A tooth infection, also known as a dental abscess, is a pocket of pus that forms in the tooth or gums as a result of a bacterial infection. If left untreated, a tooth infection can potentially spread to other areas of the head and neck and cause serious complications. Understanding the chances of a tooth infection spreading and how to prevent it from progressing is important for dental health.
What causes a tooth infection?
A tooth infection usually starts when decay reaches the inner pulp of the tooth. The pulp contains nerves, blood vessels, and connective tissue. When decay exposes the pulp, bacteria can invade and cause infection.
An infection can also occur in the gums around the tooth. This is called a periodontal abscess. Periodontal disease damages the gums and bone supporting the teeth, creating pockets where bacteria accumulate and infection develops.
Other causes of tooth infections include:
- Cracked or broken teeth that allow bacteria to enter the pulp
- Injuries that chip or damage teeth
- Previous dental procedures like root canals that become re-infected
Signs and symptoms
Signs and symptoms that may indicate a tooth infection include:
- Severe toothache or pain that is continuous and may radiate to other areas like the ear, jaw, neck or head
- Sensitivity to hot or cold temperatures
- Pain when chewing or biting down
- Swelling or lump on the gums near the affected tooth
- Redness or bleeding from the gums
- Bad breath or foul taste in the mouth
- Gum recession, exposing more of the tooth root
- Pus drainage in the mouth
- General symptoms like fever, swollen lymph nodes or feeling unwell
Potential complications
If a tooth infection is left untreated, it can spread from the tooth into the bone and tissues around it. Potential complications include:
- Facial cellulitis – a bacterial skin infection that causes swelling in the face
- Dental sinusitis – infection of the sinuses around upper teeth
- Cavernous sinus thrombosis – a rare and serious infection of the sinus cavity near the brain
- Ludwig’s angina – severe swelling under the tongue that can obstruct breathing
- Osteomyelitis – infection of the jaw bone
- Brain abscess – a collection of infected material in the brain
- Sepsis – a whole-body inflammatory response to infection
These complications are rare but can become life-threatening. Seeking emergency medical care is important if signs of infection spread beyond the tooth.
Who is at risk?
Some factors that increase the risk of developing a tooth infection include:
- Poor dental hygiene allowing dental plaque buildup
- Untreated tooth decay
- Previous dental procedures like root canals
- Cracked or broken teeth
- Dry mouth from medications or health conditions
- Weakened immune system
- Smoking, diabetes or other chronic illnesses
When to see a dentist
It’s important to see a dentist right away if you have symptoms of a possible tooth infection like unexplained tooth pain, swelling, or other signs of infection. Only a dentist can determine if an infection is present and provide appropriate treatment.
Seeking prompt treatment within a few days is important to prevent the infection from spreading. If you have difficulty breathing or swallowing, fever, or other signs the infection is progressing, seek emergency care immediately.
Diagnosis
To diagnose a tooth infection, the dentist will:
- Examine your mouth, teeth and gums for signs of infection
- Check for swelling, redness, drainage, and damage to teeth
- Tap on teeth to test for pain or sensitivity
- Order X-rays to see infection in the bone
- Test for loose teeth
- Probe gum pockets to check for periodontal disease
You’ll also be asked about your symptoms and dental history. Based on the exam and X-rays, your dentist can determine if an infection is present and recommend appropriate treatment.
Treatment
Treating a tooth infection aims to drain the pus, eliminate the infection, and prevent further spread. Common treatments may include:
- Root canal treatment – removes infected pulp and cleans canals inside the tooth. The tooth is then restored with a filling or crown.
- Tooth extraction – complete removal of the infected tooth if it cannot be saved.
- Medications – antibiotics, anti-inflammatories, and pain relievers.
- Draining the abscess – making a small incision to release pus and relieve pressure.
- Treating periodontal disease – deep cleaning below the gum line and sometimes gum surgery.
The dentist will choose the best options depending on the location and extent of infection. Prompt treatment helps prevent the spread of infection to surrounding tissues.
Can a tooth infection spread?
A tooth infection can spread from the tooth to surrounding areas in the face and neck – and in rare cases, other parts of the body – if left untreated. Here are some details on how a tooth infection can spread:
Spread to bone
The infection can progress from the tooth and spread into the bones supporting the tooth. The jaw bone below infected teeth is most commonly affected. Signs of infection spreading to bone include pain, swelling, and pus around the tooth. It can show up on X-rays as damage to bone.
Spread to facial spaces
Spaces or cavities between muscles and tissues in the face provide pathways where infection can spread rapidly. Possible types of spread include:
- Infection reaching the cheeks – called buccal space infection
- Spread under the chin – called submandibular space infection
- Infection reaching deep facial tissues – called sublingual or Ludwig’s angina
Facial swelling is usually the first sign of spread to these spaces.
Spread to sinus cavities
The maxillary sinuses above the upper teeth can sometimes become infected from a nearby infected tooth. Symptoms of sinusitis will develop, like congestion, facial pain and pressure.
Spread to other regions
In rare cases, the infection travels from facial planes to more distant areas through blood vessels and lymphatic channels. Potential types of spread include:
- To the cavernous sinus, a venous sinus near the brain
- To the eye socket, causing orbital cellulitis
- Into the brain, causing a life-threatening brain abscess
- To the lungs through aspiration, causing a lung abscess
These types of spread cause severe infections and require emergency medical treatment.
Risk factors for spread
Certain factors raise the risk of a tooth infection progressing beyond the initial site:
- Severe infection causing larger abscess formation
- Abscess located at the back of the mouth making drainage difficult
- Infection from upper wisdom teeth which are near vulnerable facial planes
- Weakened immune system from conditions like diabetes or cancer
- History of endocarditis which can allow spread to the bloodstream
Preventing spread
Seeing a dentist right away when you notice possible infection is key to preventing it from spreading. Other prevention tips include:
- Practicing good daily oral hygiene and brushing/flossing
- Getting routine dental cleanings and exams to treat early decay
- Having cracked teeth restored promptly before decay develops
- Taking antibiotics as prescribed if at high risk for infection spread
- Quitting smoking which increases infection risk and delays healing
How common is spread?
Spread of a tooth infection is relatively uncommon when the infection is treated promptly. However, some statistics on frequency include:
- Around 3-9% of untreated infections spread to nearby facial spaces
- Tooth infections cause about 60-70% of Ludwig’s angina cases
- Around 28% of brain abscesses arise from oral infections like a tooth
- Sinusitis occurs in about 14-40% of people with upper molar infections
With prompt treatment, the chances of a tooth infection spreading can be greatly reduced. Good dental care and hygiene are also key prevention factors.
When to seek emergency care
Seek emergency medical care if you have any of the following signs that indicate an infection may be spreading beyond the tooth:
- Swelling or redness that spreads to the face, neck or jaw
- Difficulty breathing or swallowing
- Fever above 100.4 F (38 C)
- Numbness in the face
- Changes in vision or eye pain
- Stiff neck with headache or light sensitivity
- Ear pain or drainage
These can indicate a spreading infection that needs urgent treatment to prevent serious complications. Don’t delay seeking help if any of these severe or unusual symptoms develop.
Conclusion
While a tooth infection can potentially spread, prompt dental treatment and good oral hygiene make progression beyond the tooth less likely. Seek care as soon as you suspect an infection, and follow up with any additional treatment needed to fully eliminate it. This can prevent a localized tooth problem from turning into a more serious facial or systemic infection. Contact your dentist if you have any questions about your infection risk.
