Oral Health and Sepsis

Sepsis is a dreaded illness, coming on quite suddenly in many cases and causing death in a surprising number of instances.

For example, from 2004 to 2009, actual deaths from sepsis were 15- to 140-percent higher than reported on death certificates, largely because sepsis is an underlying condition caused by a massive and sometimes fatal response to infection.  

Moreover, because sepsis is a “complex clinical syndrome” – a response to infection that can occur as a result of many different underlying conditions – it pays to monitor oral health, one of the surprising causes of sepsis.

Sepsis in the Mouth

Because sepsis, or blood poisoning, is a complex response to infection or injury, and develops quietly before becoming a full-blown, deadly response, the exact number of sepsis cases directly related to oral health is unknown.

We do know, however, that bacteria in the mouth can trigger heart disease, endocarditis (inflammation of the inside of the heart), or even heart attacks, which should indicate just how important oral health is to overall health.

Moreover, the mouth has many types of soft tissue in which bacteria easily take hold and cause infection, ranging from gums, lips, palate, and cheeks, to the tongue. Add to that infections within teeth (cavities) or below them, in the pulp, root or even bone –the kind that require root canals to eradicate – and the potential to develop sepsis in the mouth becomes enormous.

Signs of Mouth Infections

There are many indicators of an underlying infection in the mouth, whether soft tissues or teeth themselves. These range from bad breath to a bad taste in the mouth, and can include pain, hot or cold sensitivity, swelling of the gum, jaw, or even the glands in the neck, and finally – at the most severe stage – a fever.

Fever in adults is defined as anything over 100 degrees (Fahrenheit, as measured with an oral thermometer), or 100.8 if taken rectally, or 99.8 under the arm (called the axillary position).

Of course, fevers can arise from something as innocuous as getting too warm on a summer’s day jogging or playing basketball, but generally a high temperature accompanied by any of the other symptoms above is cause for concern.

Consequences of Mouth Infections

When in doubt, see a doctor or dentist, immediately. People die every day from sepsis. People also die from badly infected teeth, in the absence of sepsis, as a result of cellulitis – another bacterial infection that can also kill if left untreated. Cellulitis is basically massive swelling, which if left unchecked can cause Ludwig’s angina, which blocks off the airway (in the throat and neck) and suffocates the victim.

In the upper jaw, especially in the teeth closest to the center line of the face, the swelling and infection tend to move upward, under the eye socket and into the temple. The infection can also invade the sinus cavity, and cause a condition called cavernous sinus thrombosis, or move even farther upward and lead to a brain abscess.

Treating Mouth Infections

Typically, doctors and/or dentists will prescribe strong antibiotics and wait for any swelling to go down, largely because the presence of swollen tissues is a danger in itself. When antibiotics are prescribed, they must be taken, as directed, for the full course of the treatment. Do not stop taking antibiotics just because you – or your gums – feel better.

Once swelling has subsided, and any fever is within manageable bounds (99 to 99.5 degrees, considered very low-grade fever), a dentist will either remove the tooth, or cut into and remove the infection at or below the jaw line (or within the mouth). He or she may even perform a root canal to relieve infection by or in the jawbone itself. This latter is extremely painful, may have to be repeated at various stages, and is best avoided with good oral hygiene and regular dental visits.

Infections after Dental Procedures

Any procedure, from cleaning to filling, may create minor bleeding. This is not a concern in itself because the body heals such small injuries. What is of concern is the open area, which allows bacteria to enter and potentially multiply.

For most people, simple gargling with salt water or mouthwash will prevent anything too severe from developing. For others – those with immune conditions that prevent them fighting off infection normally, or those with certain heart conditions (as a result of defective heart valves, for example) that might make them prone to the previously-mentioned endocarditis – antibiotics will be prescribed even if no infection appears to be present.

This is called a “prophylactic” or preventive dose, and it is equally important to take all the medication as prescribed to prevent serious problems in the wake of any kind of dental procedure.

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