The other day I came across a very particular and rather unpleasant case of a patient who ended up in hospital because of a tooth infection that spread. Although this is too simplistic an answer for a complex problem, of course, in the end the information retained by his relatives and people close to him who know about the case is more or less this: that an infected tooth caused a very serious health problem that, if not treated in time, could have cost him his life.
In reality what he suffered is known as Ludwig's angina and, yes, in 9 out of 10 cases, as was the case in this patient, the focus of infection is the lower molars.
But how does Ludwig's angina occur?
When a cavity is not detected or treated in time, the infection spreads, as bacteria are always looking for a 'way out' through the tooth to the outside. This is what causes abscesses, as we explained last week. in this blog. When these bacteria infect the outside and reach the lower part of the mouth (which is why it happens when the focus is on the lower molars), this is when the infection becomes very dangerous, because it can quickly spread to the neck and endanger the patient's life.
It is a condition that occurs more frequently in people with diabetes or who are immunocompromised, as a weaker immune system will understandably cause the infection to spread more rapidly.
How is Ludwig's angina detected?
As the infection progresses, it causes inflammation of the affected tissues and the neck may become enlarged. In addition, patients experience discomfort such as sore throat, difficulty in swallowing, fever...
In fact, it is this inflammation that makes the condition lethal. The infection causes the back of the throat to become inflamed, which obstructs the patient's airway and makes breathing difficult or even impossible. It is estimated that even if treated in time, without the use of antibiotics, as was actually the case not so long ago, the case fatality rate would exceed 50%.
And what are the options once diagnosed?
Once the patient presents with the aforementioned discomfort, and this condition is suspected, the most common procedure is to perform a computed tomography (CT scan) or a blood test to assess the severity of the infection and the clinical condition. All of this is started in the hospital, usually after treatment has already been started, which is usually the administration of antibiotics directly intravenously. In addition, measures are taken to ensure that the patient can breathe adequately and the patient is kept under observation, usually in the ICU units set up for this purpose.
The tooth that is the source of the infection is also usually extracted and any affected tissues that may have accumulated fluid are drained.
As with any infection, the earlier it is treated and detected, the better the chances of survival. The case fatality rate even when antibiotics are administered is estimated to be around 5-8% depending on other factors such as age or other associated ailments.
And the most important point,
How to prevent it?
The best way to prevent oral infections (whether or not they are as aggressive as Ludwig's angina) is to maintain optimal oral hygiene. To this end, we recommend not only brushing three times a day, as well as the use of interdental cleaning aids such as dental floss or dental floss, but also professional cleanings to remove tartar that is inaccessible to the toothbrush.
It is also necessary to attend dental check-ups at the clinic because in this way, thanks to the use of X-rays and examination, we can detect caries and infections before they have developed to the critical point and treat them in time.
That is why at Vélez & Lozano we always carry out a check-up with our dental cleaning appointments, or as we call them internally, MRV (maintenance and revision), because dental check-ups are essential to detect problems such as these, good oral hygiene and professional prophylaxis are not enough.