Runaway Infections

General Dentistry
Runaway Infections

In the operating room at Loyola University Medical Center, oral surgeon Mark Steinberg and two residents made two small incisions inside Michener's cheek and three on his neck; then they installed flat rubber tubes in each to drain pus. They made a slice the width of a nickel through Michener's neck into his windpipe, and inserted a six-inch-long curved plastic tracheostomy tube that allowed him to breathe.

Michener remained in intensive care for two more days and in the hospital for the rest of the week. His massive infection began receding. "It was lonely," Michener remembers. "You couldn't talk. You couldn't move. You couldn't sleep." Nurses suctioned mucus from his windpipe for four days so he could breathe. "You didn't want to fall asleep and gag to death, so you had little catnaps and that was it."

Infections like Michener's are rare, but not exceedingly so. Between 1996 and 2001, physicians at San Francisco General Hospital, a large public hospital, treated 157 patients with runaway tooth infections that had eaten into their jaws, faces and necks. All the patients recovered. Still, "patients who get a big dental abscess -- well, they can die from it," cautions M. Anthony Pogrel, DDS, MD, co-author of the study and chairman of the oral and maxillofacial surgery department at the University of California, San Francisco.

A Silent Threat

Gum infections, too, harm more than just mouths. While mild gum infections called gingivitis may lead to red and swollen gums, they're not especially dangerous by themselves. But they can worsen into periodontitis, painless but chronic gum infections that, if left untreated, degrade bony sockets and ligaments that hold teeth in place. The immune system fights gum infections to keep oral bacteria from spreading to other parts of the body. It usually succeeds, but not always. Gum disease bacteria can enter the bloodstream and move to the heart, creating life-threatening infections in previously damaged heart valves. What's more, scientists believe the resulting inflammation releases infection-fighting compounds that can inadvertently damage other tissues. The arteries may be the most common target. People with periodontitis were twice as likely to die from a heart attack and three times as likely to die from a stroke, according to a study that examined 18 years of medical histories for 1,147 people. Steven Offenbacher, director of the Center for Oral and Systemic Diseases at the University of North Carolina School of Dentistry, who co-authored the study, is helping conduct another to see if treating periodontitis in heart patients will cut the risk of heart attacks.

Pregnant women with serious periodontal disease have about four times the risk of delivering preterm babies, and they face an increased risk of preeclampsia, in which blood pressure climbs sky-high after the 20th week, threatening the lives of both mother and fetus. In an early clinical trial, researchers found that treating seriously infected gums reduces pre-term births fivefold, but the work needs to be confirmed in larger trials. 

By Dan Ferber
From Reader's Digest
December 2005

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