Oral Infection – Types, Cause & Treatment Options

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The oral cavity interacts with a vast range of microorganisms as it is directly in contact with the outer environment. Some of this microorganism can do serious harm to our body. Bacteria and viruses usually cause oral infection. They can affect the teeth, gums, palate (the roof of the mouth), tongue, lips, and inside of the cheeks.

Some of the common oral infections are oral thrush, dental caries, canker sore, herpangina, gingivitis, etc. Oral infections can also lead to tooth decay, which is the second most common infectious condition after the common cold.

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Also, the oral cavity is directly connected to two major systems of our body, which is the respiratory and digestive system. The microorganism can enter from the oral cavity to these systems and can cause serious medical problems. Let’s read in read about some common oral infections, cause, and available treatment options.

What is the importance of oral health and hygiene?

Oral health is one of the crucial aspects of our life that directly impacts our overall health and well-being. Our mouth is a direct window to fulfill the nutritional requirements and energy source of the body. Several systemic health disorders like diabetes and heart disease have been linked to poor dental hygiene. (1) Moreover, clinical studies have shown that severe gum diseases account for almost 40% of the chronic systemic conditions.

It is essential to maintain proper oral hygiene to build the immunity against bacterial infection. Additionally, it is necessary to prevent the spread of disease to some of the potential vital organs like the heart brain and lungs. A proper oral health practice includes –

  • Regular tooth brushing and flossing
  • Cleaning of the tongue is crucial as the majority of the bacteria reside over the surface of the tongue
  • Regular dental checkups are essential for early diagnosis of the tooth infection and appropriate treatment

Excellent oral health is the key to increasing the longevity of the natural tooth.

What are oral infection?

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Oral infection is characterized as a group of infections that mainly affect the health of the oral tissues. Typically, oral infections originate from tooth decay and spread to the surrounding oral tissues as the disease progresses. Depending on the severity of the disease, oral infections can be categorized into two types –

  • Mild infections are mainly limited to the tooth and gum infections. Such cases can be quickly resolved by extracting the affected tooth. (2)
  • The severe spread of disease often leads to compromised situations which may require surgical drainage and antibiotic coverage in addition to tooth extraction.

One of the leading causes of oral infection is poor dental hygiene. This is evident in populations that have poor access to primary dental care. Potential oral diseases include tooth decay, tooth abscess formation, and Ludwig’s angina.

What causes oral infection?

As mentioned earlier, there are several potential causes of oral infection. One of the prime factors is poor dental hygiene. A healthy mouth consists of billions of bacteria, viruses, and fungi wit ha wide variety of more than 500 species. Together they form the oral microbiome. Poor oral hygiene creates an imbalance in the oral environment, which allows the disease-causing bacteria to multiply in number and start the process of tooth decay. Dental plaque plays a crucial role in providing a direct contact of the bacteria to the tooth surface. (3)

There is a wide range of disease-causing bacteria that may potentially lead to full-fledged chronic oral infections. Some of them include the following –

  • Streptococcus mutans
  • Staphylococcus
  • Obligate anaerobes
  • Facultative anaerobes

Let’s understand the mechanism of action of tooth decay –

  • Poor oral hygiene initiates the process of tooth decay and gum infection
  • As the bacteria weakens the tooth structure, it creates an environment which has low oxygen capacity
  • Such an oral environment gives an advantage to the overgrowth of opportunistic infections like viruses and fungal infectious agents.
  • Continuous spread of dental infection may involve the surrounding periodontium and bone.
  • In severe cases, the infection can spread to facial spaces that may cause extreme symptoms like facial swelling, restricted mouth movement, and airway blockage.

How does oral infection spread in the mouth?

As mentioned earlier, oral infection originates from simple tooth decay that progresses to involve the surrounding periodontium and underlying bone. As the disease progresses, the infection may spread in the mouth through the facial spaces. Typically, two facial spaces are affected by oral infection –

Primary space

Primary space is considered as the space between the soft tissue structures that have a direct communication with the infected tooth.

  • In the upper jaw, the primary spaces are categorized into buccal and vestibular spaces. Spread of oral infection in these spaces has the potential to reach the sinuses of the maxilla. (4)
  • In the lower jaw, the primary spaces are categorized as sublingual, submental, and submandibular spaces. This demarcation is made depending on the type of tooth involved.

Secondary space

Secondary space infections are caused by the spread of bacteria from the primary spaces into the deeper tissues. For example – deep neck space infection. This causes severe symptoms like trismus, restricted mouth opening, airway blockage, and increases the risk of systemic disease spread.

What are the signs and symptoms of oral infection?

Typically, pain and swelling in the mouth are considered as the hallmark signs of oral infection. Other potential signs and symptom of oral infection may include the following –

  • Raise in body temperature associated with chills
  • Increased heart rate
  • Persistent swelling and pain
  • Difficulty in chewing and swallowing
  • Difficulty in speaking
  • Restricted mouth opening
  • Fatigue
  • Disturbed sleep
  • Shortness of breath and in severe cases airway blockage
  • Loss of appetite
  • Weight loss
  • Excessive drooling
  • Burning mouth

What are the most common types of oral infections?

1. Dental caries

Dental caries is one of the most common oral diseases. Dental caries is the result of tooth decay which is caused by the action of acids on the enamel surface. The acid is produced when sugars in foods or drinks react with bacteria from the dental plaque present on the tooth surface.

These cavities once formed then cannot be reversed. The damage done to the tooth by Caries is permanent. Untreated cavities can cause toothache, infection, and eventually, tooth loss. Treatments include fluoride, cavity filling, and crowns. In Severe condition, you may need a root canal or extraction of the tooth.

2. Gingivitis

Gingivitis is early gum disease. Gingivitis means inflammation of the gingiva (gums). It commonly occurs because of toxins produced by a film of bacteria (plaque) that accumulates on the teeth. (5) Gingivitis can be reversed by taking good care of teeth. Untreated gingivitis can lead to periodontitis which is a severe problem as it destroys the supporting structures of the tooth and leads to tooth loss.

Symptoms of gingivitis are red, swollen, bleeding gums, persistent bad breath, and yellow patches near the gum line. Treatment involves a professional cleaning called scaling and oral rinses.

3. Periodontal disease

When gingivitis is left untreated, the infection spreads beyond the gum line and destroys alveolar bone and periodontal ligament (fibers holing teeth to the bone). This makes the tooth mobile as the supporting structures are destroyed and can lead to tooth loss. In periodontal disease, the gums pull away from the teeth and form spaces called as gum pockets that become infected due to continuous accumulation of food and plaque into these pockets.

Treatment includes cleaning the pockets around teeth by a professional dentist to prevent damage to the surrounding bone, and advanced cases may require surgery. (6)

4. Hand, foot, and mouth disease

It is a contagious viral infection common in toddlers and young children. The virus “Coxsackie A16 usually causes Hand, foot, and mouth disease”, this disease is characterized by a lesion in the mouth and a rash on the hands and feet. (7) Hand, foot, and, mouth disease is usually a mild illness causing only a few days of fever and relatively mild signs and symptoms.

5. Herpangia

Herpangina is also called mouth blisters. It is a painful mouth infection related to hand foot and mouth disease. Herpangia is most often seen in children aged three to ten, but it can occur at any age. (8) Initial symptoms are sudden fever with a sore throat, headache, loss of appetite, and often neck pain. After few days tiny blisters at the back of the mouth are found which form large ulcers when they rupture. Fever only stays for three to four days.

6. Oral thrush

Thrush is a fungal disease caused by “Candida albicans.” It’s most familiar with babies, people with immune deficiency, and those who use steroid sprays for asthma. White blotches on the tongue or inner cheeks or palate appear in thrush. Oral thrush in adults is not contagious, but when newborns come in contact with the fungus during birth if the mother has a vaginal fungal infection, it spreads from the mother to the newborn baby.

An anti-fungal medication, chemotherapy, or radiation can help. Thrush is commonly seen in people who have HIV. (9)

7. Canker sores

There are about 10 million cases of cancer sours in India alone every year. Cancer sores sours are small, superficial ulcers that appear on gums and other oral tissues. The Exact cause of cancer sours is unknown, but they are thought to be caused by stress, injured tissue, hormones, immune problems, food hypersensitivities, and other dental problems. Most sours heal on their own in two to three weeks.

8. Oral herpes

Oral herpes is a viral infection caused by a specific type of herpes simplex virus (HSV). The infection causes painful sores on the lips, gums, tongue, the roof of the mouth, and inside cheeks. It also causes symptoms like fever and muscle aches. Oral herpes causes tiny, fluid-filled lesions called cold sores or fever blisters, which can recur.

These sours are mostly found in children between the ages group 1-3 years old but can affect people of any age group. This infection is highly contagious, and can quickly spread by touching infected saliva, mucous membranes, or skin. Oral herpes causes tiny, fluid-filled lesions called cold sores or fever blisters, which can recur. (10)

9. Ludwig’s angina

Ludwig’s angina is characterized as a severe form of cellulitis that involves the floor of the mouth. This infection mainly spreads from extensive chronic molar infection of the lower jaw. Early symptoms of this condition include the raising of the floor of the mouth, difficulty in swallowing, shortness of breath, and restricted mouth opening.

As the disease progresses, the patient may experience flu-like symptoms – extreme raise in temperature, fatigue, and airway blockage. This calls for emergency surgical drainage. Some of the potential causes of Ludwig’s angina include –

  • Chronic dental infection
  • Parapharyngeal abscess
  • Mandibular fracture
  • Submandibular infection

How are oral infections diagnosed?

Mouth infections can be easily detected during a general health checkup. However, it is essential to consult a dentist to diagnose the right condition and identify the cause. Typically, the dentist takes a complete medical and dental history of the patient to rule out underlying systemic illnesses.

A clinical oral examination is performed to observe any swellings in the oral tissues like inner cheeks, tongue, the roof of the mouth, the floor of the mouth, gums, and lips. A history of the onset of the symptoms and its progression is taken to grade the severity of the infection. Many diagnostic tools like dental x-rays and CT scans are used to find out the location and extent of the oral infection. Also, these tools help to determine a tentative prognosis of the condition.

Draining abscess or cysts are often examined by a swab test for microscopic evaluation. Additionally, it helps to identify individual susceptibilities to antibiotics. Some other diagnostic tests may include complete blood work, serum electrolyte concentration, and a check on the infection levels. (11)

What are the treatment modalities to cure an oral infection?

Treatment of oral infections depends on the type of infection and its underlying cause. Several treatment modalities can be used to treat the condition quickly. However, the proper protocol for the treatment of oral diseases includes the following steps –

The prime step is to protect the airway passage

Loss of airway is an alarming emergency. Securing the airway passage is crucial for saving the life of the patient. It is, therefore, the first step towards treating oral infections. Often oral infections that involve the floor of the mouth may block the airflow to the lungs by applying pressure on the windpipe. The airway passage of a person has maintained the patent by placing flexible plastic tubes from the nasal cavity into the windpipe. This tubing is clinically referred to as endonasal intubation. This step can be performed in two ways –

  • Under direct vision with laryngoscopy
  • By using the endoscopic camera to view the location of the tube

Emergency airway protection may sometimes require tracheostomy wherein a small incision is made to gain access to the trachea for proper airflow.

Any abscesses in the mouth should be drained thoroughly

Often abscess drainage may require the help of a needle or blade. However, infected tooth abscess with poor prognosis can be treated by tooth removal. For diseases that involve multiple space infections, extensive incision, and drainage may be required with culture-guided antibiotic coverage.

Antibiotic coverage is mandatory to subside the symptoms and allow better healing

Antibiotic coverage is often referred to as subside the infection and provide relief to the patient. Typically, penicillin or amoxicillin is the preferred antibiotic as it acts effectively against Streptococcus and gram-negative anaerobes. For patients with allergy to penicillin – clindamycin or metronidazole can be given. If you have any systemic disease or weak immunity, let the dentist know about it as the antibiotic may react with the ongoing medications.

What are the complications associated with oral infection?

Oral infections can have certain complications depending on the persistence and mode of infection. Some of the complexities of oral infections are listed below –

  • Osteomyelitis – osteomyelitis is considered as the spread of infection to the bone. Usually, persistent mouth infections or tooth infections progress for months and cause chronic infection of the surrounding bone. (11)
  • Deep neck space infection – the spread of chronic oral infection between the connective tissue spaces in the neck can cause a severe case of deep neck space infection. In this condition, a person may experience high fever, pain in swallowing, difficulty in breathing, chest pain, limited motion of the neck, and confusion. Untreated, deep neck space infections have the potential to develop necrotizing lesions.
  • Cavernous sinus thrombosis – this is a rare complication of oral infection. However, cavernous sinus thrombosis can be caused by the spread of oral infection through systemic blood transmission. Typical symptoms of this condition include pain and swelling in the eyes, headache, fever, and change in vision.
  • Endocarditis – talking about the transmission of bacteria from the mouth to the vital organs, endocarditis is one of the prime complications that happen when oral bacteria block the valves of the heart.

How can you prevent an oral infection?

  • Avoid direct contact with the people who are suffering from various oral infections.
  • Avoid tobacco products.
  • Brush and floss daily
  • Visit a dentist for regular cleanings and checkups for any oral infection. (12)
  • Rinse your mouth with saltwater.
  • Eat more vitamin C rich food to keep your gums and periodontal fibers healthy.

Over to you on oral infection

Oral infection may seem like a simple term. However, it has the potential to cause severe deterioration of the surrounding oral tissues. Oral infections, mainly originate from tooth decay. Untreated tooth infections can progress rapidly to not only affect the health of the surrounding dental tissues but to involve the facial spaces. Such situations can pose a threat to the systemic spread of oral bacteria.

There are many types of oral infections that may affect the health of the dental tissues. Some of the common ones include dental caries, herpes, canker sore, Ludwig’s angina and fungal infections like oral thrush. Treatment of oral infection mainly depends on the type of underlying cause. Oral disease is a prevalent problem and affects millions of people every year, but a proper diet and good oral hygiene can help you beat these infections.

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