pus, prescribe an antibiotic in some cases and start root canal treatment or remove the tooth.

Untreated teeth cause hospitalization?

Sick teeth are not widely associated with the hospital. This is a dangerous ignorance, as purulent inflammation can penetrate beyond the area of ​​the teeth, e.g. into the maxillary sinus, parapharyngeal space, neck tissue, orbit, and even inside the skull or mediastinum.

Complications of odontogenic infections can be dire consequences: from long-term hospital stays to immediate life-threatening. A "trivial" tooth may turn out to be the cause of long-term problems, which is why it is so important to seek medical help early.

Time flies and bacteria attack

Untreated tooth with dead pulp, after acute inflammation has subsided, is still a source of infection and a reservoir of bacteria. Chronic infection leads to chronic inflammation of the periapical tissues. They are usually painless, but that doesn't mean they're not a problem. They can worsen over time and remind you of pain from a few months ago or, worse, make you see your surgeon.

When an infection has low immune potential, chronic fibrous inflammation of the periapical tissues develops. There is a build-up of root cement at the apex of the root and distortion of the periodontal space - this can be identified by radiological examination.

Chronic infection can lead to the formation of a granuloma. Then the bone near the root apex is replaced by the granulation tissue surrounded by the connective tissue capsule. The granuloma resorbs the surrounding bone, root cementum, and sometimes even the root dentin.

Bacterial toxins from an untreated, dead tooth stimulate the development of granulation tissue and cause the growth of Malassez epithelial cells (cells left over from odontogenesis - the process of tooth formation), which begin to penetrate the granulation tissue. The enlarging granulomas over time begin to die in the central part and develop into a root cyst.

Read more: Odontogenic cysts: types, causes, symptoms, treatment

Root cyst - "balloon" that grows and grows …

A cyst is a pathological body filled with fluid. A root cyst arises from a long untreated granuloma. It is made of a lined connective tissue bagepithelium filled with eosinophilic fluid. Over time, the volume of fluid in the cyst increases and the increasing pressure inflates the cyst more and more.

Such a "balloon" begins to resorb the surrounding bone, tooth tissues and separate the adjacent teeth. Large cysts may cause pathological fractures of the jaw, or they may start to grow into the surrounding anatomical spaces, e.g. into the maxillary sinus.

Treatment of cysts requires surgical intervention. Depending on the location and size of the lesion, treatment will be more or less invasive and long-lasting. It will be aimed at removing the cyst with the cause and possibly reconstructing the damaged structures.

Doctor, I have a fistula - purulent fistula

Acute condition can also turn into chronic purulent inflammation. It is characterized by the formation of a fistula (canal) through which purulent content escapes periodically or continuously from the apical area. A fistula can open up both inside the mouth and on the skin of the face or neck.

Although the condition is not painful, it does not mean that the presence of a purulent fistula should be underestimated. The body's inflammation continues and the bacteria infect the tissues. The best method for chronic purulent inflammation of the periapical tissues is, as in each of the described situations, to resolve the issue of the causal teeth.

Effect of odontogenic inflammations on general he alth

Untreated caries and its subsequent complications constitute a significant he alth problem. Not only are they a painful ailment, but they can also worsen your overall he alth. Before procedures in numerous fields of medicine, from transplantology, through the treatment of cardiovascular diseases, to oncology, patients are required to eliminate potential inflammatory foci from, among others, oral cavity. This is to reduce the risk of complications during treatment. What are these mouth lesions?

These are all teeth with dead pulp, diseased periodontium, periapical lesions, and jaw bones.

Dear Patients, if something hurts or bothers you, don't wait. Early actions will help to avoid more and more serious local and systemic complications and to preserve the dentition.

About the authorMateusz Król5th year student of dentistry at the Medical University of K. Marcinkowski in Poznań. An active member of the Scientific Society of Maxillofacial Surgery and the Scientific Society of Conservative Dentistry and Endodontics. Author of conference speeches and scientific publications. Particularly interested in the issues of oral surgery andconservative dentistry.

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Dentistry and Orthodontics