Materiały źródłowe

• #1 Tooth abscess – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tooth-abscess/symptoms-causes/syc-20350901

  A tooth abscess is a pocket of pus that’s caused by a bacterial infection. The abscess can occur at different areas near the tooth for different reasons. A periapical (per-e-AP-ih-kul) abscess occurs at the tip of the root. A periodontal (per-e-o-DON-tul) abscess occurs in the gums at the side of a tooth root. The information here is about periapical abscesses. […] A periapical tooth abscess usually occurs as a result of an untreated dental cavity, an injury or prior dental work. The resulting infection with irritation and swelling (inflammation) can cause an abscess at the tip of the root. […] A periapical tooth abscess occurs when bacteria invade the dental pulp. The pulp is the innermost part of the tooth that contains blood vessels, nerves and connective tissue. […] Bacteria enter through either a dental cavity or a chip or crack in the tooth and spread all the way down to the root. The bacterial infection can cause swelling and inflammation at the tip of the root.

• #2 Periapical Abscess: Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24896-periapical-abscess

  A periapical abscess is a pocket of infection around your tooth root. It happens when bacteria invade your tooth pulp, usually through a crack or cavity. The infection spreads down to the root of your tooth, causing inflammation and swelling. […] A periapical abscess is a pocket of infection (pus) around your tooth root. This type of abscess forms when harmful bacteria from your mouth invade your tooth pulp. (This can happen if you have a cavity or a crack in your tooth.) The infection can spread all the way to the tip of the root and into the surrounding tissues. […] Bacteria cause a periapical abscess. Bacteria can enter your tooth pulp through a crack or cavity. The infection can then spread to the tip of your tooth root and into the surrounding tissues. […] Left untreated, a periapical abscess can spread to your jaw and eventually, to other areas of your head and neck. In some cases, infection can even get into your blood and cause sepsis, a life-threatening condition.

• #3 Dental abscess: A microbiological review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3858730/

  Dental abscess is a frequently occurring infectious process known to the health practice. […] The pathogenesis of dentoalveolar abscess is polymicrobial in nature, comprising of various facultative anaerobes, such as the viridans group streptococci and the Streptococcus anginosus group, and strict anaerobes, especially anaerobic cocci, Prevotella and Fusobacterium species. […] If not treated at an early stage it may rapidly evolve and spread to adjacent anatomic structures, leading to serious complications such as septicemia, cavernous sinus thrombosis, brain abscess, shock, and occasionally to death. […] Determination of various host and environmental factors that put an individual at risk for development of dental abscess, influence the spread of infection from a localized collection at the apex of a tooth to a cellulitis and further life-threatening sepsis would aid treatment decisions. […] Increased reliance on novel molecular techniques has enriched our knowledge of the diverse polymicrobial collection that constitutes a dental abscess.

• #4 Dental Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493149/

  Dental abscesses or periapical infections typically arise secondary to dental caries (tooth rot related to poor dental hygiene), trauma, or failed dental root canal treatment. […] A breakdown in the protective enamel of teeth allows oropharyngeal bacteria to enter the tooth cavity (pulp cavity), causing a local infection. […] As this infection within the pulp cavity grows within the limited space of the tooth, it compresses the inner dentine walls, causing severe pain. […] This infection then tracks down through the root canal and inferiorly into the mandible or superiorly into the maxilla, depending on the location of the infected tooth. […] Another cause that predisposes individuals to a dental abscess is a partially erupted tooth, most commonly a wisdom tooth, where bacteria get trapped between the crown and soft tissues, causing inflammation.

• #5 Tooth abscess – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tooth-abscess/symptoms-causes/syc-20350901

  A tooth abscess is a pocket of pus that’s caused by a bacterial infection. The abscess can occur at different areas near the tooth for different reasons. A periapical (per-e-AP-ih-kul) abscess occurs at the tip of the root. A periodontal (per-e-o-DON-tul) abscess occurs in the gums at the side of a tooth root. The information here is about periapical abscesses. […] A periapical tooth abscess usually occurs as a result of an untreated dental cavity, an injury or prior dental work. The resulting infection with irritation and swelling (inflammation) can cause an abscess at the tip of the root. […] A periapical tooth abscess occurs when bacteria invade the dental pulp. The pulp is the innermost part of the tooth that contains blood vessels, nerves and connective tissue. […] Bacteria enter through either a dental cavity or a chip or crack in the tooth and spread all the way down to the root. The bacterial infection can cause swelling and inflammation at the tip of the root.

• #6 Dental Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493149/

  Other causes include genetic causes such as imperfect amelogenesis, which predisposes individuals to weakened enamel and makes them more susceptible to wear. […] Mechanical causes tooth grinding to break down tooth enamel. […] Medical conditions like Sjogren syndrome cause dry mouth, accelerating oropharyngeal microbial growth. […] Chemical irritants such as smoke from methamphetamine, immunosuppression arising from chemotherapy, or chronic immunosuppressive medical conditions such as HIV/AIDs can predispose individuals to dental caries. […] The oral cavity hosts many bacteria, mainly gram-negative and facultative anaerobes. […] These bacteria have varying distributions in the cavity; in particular, Streptococcus mitis was most typically found on tooth surfaces. […] This is not always the causative organism in a dental abscess because other oral bacterial species can become introduced into the tooth by other means, including, but not limited to, trauma.

• #7 Tooth abscess – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tooth-abscess/symptoms-causes/syc-20350901

  A tooth abscess is a pocket of pus that’s caused by a bacterial infection. The abscess can occur at different areas near the tooth for different reasons. A periapical (per-e-AP-ih-kul) abscess occurs at the tip of the root. A periodontal (per-e-o-DON-tul) abscess occurs in the gums at the side of a tooth root. The information here is about periapical abscesses. […] A periapical tooth abscess usually occurs as a result of an untreated dental cavity, an injury or prior dental work. The resulting infection with irritation and swelling (inflammation) can cause an abscess at the tip of the root. […] A periapical tooth abscess occurs when bacteria invade the dental pulp. The pulp is the innermost part of the tooth that contains blood vessels, nerves and connective tissue. […] Bacteria enter through either a dental cavity or a chip or crack in the tooth and spread all the way down to the root. The bacterial infection can cause swelling and inflammation at the tip of the root.

• #8 Periapical Abscess: Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24896-periapical-abscess

  A periapical abscess is a pocket of infection around your tooth root. It happens when bacteria invade your tooth pulp, usually through a crack or cavity. The infection spreads down to the root of your tooth, causing inflammation and swelling. […] A periapical abscess is a pocket of infection (pus) around your tooth root. This type of abscess forms when harmful bacteria from your mouth invade your tooth pulp. (This can happen if you have a cavity or a crack in your tooth.) The infection can spread all the way to the tip of the root and into the surrounding tissues. […] Bacteria cause a periapical abscess. Bacteria can enter your tooth pulp through a crack or cavity. The infection can then spread to the tip of your tooth root and into the surrounding tissues. […] Left untreated, a periapical abscess can spread to your jaw and eventually, to other areas of your head and neck. In some cases, infection can even get into your blood and cause sepsis, a life-threatening condition.

• #9 Tooth Abscess Stages – Why They Occur And How They Can Be Treated | No Gaps Dental

  https://www.nogapsdental.com/blog/tooth-abscess-stages/

  A dental abscess doesn’t occur without the formation of pus. Pus doesn’t occur without the presence of bacteria, and a build-up of bacteria doesn’t occur without the presence of plaque. When plaque is allowed to accumulate on the surface of the tooth and gums it releases an acid which starts to erode the tooth enamel. Once this happens, the tooth starts to decay as a cavity is formed. […] After the bacteria has eaten through the dentin, it’s free to enter the inner tooth pulp. When this happens, it can play havoc with the nerves of the tooth, causing them to die. Once this starts to occur, the body’s immune system begins to attack the infection. As such, pus is formed around the dying roots causing the abscess. […] If for some reason the dental abscess is still ignored, the tooth abscess can erode further bone causing tooth loss. Moreover, in those with weakened immune systems, infections can spread and if continually ignored, what started out as an abscessed tooth, can actually become fatal as it spreads to other parts of the body.

• #10 Dental Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493149/

  Dental abscesses or periapical infections typically arise secondary to dental caries (tooth rot related to poor dental hygiene), trauma, or failed dental root canal treatment. […] A breakdown in the protective enamel of teeth allows oropharyngeal bacteria to enter the tooth cavity (pulp cavity), causing a local infection. […] As this infection within the pulp cavity grows within the limited space of the tooth, it compresses the inner dentine walls, causing severe pain. […] This infection then tracks down through the root canal and inferiorly into the mandible or superiorly into the maxilla, depending on the location of the infected tooth. […] Another cause that predisposes individuals to a dental abscess is a partially erupted tooth, most commonly a wisdom tooth, where bacteria get trapped between the crown and soft tissues, causing inflammation.

• #11 Common Dental Emergencies | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0201/p511.html

  Dental caries is a bacterial disease of teeth characterized by demineralization of tooth enamel and dentine by acid produced during the fermentation of dietary carbohydrates by oral bacteria, predominately Streptococcus mutans. Dental decay presents visually as opaque white areas of enamel with grey undertones or, in more advanced cases, as brownish, discolored cavitations. Caries is initially asymptomatic. Pain does not occur until the decay impinges on the pulp, and an inflammatory process develops. […] A severely inflamed pulp will eventually necrose, causing apical periodontitis, which is inflammation around the apex of the tooth. Pain is severe, spontaneous, and persistent, but unlike that of irreversible pulpitis, localizes to the affected tooth. The tooth is sensitive to percussion with a metal object. Regional lymphadenopathy can be present. Management is root canal treatment or extraction.

• #12 Tooth Abscess Stages & What You Should Do at Each

  https://www.azarkodental.com/site/dental-blog-edmonton/2022/08/15/tooth-abscess-stages

  Pockets of pus can accumulate as a result a bacterial tooth infection, leaving you at risk for a dental abscess or tooth abscess. […] While a tooth abscess can cause problems, you may be surprised to learn that it is the body’s natural defence mechanism in the battle against infection. By building up a layer of pus, the abscess prevents the infection from reaching other areas. […] Unfortunately, along with its natural defence properties a dental abscess poses further risk for the teeth and gums and can erode the periodontium – the tooth structure made of gum (gingiva), periodontal ligament (PDL), or hard compact alveolar bone – and cause irreparable damage. […] In response to this invasion of bacteria, the body develops a protective barrier or shield in the form of pus. As we already know, this can cause more harm than good.

• #13 Tooth Abscess Stages – Why They Occur And How They Can Be Treated | No Gaps Dental

  https://www.nogapsdental.com/blog/tooth-abscess-stages/

  A dental abscess or tooth abscess occurs when a pocket of pus accumulates after a bacterial tooth infection. A dental abscess is a natural defense mechanism in the fight against infection. By building up a barrier of pus, the abscess blocks the infection from reaching other areas. […] Unfortunately, a dental abscess puts both the gums and teeth at further risk and can erode the periodontium the tooth structure made up of gum (gingiva), periodontal ligament (PDL), or hard compact alveolar bone causing irreparable damage. […] Typically a dental abscess occurs as a result of tooth decay, but it can also occur as a result of a chipped, cracked, or broken tooth. Either way, bacteria is the main culprit as it enters either through a tooth cavity or via a crack or chip in the tooth. As already stated, the body’s response to an onslaught of bacteria is to form a protective shield or barrier in the form of pus and, as we already know, this can cause more harm than good.

• #14 Tooth Abscess Stages – Why They Occur And How They Can Be Treated | No Gaps Dental

  https://www.nogapsdental.com/blog/tooth-abscess-stages/

  A dental abscess doesn’t occur without the formation of pus. Pus doesn’t occur without the presence of bacteria, and a build-up of bacteria doesn’t occur without the presence of plaque. When plaque is allowed to accumulate on the surface of the tooth and gums it releases an acid which starts to erode the tooth enamel. Once this happens, the tooth starts to decay as a cavity is formed. […] After the bacteria has eaten through the dentin, it’s free to enter the inner tooth pulp. When this happens, it can play havoc with the nerves of the tooth, causing them to die. Once this starts to occur, the body’s immune system begins to attack the infection. As such, pus is formed around the dying roots causing the abscess. […] If for some reason the dental abscess is still ignored, the tooth abscess can erode further bone causing tooth loss. Moreover, in those with weakened immune systems, infections can spread and if continually ignored, what started out as an abscessed tooth, can actually become fatal as it spreads to other parts of the body.

• #15 Dental abscess: A microbiological review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3858730/

  Dental abscess is a frequently occurring infectious process known to the health practice. […] The pathogenesis of dentoalveolar abscess is polymicrobial in nature, comprising of various facultative anaerobes, such as the viridans group streptococci and the Streptococcus anginosus group, and strict anaerobes, especially anaerobic cocci, Prevotella and Fusobacterium species. […] If not treated at an early stage it may rapidly evolve and spread to adjacent anatomic structures, leading to serious complications such as septicemia, cavernous sinus thrombosis, brain abscess, shock, and occasionally to death. […] Determination of various host and environmental factors that put an individual at risk for development of dental abscess, influence the spread of infection from a localized collection at the apex of a tooth to a cellulitis and further life-threatening sepsis would aid treatment decisions. […] Increased reliance on novel molecular techniques has enriched our knowledge of the diverse polymicrobial collection that constitutes a dental abscess.

• #16 Pathophysiology of Dental Infection – RCEMLearning India

  https://www.rcemlearning.org/modules/dental-emergencies/lessons/pathophysiology-of-dental-infection/

  Acute dental abscess usually occurs secondary to dental caries or following a dental procedure or trauma. […] Infection then may spread superficially into the tissues producing gingivitis or a dental abscess. […] Dental abscess is usually polymicrobial with numerous pathogen combinations being recognised. Common pathogens include Streptococcus sp. Along with Staphylococcus sp, Staph.aureus has been isolated in up to 15% of abscess cultures (MSSA in 90% of these cases, MRSA in 10%) with the most common anaerobic species being Prevotella sp of dentoalveolar abscesses. […] Dental infection most commonly arises from the process of dental caries and is usually polymicrobial with both aerobic and anaerobic bacteria being responsible.

• #17 Dental Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493149/

  Other causes include genetic causes such as imperfect amelogenesis, which predisposes individuals to weakened enamel and makes them more susceptible to wear. […] Mechanical causes tooth grinding to break down tooth enamel. […] Medical conditions like Sjogren syndrome cause dry mouth, accelerating oropharyngeal microbial growth. […] Chemical irritants such as smoke from methamphetamine, immunosuppression arising from chemotherapy, or chronic immunosuppressive medical conditions such as HIV/AIDs can predispose individuals to dental caries. […] The oral cavity hosts many bacteria, mainly gram-negative and facultative anaerobes. […] These bacteria have varying distributions in the cavity; in particular, Streptococcus mitis was most typically found on tooth surfaces. […] This is not always the causative organism in a dental abscess because other oral bacterial species can become introduced into the tooth by other means, including, but not limited to, trauma.

• #18 The microbiology of the acute dental abscess | Microbiology Society

  https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.003517-0

  The acute dental abscess is usually polymicrobial comprising facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group, with predominantly strict anaerobes, such as anaerobic cocci, Prevotella and Fusobacterium species. […] The use of non-culture techniques has expanded our insight into the microbial diversity of the causative agents, identifying such organisms as Treponema species and anaerobic Gram-positive rods such as Bulleidia extructa, Cryptobacterium curtum and Mogibacterium timidum. […] Despite some reports of increasing antimicrobial resistance in isolates from acute dental infection, the vast majority of localized dental abscesses respond to surgical treatment, with antimicrobials limited to spreading and severe infections.

• #19 Dental abscess: A potential cause of death and morbidity

  https://www1.racgp.org.au/ajgp/2020/september/dental-abscess-death-and-morbidity

  Odontogenic infections are polymicrobial with a mixture of aerobic, facultative anaerobic and strict anaerobic organisms. The deeper the infection, the more likely that the involved organisms are anaerobic. Generally, the more skilled and intensive the microbiological study, the greater the range and type of bacteria will be shown. Current hospital bacteriological studies are usually brief, limited to indicating the general site (eg oral or respiratory). It is best to involve infectious disease consultants when complex resistant cases are encountered. The most common organisms are viridans streptococci initially, with the subsequent anaerobes being Fusobacterium spp. and Prevotella spp. […] If the patient is immunocompromised (eg with human immunodeficiency virus/acquired immunodeficiency syndrome, haematological neoplasms or poorly controlled diabetes), there is likely to be increased difficulty in management and a longer hospital stay for the patient.

• #20 SciELO Brazil – Bacterial pathogenesis and mediators in apical periodontitis Bacterial pathogenesis and mediators in apical periodontitis

  https://www.scielo.br/j/bdj/a/7zJkFZSFQFxGDy838ywPRcb/

  Bacteria exert their pathogenicity by wreaking havoc to the host tissues through direct and/or indirect mechanisms. Bacterial factors that cause direct tissue harm include those that damage host cells and/or the intercellular matrix of the connective tissue. […] Therefore, bacteria can exert indirect destructive effects, which seem to be even more significant in the tissue damage associated with acute and chronic apical periodontitis lesions. […] Depending on several factors, apical periodontitis can be chronic or acute. A chronic disease is usually associated with low virulence of the involved bacterial consortium, which though represents a persistent source of aggression to the tissues. […] The isolate location of the root canal microbiota indicates that to exert its pathogenicity the bacteria must either invade the periradicular tissues or their products and/or structural components must penetrate the tissue and be able to evoke a defense response in the host.

• #21 SciELO Brazil – Bacterial pathogenesis and mediators in apical periodontitis Bacterial pathogenesis and mediators in apical periodontitis

  https://www.scielo.br/j/bdj/a/7zJkFZSFQFxGDy838ywPRcb/

  Bacteria exert their pathogenicity by wreaking havoc to the host tissues through direct and/or indirect mechanisms. Bacterial factors that cause direct tissue harm include those that damage host cells and/or the intercellular matrix of the connective tissue. […] Therefore, bacteria can exert indirect destructive effects, which seem to be even more significant in the tissue damage associated with acute and chronic apical periodontitis lesions. […] Depending on several factors, apical periodontitis can be chronic or acute. A chronic disease is usually associated with low virulence of the involved bacterial consortium, which though represents a persistent source of aggression to the tissues. […] The isolate location of the root canal microbiota indicates that to exert its pathogenicity the bacteria must either invade the periradicular tissues or their products and/or structural components must penetrate the tissue and be able to evoke a defense response in the host.

• #22 SciELO Brazil – Bacterial pathogenesis and mediators in apical periodontitis Bacterial pathogenesis and mediators in apical periodontitis

  https://www.scielo.br/j/bdj/a/7zJkFZSFQFxGDy838ywPRcb/

  Apical periodontitis is a group of inflammatory diseases caused by microorganisms (mainly bacteria) infecting the necrotic root canal system. The pathogenesis of different types of apical periodontitis and even the same type in different individuals is unlikely to follow a stereotyped fashion with regard to the involved bacterial mediators. […] Disease pathogenesis is rather complex and involves a multitude of bacteria- and host-related factors. This review article discusses the bacterial pathogenesis of acute and chronic apical periodontitis, with the main focus on the bacterial mediators conceivably involved in the different stages of the infectious process, including secreted products (enzymes, exotoxins, N-formyl-methionyl-leucyl-phenylalanine peptides, heat-shock proteins and metabolic end-products) and structural components (lipopolysaccharide, peptidoglycan, lipoteichoic acid, lipoproteins, fimbriae, flagella, outer membrane proteins and vesicles, DNA, and exopolysaccharides). Knowledge of the bacterial factors involved in the pathogenesis of apical periodontitis is important to the understanding of the disease process and to help establishing proper therapeutic measures to inactivate this bacterial „artillery”.

• #23 SciELO Brazil – Bacterial pathogenesis and mediators in apical periodontitis Bacterial pathogenesis and mediators in apical periodontitis

  https://www.scielo.br/j/bdj/a/7zJkFZSFQFxGDy838ywPRcb/

  Apical periodontitis is a group of inflammatory diseases caused by microorganisms (mainly bacteria) infecting the necrotic root canal system. The pathogenesis of different types of apical periodontitis and even the same type in different individuals is unlikely to follow a stereotyped fashion with regard to the involved bacterial mediators. […] Disease pathogenesis is rather complex and involves a multitude of bacteria- and host-related factors. This review article discusses the bacterial pathogenesis of acute and chronic apical periodontitis, with the main focus on the bacterial mediators conceivably involved in the different stages of the infectious process, including secreted products (enzymes, exotoxins, N-formyl-methionyl-leucyl-phenylalanine peptides, heat-shock proteins and metabolic end-products) and structural components (lipopolysaccharide, peptidoglycan, lipoteichoic acid, lipoproteins, fimbriae, flagella, outer membrane proteins and vesicles, DNA, and exopolysaccharides). Knowledge of the bacterial factors involved in the pathogenesis of apical periodontitis is important to the understanding of the disease process and to help establishing proper therapeutic measures to inactivate this bacterial „artillery”.

• #24 SciELO Brazil – Bacterial pathogenesis and mediators in apical periodontitis Bacterial pathogenesis and mediators in apical periodontitis

  https://www.scielo.br/j/bdj/a/7zJkFZSFQFxGDy838ywPRcb/

  The process starts after pulp necrosis as a result of caries, trauma or iatrogenic procedures, when bacteria invade and colonize the root canal system. […] Disease pathogenesis is rather complex and involves a multitude of bacteria- and host-related factors. This review article discusses the bacterial pathogenesis of apical periodontitis, with the main focus on the bacterial mediators (or virulence factors) involved in the different stages of the disease process. […] Bacteria involved in the pathogenesis of apical periodontitis may have participated in the early stages of pulp inflammation and necrosis or they may have gained entry into the canal space any time after pulpal necrosis. […] The usual sequential stages for bacterial infections in several body sites include a) attachment to and colonization of host surfaces; b) invasion of host tissues; c) survival within the tissue by acquiring nutrients and evading host defense mechanisms; d) and induction of direct or indirect damage to the host tissues. The process of early pulp infection is likely to follow similar events, even though it should be assumed that the sequence of events is more didactic than real and some phases may overlap or swap positions. Several bacterial mediators (virulence factors) are involved in each of these events.

• #25 Dental abscess: A microbiological review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3858730/

  Dental abscess is a frequently occurring infectious process known to the health practice. […] The pathogenesis of dentoalveolar abscess is polymicrobial in nature, comprising of various facultative anaerobes, such as the viridans group streptococci and the Streptococcus anginosus group, and strict anaerobes, especially anaerobic cocci, Prevotella and Fusobacterium species. […] If not treated at an early stage it may rapidly evolve and spread to adjacent anatomic structures, leading to serious complications such as septicemia, cavernous sinus thrombosis, brain abscess, shock, and occasionally to death. […] Determination of various host and environmental factors that put an individual at risk for development of dental abscess, influence the spread of infection from a localized collection at the apex of a tooth to a cellulitis and further life-threatening sepsis would aid treatment decisions. […] Increased reliance on novel molecular techniques has enriched our knowledge of the diverse polymicrobial collection that constitutes a dental abscess.

• #26 Infections of the Teeth, Jaw and Mouth

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/gi2.htm

  Dentoalveolar abscess usually follows an infection of the pulp of the tooth that extends to the base of the tooth roots. Periodontal abscesses usually are an extension of periodontal disease and form deep in the gingivae along the roots of the teeth. […] Ludwigs angina is a rapidly developing cellulitis of the sublingual and submaxillary spaces, often arising from infection of the tooth roots (molars and premolars) that extend below the mylohyoid line of the mandible. Ludwigs angina can also occur following infections in the floor of the mouth, the base of the tongue, and the lingual tonsils, and following salivary calculi or from intravenous injection of the internal jugular vein (especially in intravenous drug users).

• #27 Acute Periodontal Problems | Dental Practice Education Research Unit | University of Adelaide

  https://health.adelaide.edu.au/arcpoh/dperu/colgate-periodontal-education-program/practice-information-sheets/acute-periodontal-problems

  Factors influencing microbial virulence may trigger the formation of a periodontal abscess. One of the most common of these is the formation of resistant bacterial species following the use of systemic antibiotics. Bacterial samples, taken from patients with multiple periodontal abscesses which developed 1-3 weeks after penicillin or tetracycline therapy, revealed the presence of resistant strains to antibiotics in 55 percent of samples.

• #28 Acute Periodontal Problems | Dental Practice Education Research Unit | University of Adelaide

  https://health.adelaide.edu.au/arcpoh/dperu/colgate-periodontal-education-program/practice-information-sheets/acute-periodontal-problems

  A periodontal abscess is defined as: „An acute, destructive process in the periodontium resulting in localised collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp”. (International Conference on Research in the Biology of Periodontal Disease, 1977). […] The majority of periodontal abscesses occur in a pre-existing periodontal pocket. If the pocket is occluded, then infectious materials within the pocket can accumulate and the build-up of a purulent discharge can result in the formation of the clinical signs and symptoms of a periodontal abscess. […] Compromised host immune response may predispose a patient to the formation of periodontal abscesses. The presence of multiple periodontal abscesses is typically seen in poorly controlled diabetic patients. Examination of the microbial factors involved in the formation of acute periodontal abscesses has revealed the predominance of gram negative anaerobic rods, and the presence of fungi resembling Candida species (assumed to be secondary invaders in the area of pre-existing infection).

• #29 Apical Periodontitis in Primary Teeth. Etiology, Pathogenesis, Diagnostics

  https://es.ohi-s.com/articles-videos/2515/

  Apical periodontitis is an inflammatory process affecting the periapical tissues of a tooth. It can result from infectious, toxic, allergic, or traumatic causes. This condition is characterized by the necrosis of the dental pulp and the destruction of surrounding bone tissue. […] Apical periodontitis arises primarily due to bacterial invasion of the root canal system. Clinical evidence supports that periapical inflammation and bone resorption occur only when microorganisms infiltrate necrotic pulpal tissue. […] Key mechanisms include: Bacterial Cytotoxicity. Certain bacteria, such as Actinobacillus actinomycetemcomitans, produce toxins (e.g., leukotoxins, collagenases, and lipopolysaccharides) that destroy neutrophils and monocytes. […] In acute apical periodontitis, neutrophils and exudate dominate the response. Proteolytic enzymes from these cells contribute to tissue breakdown, abscess formation, and elevated pressure in the periapical region.

• #30 Apical Periodontitis in Primary Teeth. Etiology, Pathogenesis, Diagnostics

  https://es.ohi-s.com/articles-videos/2515/

  Apical periodontitis is most commonly chronic, representing a balance between microbial activity and the host’s immune defenses. Bacteria within the root canal and dentinal tubules remain protected from immune surveillance, proliferating and releasing metabolic by-products that damage periapical tissues. Even microorganisms with low virulence can perpetuate chronic inflammation in these protected environments.

• #31 Dental abscess: A potential cause of death and morbidity

  https://www1.racgp.org.au/ajgp/2020/september/dental-abscess-death-and-morbidity

  Once the infection spreads beyond the confines of the jaws and into the soft tissue spaces, it becomes much more difficult to treat and potentially life threatening. […] Anatomical factors play a key part in the progression of infection once beyond the confines of the teeth and jaws. Spread follows the line of least resistance, which is dictated by the fascia and muscles. The anatomical space involved depends on the affected tooth. The most dangerous space is the submandibular space, which is bounded by the mandible laterally, the mylohyoid muscle above and the subcutaneous tissue and skin below. It contains the submandibular gland, lymph nodes and the masseter muscle. When this muscle is irritated by the inflammation, trismus or difficulty in jaw opening ensues. The submandibular space is in direct contact with the pharyngeal spaces and down through the neck to the mediastinum. It also connects to the contralateral side.

• #32 Odontogenic Infections: General Principles | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-15-1346-6_20

  When the host defense mechanism is low, a highly virulent pathogen from a decayed tooth, either through a periapical or periodontal route, may get an environment that favours it growth, leading to odontogenic infection that follows the path of least resistance. […] Odontogenic infections arise within or around the dentition, initiating from simple dental caries, periodontal diseases, and pulpitis, and may spread way beyond their loco-regional origin, invading deeper structures of the face, oral cavity, head and neck, and even mediastinum or the vertebral column. […] Once the periodontal or periapical tissues get inoculated with bacteria, the infection may spread equally in all directions but mostly follows the path of least resistance. It travels through the cancellous bone to reach the cortical plate. If the cortical plate is thin, infection easily perforates it to enter the surrounding soft tissue. Periapical enzymes that help the bacteria in doing so include collagenase, hyaluronidase, and streptokinase, which dissolve through the organic matrix of the bone, while the acids produced by the bacteria eliminate the mineral content.

• #33 Odontogenic Infections: General Principles | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-15-1346-6_20

  When left untreated, the infection continues to spread depending principally on the thickness of bone and the type of muscle attachment. […] The commonest manifestation of odontogenic infections is either a palatal or a vestibular abscess. When untreated, it may lead to an intraoral or extraoral drainage, in due course establishing a sinus tract. […] A periapical infection may perforate the nearest or the weakest cortex and travel along the soft tissue, initially as cellulitis and eventually resulting in abscess formation.

• #34 Dental abscess: A potential cause of death and morbidity

  https://www1.racgp.org.au/ajgp/2020/september/dental-abscess-death-and-morbidity

  The onset of a dental abscess is usually slow over many months. Dental decay takes several months to reach the dental pulp. Pulpitis results in pain that is poorly localised. When pulp necrosis finally occurs, there is no pain. However, when an acute periapical abscess develops, a severe well-localised pain develops. At this stage, the dental abscess is easily treated by extraction or root filling. By this time, all patients have had intermittent episodes of pain as a warning that something is wrong. Other causes of dental abscess are pericoronal infections around partially erupted impacted teeth or failed dental treatment. Thus, there are clear warning symptoms; some patients ignore the symptoms while others receive temporary relief with antibiotics from medical or dental practitioners. Antibiotic treatment without dental treatment to remove the cause always fails.

• #35 Endodontic Disease in Small Animals – Digestive System – Merck Veterinary Manual

  https://www.merckvetmanual.com/digestive-system/dentistry-in-small-animals/endodontic-disease-in-small-animals

  Endodontic disease can be categorized as either reversible or irreversible. […] An inflamed pulp can heal after a minor injury. However, more-severe trauma will cause irreversible pulpitis, eventually leading to pulp necrosis. […] The pulp is protected from bacteria by the impervious enamel covering the dentin of the crown of the tooth. Damage to the enamel surface, either through trauma or from a developmental abnormality that allows bacteria to reach the pulp, will result in pulpitis and possibly pulp necrosis. […] Direct exposure of the pulp at a fracture site will lead a tooth to die and therefore necessitates endodontic treatment or surgical extraction. […] Severe periodontitis may progress apically to reach the apex of the root of a tooth, producing secondary endodontic disease.

• #36 Common Dental Emergencies | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0201/p511.html

  Apical abscess is a localized, purulent form of apical periodontitis. It may present clinically as a fluctuant buccal or palatal swelling, with or without a draining fistula. Regional adenopathy is usually present. If pus is draining, pain usually is not severe. Antibiotics are not necessary unless concurrent cellulitis is present. […] Cellulitis may follow apical periodontitis if the infection spreads into the surrounding tissues. Diffuse, tense, painful swelling of the affected tissues occurs. Regional lymphadenopathy is common, and fever may be present. The infection can spread into the major fascial spaces of the head and neck, with the attendant risk of airway compromise. […] Periodontal disease is an inflammatory destruction of the periodontal ligament and supporting alveolar bone. The main etiologic agent is bacterial plaque. Multiple bacteria are implicated, but as the disease progresses, gram-negative anaerobes predominate.

• #37 Common Dental Emergencies | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0201/p511.html

  Apical abscess is a localized, purulent form of apical periodontitis. It may present clinically as a fluctuant buccal or palatal swelling, with or without a draining fistula. Regional adenopathy is usually present. If pus is draining, pain usually is not severe. Antibiotics are not necessary unless concurrent cellulitis is present. […] Cellulitis may follow apical periodontitis if the infection spreads into the surrounding tissues. Diffuse, tense, painful swelling of the affected tissues occurs. Regional lymphadenopathy is common, and fever may be present. The infection can spread into the major fascial spaces of the head and neck, with the attendant risk of airway compromise. […] Periodontal disease is an inflammatory destruction of the periodontal ligament and supporting alveolar bone. The main etiologic agent is bacterial plaque. Multiple bacteria are implicated, but as the disease progresses, gram-negative anaerobes predominate.

• #38 Tooth Abscess Stages: A Comprehensive Overview

  https://adfct.com/tooth-abscess-stages-a-comprehensive-overview/

  A periapical abscess is the most common type of dental abscess, occurring when the pulp chamber, located at the tip of the tooth’s root, becomes infected by bacteria. This usually happens when the insides of the tooth, comprising of blood vessels and nerves, get damaged due to a deep cavity or significant trauma to the tooth. […] Left untreated, these bacteria can multiply and spread to the bones that support the tooth, leading to severe pain, sensitivity, and swelling. Therefore, professional dental treatment like root canal therapy is essential to prevent potential tooth loss. […] In the final stage, the abscess may rupture, causing the pus to drain out of your mouth or into the surrounding tissue. This can relieve pain and swelling temporarily, but it does not mean the infection has been resolved. Without proper treatment, the infection can spread and cause further complications.

• #39 Tooth Abscess: Prevention and Complications

  https://www.longdom.org/open-access/tooth-abscess-prevention-and-complications-100874.html

  A root canal procedure entails extracting the infected pulp from the tooth and filling it with a dental substance to avoid further infection. Tooth extraction is the removal of the infected tooth from the mouth, which may be necessary if the tooth is too damaged to be saved. […] If left untreated, an abscess tooth can lead to serious health complications, including the spread of infection to other parts of the body. The infection can spread to the jawbone, sinuses, or brain, which can lead to meningitis, brain abscess, or sepsis. In rare cases, an abscess tooth can also cause Ludwig’s angina, which is a serious infection that affects the tissues of the neck and can cause difficulty breathing or swallowing.

• #40 Laser + Holistic Dental – A unique, science based approach to dentistry

  https://laserandholisticdental.com/patient-information/treatment-philosophy/eliminating-infection/

  What is broadly recognized by the scientific community is that most root filled teeth have residual root infection which may allow the systemic spread of bacteria and/or their byproducts to other sites of the body. […] The possible mechanism of transmission of infections originating in the mouth causing systemic disease was put forward last century by eminent dental teachers led by Dr. Weston A. Price. The mechanism was described as Dental Foci of Infection. […] Today modern researchers using DNA typing of microorganisms are able to verify that microorganisms from root canal filled teeth seed to other body sites and especially to sites that have had some form of prosthetic implant such as joint replacements and stents. […] The types of microorganisms identified from root filled teeth include fungi, viruses, archaea (methane producing hybrid bacteria), and a host of bacteria. Enterococcus faecalis seems to be present in at least 90% of root filled teeth.

• #41 Laser + Holistic Dental – A unique, science based approach to dentistry

  https://laserandholisticdental.com/patient-information/treatment-philosophy/eliminating-infection/

  E. faecalis is often resistant to antibiotics and seems to remain unaffected by the conventional root canal therapy methods such as chlorhexidine, bleach, and calcium hydroxide. […] A few bacteria survive in the circulation after a bacteremic challenge from the oral cavity. The role of these bacteria and how they survive host defenses need to be evaluated further, as they may well be the ones that evade the initial host immune burst and have the propensity to seed target organs and cause systemic and distant infections. […] It also seems that certain oral microorganisms have the ability to become dormant and before being triggered. This may stimulate the production of broad range growth stimulation factors that cause the community/biofilm of bacteria to undergo rapid growth, causing damage to the affected tooth and pain to the patient.

• #42 Abscess: Types, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22876-abscess

  A tooth abscess is a pocket of pus that forms around or near your tooth. It may cause pain and swelling on your gums. […] A tooth abscess (dental abscess) is an abscess that forms around a tooth. […] A periapical abscess is an infection that forms at the tip of the root of your tooth. This type of abscess can occur due to dental injuries or cavities. […] Bacterial infections usually cause abscesses. A bacteria called Staphylococcus causes most abscesses. When bacteria enter your body, your immune system sends white blood cells to go fight the infection. This process causes inflammation, and the tissue nearby dies. When this happens, a pocket forms and fills with pus, creating an abscess. […] Treatment for tooth and other mouth abscesses is especially important. Untreated tooth abscesses can kill you. Untreated infections can spread to surrounding tissues in your body. This can cause serious complications including sepsis and necrotizing fasciitis, which can lead to death.

• #43 Dental abscess: A potential cause of death and morbidity

  https://www1.racgp.org.au/ajgp/2020/september/dental-abscess-death-and-morbidity

  The onset of a dental abscess is usually slow over many months. Dental decay takes several months to reach the dental pulp. Pulpitis results in pain that is poorly localised. When pulp necrosis finally occurs, there is no pain. However, when an acute periapical abscess develops, a severe well-localised pain develops. At this stage, the dental abscess is easily treated by extraction or root filling. By this time, all patients have had intermittent episodes of pain as a warning that something is wrong. Other causes of dental abscess are pericoronal infections around partially erupted impacted teeth or failed dental treatment. Thus, there are clear warning symptoms; some patients ignore the symptoms while others receive temporary relief with antibiotics from medical or dental practitioners. Antibiotic treatment without dental treatment to remove the cause always fails.

• #44 Endodontic Abscess – Wendel Family Dental Centre

  https://www.wendeldental.com/services/endodontics/endodontic-abscess/

  Left untreated, an endodontic abscess can damage the adjacent soft tissue in the mouth and face, lead to bone loss, be a continuing source of infection that drags down your immune system, and may even be life threatening. […] To treat an endodontic abscess, we must drain the abscess and remove the source of infection. Root canal therapy is often the treatment of choice because it removes the infection, relieves the pressure, and usually heals the abscess. […] Sometimes however, even after a root canal, the infection continues to grow. In that case, retreating the tooth with root canal therapy or a further surgical procedure, called an apicoectomy, will stop the infection and restore the health of your tooth.

• #45 How to Identify, Treat and Prevent a Tooth Abscess – Carlos E. Sanchez, DDS Tracy California

  https://www.carlosesanchezdds.com/blog/how-to-identify-treat-and-prevent-a-tooth-abscess/

  Dentists typically treat tooth abscesses based mainly on the severity of the condition. When you visit for your first appointment, the dentist will scrutinize the abscess and probe it to determine the level of pain. Afterward, they will suggest an x-ray scan to know the state of the bone and surrounding tissues. Your dentist’s first course of action would be to treat the infection without tooth removal, if possible. If antibiotics fail, a root canal is the next action to take to save the tooth. If it is impossible to clean the tooth during the root canal treatment or if infection sets in again, then the tooth will need to be removed.

• #46 Dental abscess: A potential cause of death and morbidity

  https://www1.racgp.org.au/ajgp/2020/september/dental-abscess-death-and-morbidity

  The key first step is to assess whether the patient is low or high risk for airway embarrassment. This begins with a thorough history and clinical examination. It is important to determine whether this is the first episode or infection or whether the patient has had previous courses of antibiotics. […] Patients with a high risk of airway obstruction should be promptly transferred to a tertiary hospital. If they are being transferred any distance by road or air, intubation should be considered. Patients without these signs of airway compromise are low risk. […] Dental abscess is a common preventable disease that can be simply treated in general dental practice. Unfortunately, less than half of all Australians have regular or emergency-only dental care. If an abscess spreads beyond the tooth, it requires dental treatment and will not respond to antibiotics alone. If the infection spreads into the fascial planes of the neck or face, then there is risk of airway compromise or spread to the brain. Appropriate protocols of management have been established at tertiary hospitals, but there is still morbidity and mortality. […] The condition of dental abscess can be prevented, but this requires better access to dental care and careful antibiotic stewardship by all health professionals.

• #47 Dental abscess: A potential cause of death and morbidity

  https://www1.racgp.org.au/ajgp/2020/september/dental-abscess-death-and-morbidity

  The key first step is to assess whether the patient is low or high risk for airway embarrassment. This begins with a thorough history and clinical examination. It is important to determine whether this is the first episode or infection or whether the patient has had previous courses of antibiotics. […] Patients with a high risk of airway obstruction should be promptly transferred to a tertiary hospital. If they are being transferred any distance by road or air, intubation should be considered. Patients without these signs of airway compromise are low risk. […] Dental abscess is a common preventable disease that can be simply treated in general dental practice. Unfortunately, less than half of all Australians have regular or emergency-only dental care. If an abscess spreads beyond the tooth, it requires dental treatment and will not respond to antibiotics alone. If the infection spreads into the fascial planes of the neck or face, then there is risk of airway compromise or spread to the brain. Appropriate protocols of management have been established at tertiary hospitals, but there is still morbidity and mortality. […] The condition of dental abscess can be prevented, but this requires better access to dental care and careful antibiotic stewardship by all health professionals.

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