The Correlation between dental abscess and sepsis

Andravina Pranathania 030.09.015

CONTENT PREFACE..............................................................................................................2 ABSTRACT.......................................................................................3 INTRODUCTION.................................................................................4 CHAPTER I DENTAL ABSCESS.............................................5 Symptoms........................................5 Caus s......................................! CHAPTER II SEPSIS..........." Symptoms........................................................................................................." CHAPTER III THE CORRELATION BET#EEN DENTAL ABSCESS AND

SEPSIS..........................................................................................................$2 CONCLUSION........$4 REFERENCES........$5

PREFACE Sepsis causes ore deaths each !ear than prostate cancer" breast cancer and #$%&A$'S illion people contract sepsis ever! !ear" the nu ber o) sepsis ore than doubled an! countries" ore people are hospitali*ed each !ear )or

co bined. An esti ated 1( over the last 10 !ears" and in

cases continues to increase dra aticall!. #ospitali*ations )or sepsis have

sepsis than )or heart attac+. $nternational studies show that ,0-.0/ o) sepsis patients re0uirin1 intensive care treat ent developed sepsis outside the hospital. 2ecause o) that i want to write about sepsis" and sepsis can caused b! dental abscess. $t3s i portant to +now about sepsis caused b! dental abscess" because sepsis is a edical e er1enc! and o)ten dia1nosed too late. $ would li+e to than+ !ou to Allah swt" ! )a il!" ! teacher and collea1ues who helped with this paper. $ hope this paper use)ul and can reduce the late dia1ones o) sepsis. an! )actor" one o) the is because

ABSTRACT A dental a%s& ss is an in)ection o) the result )ro underl!in1 i outh" )ace" 4aw" or throat that be1ins as a tooth a! also occur in people with

in)ection or cavit!. Althou1h these in)ections can be caused b! poor dental health and can lac+ o) proper and ti el! dental care" the! edical conditions such as autoi une disorders or conditions that wea+en the

une s!ste

5'(a% t s" post-radiation&che otherap! cancer care6. 'ental abscesses can inor trau a in the oral cavit!. is in)ected b! bacteria.

also be tri11ered b!

Sepsis is t!pe o) blood in)ection in bod!" where blood strea This condition o) blood is also +nown as bactere ia.

An untreated abscess" can beco e worse without treat ent. The in)ection will o)ten continue to 1row until the bacteria enters the bloodstrea . 7nce the bacteriu bloodstrea " it can in)ect the entire bod!. Sepsis is dia1nosed when a patient in)ection. These sepsis are co eets S$8S criteria" and has a suspected source o) icroor1anis s include bacteria" )un1i" viruses" and parasites. People with onl! treated in the intensive care unit" or $C9" o) the hospital and started on antibiotics and a dentist a! reco end a root canal i) the enters the

intravenous broad spectru

person wishes to +eep the tooth. A severe tooth abscess can o)ten re0uire sur1ical draina1e o) the abscess and re oval o) the in)ected tooth. :;< =78'S > 'ental Abscess" The Cause o) Sepsis" Sepsis 'ia1nosed" S$8S

INTRODUCTION A 'ental abscess can lead to a blood in)ection +nown as sepsis. Sepsis arises when the bod!3s response to an in)ection da a1es its own tissues and or1ans. $t can lead to shoc+" ultiple or1an )ailure" and death" especiall! i) it is not reco1ni*ed earl! and treated pro ptl!. 2etween one-third and one-hal) o) all sepsis patients die. $n developin1 countries" sepsis accounts )or ?0-(0/ o) all deaths. $t +ills 100"000 new ore than ? illion in)ants and !oun1 children" and others ever! !ear. ;ver! )ew seconds" so eone in the world dies o) sepsis.1

'ental sepsis in children can be de)ined as dental abscesses presentin1 as localised swellin1s or drainin1 sinuses ad4acent to carious or trau atised teeth. The conse0uences o) such an in)ection" in addition to pain and disco )ort" are two-)old> )irstl! a chronic abscess can result in da a1e to developin1 per anent teeth@ secondl!" acute abscesses related to deciduous teeth can lead to rare" althou1h serious" se0uelae such as orbital cellulitus" brain abscesses and AuneBplained3 recurrent )ever.,

CHAPTER I DENTAL ABSCESS A dental abscess is a collection o) pus that can )or bacterial in)ection.3 There are two t!pes o) dental abscess>

in the teeth or 1u s as a result o) a

periapical abscess 5the

ost co

on t!pe6" when bacteria in)ect the inside o)

the tooth as a result o) dental deca!

periodontal abscess" when bacteria in)ect the 1u s

a+e a person )eel unwell.

'ental abscesses can be ver! pain)ul and tender and can

F()u* $> A collection o) in)ected aterial 5pus6 resultin1 )ro bacterial in)ection o) the center 5pulp6 o) a tooth. Paul Cote+" 'D'. Tooth abscess" available at http>&&www.nl .nih.1ov& edlineplus&enc!&article&0010?0.ht . 9pdate> ,&,,&,01,. accessed 9 4ul! ,01,

Symptoms The ain s! pto o) a dental abscess is a severe toothache in a))ected tooth" which can be intense and throbbin1. The pain usuall! co es on 0uite suddenl! and 1raduall! worsens over a )ew hours to a )ew da!s. The pain a! spread to ear" lower 4aw and nec+ on the sa e side as the a))ected tooth.

7ther s! pto s o) a dental abscess include>

tenderness o) tooth sensitivit! 2itter taste in the )ever a 1eneral )eelin1 o) bein1 unwell di))icult! openin1 outh
6

outh

d!spha1ia disturbed sleep

Caus s Causes o) a periapical abscess =hen a periapical abscess occurs" pla0ue bacteria in)ect the tooth as a result o) dental caries 5tin! holes caused b! tooth deca!6 that )or ena el6. 'ental caries brea+ down the ena el and the so)ter la!er o) tissue underneath 5dentine6 and eventuall! reach the centre o) !our tooth 5pulp6. This is +nown as pulpitis. The dental pulp in the iddle o) the tooth dies and the pulp cha ber beco es in)ected. The bacteria continue to in)ect the pulp until it reaches the bone that surrounds and supports the tooth 5alveolar bone6" where the periapical abscess )or s. Causes o) a periodontal abscess A periodontal abscess occurs when pla0ue bacteria a))ect the 1u s" causin1 1u disease 5periodontitis6. Periodontitis causes in)la ation 5redness and swellin16 in 1u s" which can a+e the tissue that surrounds the root o) tooth separate )ro the base. This separation creates a tin! in the hard outer la!er o) tooth 5the

1ap +nown as a periodontal poc+et" which can be ver! di))icult to +eep clean and allows bacteria to enter and spread. The periodontal abscess is )or ed b! the build-up o) bacteria in the periodontal poc+et. A periodontal abscess

a! also occur as a result o)> as+ the be1innin1s o) an

dental procedures that create accidental periodontal poc+ets antibiotic use in untreated periodontitis" which can abscess da a1e to the 1u s" even i) there3s no periodontitis

$n)ection results in a collection o) pus 5dead tissue" live and dead bacteria" white blood cells6 and swellin1 o) the tissues within the tooth. This causes a pain)ul toothache. $) the pulp o) the tooth dies" the toothache 2acteria )ro a! stop" unless an abscess develops. This is especiall! true i) the in)ection re ains active and continues to spread and destro! tissue.. dental caries 5a tooth cavit!6 can eBtend into the 1u s" the chee+" the throat" beneath the ton1ue" or even into the 4aw or )acial bones. A dental abscess can beco e ver! pain)ul when tissues beco e in)la ed or due to the pressure within the abscess. A 1u
7

or 1in1ival abscess is the result o) in)ection or trau a to the sur)ace o) the 1u Periodontal abscesses are the result o) an in)ection that has oved deeper into 1u a periapical abscess re)ers to a tooth with an in)ection o) the pulp.

tissue.

areas" and ore

Pus collects at the site o) the in)ection. The condition will beco e pro1ressivel! pain)ul until the abscess either ruptures and drains on its own or is drained sur1icall!.

8arel!" the in)ection can pro1ress to the point at which swellin1 threatens to bloc+ the airwa!" causin1 di))icult! breathin1. 'ental abscesses can also nausea" vo itin1" )evers" chills" and sweats.5 a+e !ou 1enerall! ill" with

CHAPTER II SEPSIS

Sepsis is an illness in which the bod! has a severe response to bacteria or other 1er s that is tri11ered b! an in)ection. This response s!ndro e 5S$8S6. The bod! a! develop this in)la ator! response b! the i une s!ste to icrobes in the blood" urine" lun1s" s+in" or other tissues. A la! ter and the presence o) or1an d!s)unction. Septice ia is a related edical ter re)errin1 to the presence o) patho1enic or1anis s in the bloodstrea " leadin1 to sepsis. Symptoms $n sepsis" blood pressure drops" resultin1 in shoc+. Da4or or1ans and bod! s!ste s" includin1 the +idne!s" liver" lun1s" and central nervous s!ste " stop wor+in1 properl!
8

a! be called s!ste ic in)la

ator! response

)or sepsis is blood poisonin1" also ator! response" in)ection

used to describe septicae ia. Severe sepsis is the s!ste ic in)la

because o) poor blood )low. A chan1e in

ental status and ver! )ast breathin1

a! be the earliest si1ns o) sepsis.

$n 1eneral" s! pto s o) sepsis can include> Chills Con)usion or deliriu Cever or low bod! te perature 5h!pother ia6 Ei1ht-headedness due to low blood pressure 8apid heartbeat Sha+in1 S+in rash =ar s+in a! also occur.

2ruisin1 or bleedin1

Accordin1 to the A erican Colle1e o) Chest Ph!sicians and the Societ! o) Critical Care Dedicine" there are di))erent + , +s o- s ps(s>

Syst m(& (.-+ammato*y * spo.s sy.'*om 5S$8S6. 'e)ined b! the presence o) two or
o

ore o) the )ollowin1 )indin1s>

2od! te perature F 3? GC 59?.( GC6 or H 3( GC 5100.. GC6 5h!pother ia or )ever6. #eart rate H 90 beats per 3, inute. inute or" on blood 1as" a PaC7, less than
3

o o

8espirator! rate H ,0 breaths per

#1 5..3 +Pa6 5tach!pnea or h!pocapnia due to h!perventilation6. or H 1,"000 cells&

3

=hite blood cell count F ."000 cells&

5F . I 109 or

H 1, I 109 cells&E6" or 1reater than 10/ band )or s 5i cells6. 5leu+openia" leu+oc!tosis" or bande ia6.

ature white blood

S ps(s. 'e)ined as S$8S in response to a con)ir ed in)ectious process. $n)ection can be suspected or proven 5b! culture" stain" or pol! erase chain reaction 5PC866" or a clinical s!ndro e patho1no onic )or in)ection. Speci)ic evidence )or in)ection includes =2Cs in nor all! sterile )luid 5such as urine or cerebrospinal )luid 5CSC66@ evidence o) a per)orated viscus 5)ree air on abdo inal B-ra! or CT scan@ si1ns o) acute peritonitis6@ abnor al chest B-ra! 5CJ86 consistent with pneu onia 5with )ocal opaci)ication6@ or petechiae" purpura" or purpura )ul inans.
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S , * s ps(s. 'e)ined as sepsis with or1an d!s)unction" h!poper)usion" or h!potension. S pt(& s/o&0. 'e)ined as sepsis with re)ractor! arterial h!potension or h!poper)usion abnor alities in spite o) ade0uate )luid resuscitation. Si1ns o) s!ste ic h!poper)usion 1reater than . a! be either end-or1an d!s)unction or seru lactate ol&E. 7ther si1ns include oli1uria and altered ental status. l&+1 o)

Patients are de)ined as havin1 septic shoc+ i) the! have sepsis plus h!potension a)ter a11ressive )luid resuscitation 5t!picall! upwards o) ? liters or .0 cr!stalloid solution6. ;Ba ples o) end-or1an d!s)unction include the )ollowin1>

Eun1s> acute lun1 in4ur! 5AE$6 5Pa7,&Ci7, F 3006 or acute respirator! distress s!ndro e 5A8'S6 5Pa7,&Ci7, F ,006

2rain> encephalopath! s! pto s> a1itation" con)usion" co a@ cause> ische ia" he orrha1e" icrothro bi" icroabscesses" ulti)ocal necroti*in1 leu+oencephalopath!

Eiver> disruption o) protein s!nthetic )unction> etabolic )unctions>

ani)ests acutel! as pro1ressive etabolis " resultin1 in

coa1ulopath! due to inabilit! to s!nthesi*e clottin1 )actors" disruption o) ani)ests as cessation o) bilirubin elevated uncon4u1ated seru

bilirubin levels 5indirect bilirubin6

:idne!> oli1uria and anuria" electrol!te abnor alities" volu e overload #eart> s!stolic and diastolic heart )ailure" li+el! due to c!to+ines that depress !oc!te )unction" cellular da a1e" necessaril! ische ic in nature6 ani)est as a troponin lea+ 5althou1h not

Dore speci)ic de)initions o) end-or1an d!s)unction eBist )or S$8S in pediatrics>

Cardiovascular d!s)unction 5a)ter )luid resuscitation with at least .0 cr!stalloid6

o

l&+1 o)

h!potension with blood pressure F 5th percentile )or a1e or s!stolic blood pressure F , standard deviations below nor al )or a1e" 78 re0uire ent" 78 etabolic acidosis with base de)icit H 5
10

o vasopressor o two

o) the )ollowin1 criteria>

uneBplained

;0&E

lactic acidosis> seru

lactate , ti es the upper li it o) nor al l&+1&hr6

oli1uria 5urine output F 0.5

prolon1ed capillar! re)ill H 5 seconds core to peripheral te perature di))erence H 3GC

8espirator! d!s)unction 5in the absence o) c!anotic heart disease or +nown chronic lun1 disease6
o

the ratio o) the arterial partial-pressure o) oB!1en to the )raction o) oB!1en in the 1ases inspired 5Pa7,&Ci7,6 F 300 5the de)inition o) acute lun1 in4ur!6" 78 arterial partial-pressure o) carbon dioBide 5PaC7,6 H ?5 torr 5,0 #16 over baseline PaC7, 5evidence o) h!percapnic respirator! )ailure6" 78 supple ental oB!1en re0uire ent o) 1reater than Ci7, 0.5 to oB!1en saturation K 9,/ aintain

Leurolo1ic d!s)unction
o Mlas1ow o

Co a Score 5MCS6 N 11" 78 ental status with drop in MCS o) 3 or ore points in a patient

altered

with develop ental dela!& ental retardation

#e atolo1ic d!s)unction
o platelet

count F (0"000&

or 50/ drop )ro

aBi u

in

chronicall! thro boc!topenic patients" 78

o international o 'isse

nor ali*ed ratio 5$L86 H ,

inated intravascular coa1ulation creatinine K , ti es the upper li it o) nor al )or a1e or ,-)old onth6

8enal d!s)unction
o

seru

increase in baseline creatinine in patients with chronic +idne! disease

#epatic d!s)unction 5onl! applicable to in)ants H 1

o total

seru

bilirubin K .

1&dl" 78

o alanine

a inotrans)erase 5AET6 K , ti es the upper li it o) nor al

Consensus de)initions" however" continue to evolve" with the latest eBpandin1 the list o) si1ns and s! pto s o) sepsis to re)lect clinical bedside eBperience

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F()u* 21 'r. 9+do. 'e)inin1 S!ste ic $n)la ator! 8esponse S!ndro e 5S$8S6 and Sepsis Criteria http>&&www.internali*e edicine.co &,01,&0,&s!ste ic-in)la ator!-response-s!ndro e.ht l. 1O Cebruar! ,01,. Accessed ( Pul! ,01,

CHAPTER III THE CORRELATION BET#EEN DENTAL ABSCESS AND SEPSIS

A tooth abscess is a poc+et o) in)ected o) the tooth. Tooth deca! is o)ten the

aterial resultin1 )ro

an in)ection in the center

ain culprit o) a tooth abscess. Tooth deca! causes

openin1s in tooth ena el" allowin1 har )ul bacteria" dead tissue and white blood cells" o)ten re)erred to as pus" to enter the center o) the tooth. Antibiotics o)ten are enou1h to destro! the bacteria and allow the abscess to heal. #owever" occasionall!" an abscess can lead to a blood in)ection +nown as sepsis. An untreated abscess" li+e an! wound" can beco e worse without treat ent. The in)ection will o)ten continue to 1row until the bacteria enters the bloodstrea . 7nce the bacteriu enters the bloodstrea " it can in)ect the entire bod!.

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F()u* 41 #isto1ra o) nu ber o) untreated deca!ed teeth and the prevalence o) dental sepsis Pine" CD" #arris" 8.%. 2ritish 'ental Pournal %olu e ,00 Lo. 1> An investi1ation o) the relationship between untreated deca!ed teeth and dental sepsis in 5-!ear-old children. Pan ,00?. p .?

$) a tooth abscess pro1resses to a s!ste ic in)ection" it can i pair blood )low to the a4or or1ans such as the heart" brain and +idne!s. The Lational $nstitutes o) #ealth warns that sepsis can cause a co plication called disse inated intravascular coa1ulation" or '$C" which leads to the )or ation o) blood clots in the or1ans. This can cause stro+e" heart attac+ and even death. A s!ste ic blood in)ection re0uires pro pt treat ent to prevent co plications. People with sepsis are co A broad spectru onl! treated in the intensive care unit" or $C9" o) the hospital and started antibiotics" accordin1 to The Lational $nstitutes o) #ealth. ediate treat ent while the lab runs blood tests to deter ine antibiotic treats a wide variet! o) bacteria. Ph!sicians use these antibiotics on intravenous broad spectru so that a person can receive i

the speci)ic bacteria causin1 the in)ection. These tests can ta+e up to three da!s )or results. A)ter the laborator! deter ines the speci)ic bacteria" ph!sicians will 1ive intravenous antibiotics that to speci)icall! tar1et the eBact bacteria. Ph!sicians )luids and reco a! also include oB!1en" a! edications to increase blood pressure in a patientQs treat ent. A dentist

end a root canal i) the person wishes to +eep the tooth. A severe tooth abscess can

o)ten re0uire sur1ical draina1e o) the abscess and re oval o) the in)ected tooth.?

13

CONCLUSION Abscess )or ation and the spread o) in)ection within the )ascial nec+ spaces can lead to direct pressure on the upper airwa!. This can result in si1ni)icant co pro ise to airwa! patenc! with i 7nce the bacteriu ediate threat to li)e. An untreated abscess" can beco e worse without enters the bloodstrea " it can in)ect the entire bod!.O ediatel!" without dental treat ent" a pro1ressin1 to blood treat ent. The in)ection will o)ten continue to 1row until the bacteria enters the bloodstrea .

People with an abscess should see a dentist i dental abscess will 1et worse and in)ection

a! lead to the destruction o) surroundin1 bone and other

serious health proble s and it can preventin1 a tooth abscess )ro

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REFERENCES 1. Pen+ins" Sophie. Sepsis. http>&&www.)astbleep.co & edical-notes&other&15&3,&19O. Access ( Pul! ,01,. ,. Pine" CD" #arris" 8.%. 2ritish 'ental Pournal %olu e ,00 Lo. 1> An investi1ation o) the relationship between untreated deca!ed teeth and dental sepsis in 5-!ear-old children. Pan ,00?. p .5 3. L#S Choise" 'ental abscess" available at http>&&www.nhs.u+&conditions&'ental-

abscess&Pa1es&$ntroduction.aspB" update> 11&03&,01,"accsess ( 4ul! ,01, .. Paul Cote+" 'D'. Tooth abscess" available 9pdate> at

http>&&www.nl .nih.1ov& edlineplus&enc!&article&0010?0.ht .

15

,&,,&,01,.

accesses 9 4ul! ,01,

5. 2alentine"

8"

'7"

CAC;P.

Sepsis

52lood

$n)ection6.

Available

at

http>&&www.e edicinehealth.co &sepsisRbloodRin)ection&articleRe .ht . Accesses 9 Pul! ,01,.

6. DcDann"Delanie. Can a Tooth Abscess Cause a 2lood $n)ectionS. Available at

http>&&www.livestron1.co &article&,3.O..-can-a-tooth-abscess-cause-a-bloodin)ection&. 9pdate Au1 10" ,011. Accesses 9 Pul! ,01,. O. #andle!" T" 'evlin" D. P$CS %olu e 10 Lu ber 1> The sepsis s!ndro e in odonto1enic in)ection.. Panuar! ,009. p ,.

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