TEETH PAIN

School of nursing bida

What causes teeth pains is infections of the month.

Mouth infections, also known as oral infections, are a group of infections that occur around the oral cavity. They include dental infection, dental abscess, and Ludwig's angina. Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures. In otherwise healthy patients, removing the offending tooth to allow drainage will usually resolve the infection. In cases that spread to adjacent structures or in immunocompromised patients cancer, diabetes, transplant immunosuppression, surgical drainage and systemic antibiotics may be required in addition to tooth extraction. Since bacteria that normally reside in the oral cavity cause mouth infections, proper dental hygiene can prevent most cases of infection. As such, mouth infections are more common in populations with poor access to dental care homeless, uninsured, etc. or populations with health-related behaviors that damage one's teeth and oral mucosa (tobacco, methamphetamine, etc. This is a common problem, representing nearly 36% of all encounters within the emergency department related to dental conditions.

Patients with mouth infections usually complain of pain at the affected tooth with or without fevers. Inability to fully open one's mouth, also known as trismus, suggests that the infection has spread to spaces between the jaw and muscles of mastication masseter, medial pterygoid, and temporalis. If an abscess has formed, swelling, redness, and tenderness will be present. Depending on the location of the abscess, it will be visible intraorally, extraorally, or both. Severe infections with significant swelling may cause airway obstruction by shifting, enlarging soft tissue structures floor of mouth, tongue, etc. or by causing dysphagia that prevents adequate clearance of saliva. This is a medical emergency and may require endonasal intubation or tracheotomy to protect one's airway. The development of stridor, shortness of breath, and pooling oral secretions may indicate impending airway compromise due to a worsening mouth infection. Other rare but dangerous complications include osteomyelitis, cavernous sinus thrombosis, and deep neck space infection.

Anatomy of mouth 

Causes Edit

Mouth infections are most commonly caused by an overgrowth of bacteria that normally populate the oral cavity. In a healthy adult, billions of bacteria, viruses, and fungi reside within the oral cavity and represent more than 500 different species. They are collectively known as the oral microbiome. When healthy, the oral microbiome is in dynamic equilibrium such that no one bacteria or group of organisms dominates. However, certain situations, like a decaying tooth root or a penetrating puncture wound from a fish bone, can generate an environment that disrupts the normal oral microbiome and promote the growth of pathogenic bacteria. Although sore throats pharyngitis are caused by viruses and oral yeast infections candidiasis) are caused by fungi, most mouth infections that lead to swelling and abscesses are caused by bacteria.

The bacteria of the oral microbiome consist of a wide variety of gram positive cocci and rods, gram negative cocci and rods, obligate anaerobes, and facultative anaerobes. The most common bacteria that causes mouth infections are Streptococcus species.[8] Poor dental hygiene promotes the accumulation of these bacteria at the tooth root, eventually causing a cavity or dental caries. The decaying tooth root provides bacteria with an enclosed environment with low oxygen content. Consequently, the obligate and facultative anaerobes present within the oral cavity flourish and outcompete the other bacteria at the site of tooth decay, causing the dental caries to escalate into a mouth infection. The corrosive enzymes released by the anaerobes erode the surrounding bone and enable the infection to invade surrounding structures. Given the natural history of a mouth infection, the vast majority of clinically-treated oral infections are polymicrobial, or caused by multiple different species of bacteria at the same time. Until the source of the infection is controlled with some form of drainage and antibiotics, a mouth infection will likely not resolve on its own.

Signs and symptoms Edit

Dental pain and swelling are the two hallmark symptoms of a mouth infection. Fever is sometimes present, but not as frequently as tooth pain or persistent swelling. The swelling will occur at the tooth root or at the spaces occupied by the infection. Other symptoms that usually accompany an infection like increased heart rate, low energy, chills, and sweating may also be present. If infection spreads to the space between the muscles of mastication, then trismus, the inability to completely open one's mouth, will also be present.

Severe mouth infections become dangerous when breathing or swallowing are impaired.Since the primary and secondary spaces extend towards the back of the throat, significant swelling can lead to airway obstruction. Signs and symptoms of airway obstruction are difficulty breathing, stridor, low oxygen saturation measured by a pulse oximeter, blue discoloration of the skin or lips, and stridor. Similarly, infections that spread to adjacent structures may also impair swallowing or cause significant pain with swallowing. Individuals with long-standing infections may lose significant weight because pain blunts their desire and impairs their ability to eat food. When infections affect swallowing, one may not be able to swallow saliva and other oral secretions faster than they are produced, causing drooling. Pooling secretions at the back of the throat increases the likelihood of the saliva traveling down the windpipe and into the lungs instead of through the esophagus and into the stomach. This process of breathing in material that should be swallowed is known as aspiration, and can lead to more infections like pneumonia.

Diagnosis experiment.

Green arrows indicate tooth decay. Blue arrows indicate abscess at root of tooth. The infection at the root of the tooth can travel through bone and infect surrounding soft tissue.

Mouth infections are usually diagnosed on history and physical exam in the dental office or at a clinic visit with an otolaryngologist. Swelling within the oral cavity or cheeks, along with a history of progressively worsening tooth pain and fevers, is usually enough evidence to support the diagnosis of a mouth infection. Depending on the severity of the infection, further tests may include x-rays and CT scans of the mouth to better characterize the location and extent of the infection. If the infection is drained with a needle or scalpel, then a swab of the infection is collected to identify the microbes present in the abscess and to determine their respective susceptibilities to antibiotics. Other lab tests may include a complete blood count with differential, serum electrolyte concentrations, and other routine assays for an infectious workup.

Treatment analysis.

Although mouth infections can present in many different ways, they are managed according to the same guiding principles - protect the airway, drain the abscess, and treat with antibiotics if necessary. Securing a patient's airway is the most important part of initial treatment because loss of airway is emergently life-threatening. Inflammation and large abscesses, particularly those within the floor of the mouth, may block airflow into the lungs.To pre-emptively protect a patient's airway, placing flexible plastic tubing through the nasal cavity and into the trachea, called endonasal intubation, is typically the first option. It can be performed with or without direct visualization with laryngoscopy, a small camera with a live video feed to ensure the tubing is placed in the proper location. If attempts to intubate through the nasal cavity are unsuccessful or if the airway must be re-established quickly, then an incision can be made through the front of the neck to gain access into the trachea, also known as a tracheotomy.

After stabilizing the patient's airway, extracting the infected tooth will typically promote adequate drainage and the infection will resolve shortly thereafter. If the infection involves multiple primary spaces or any of the secondary spaces previously mentioned, then incision and drainage with culture-guided antibiotics may be indicated. Since most mouth infections are polymicrobial, penicillin is an appropriate initial choice of antibiotic because of its activity against Streptococcus and gram negative anaerobes. If the patient has a penicillin allergy, then clindamycin with or without metronidazole are also effective empiric antibiotic regimens. Additionally, empiric antibiotics should be initiated in patients with a compromised immune system, like those on immunosuppressive medications, with diabetes, or with cancer. In situations where the infection worsens or fails to improve after multiple days, washing out the wound in the operating room should control the source of infection and promote healing.

Complications 

And side effects.

Last analysis 2 months ago by NATURAL organic doctors.

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