The Call-On-Doc Guide to Dental Infections

Like other parts of the body, your mouth is a microbiome that supports microbes like bacteria, fungi, viruses, and more. On a normal basis, these help us break down food, counteract harmful microbes that enter through the oral cavity, and keep the environment clean. (2) However, just as oral thrush is a result of an overgrowth of fungus in the mouth, a dental infection is caused by an overgrowth of harmful bacteria. Such an imbalance of bacteria can have multiple sources, including: 

• Poor Oral Hygiene: Inadequate oral hygiene practices, such as infrequent brushing and not flossing, allow bacteria to accumulate on teeth and gums. Plaque, a sticky film of bacteria, forms on teeth and can harden into tartar if not removed through proper cleaning. Bacteria in plaque and tartar produce acids that damage tooth enamel and lead to infections.
• Diet: Diets high in sugars and carbohydrates provide fuel for bacteria in the mouth. Bacteria metabolize these sugars, producing acids that erode tooth enamel and create cavities. Frequent snacking and sugary beverages can prolong exposure to acids, increasing the risk of decay.
• Gum Disease: Gingivitis occurs when bacteria in plaque cause inflammation of the gums, leading to redness, swelling, and bleeding. If not addressed, gingivitis can progress to periodontitis, where bacteria move below the gumline, leading to bone loss and deeper infection.
• Tooth Decay: Bacteria feed on sugars in the mouth, producing acids that weaken tooth enamel. As enamel breaks down, cavities form. Without treatment, cavities can extend into the dentin and potentially reach the pulp, causing infection.
• Trauma or Injury: Accidental injury, such as chipping or cracking a tooth, can create openings that allow bacteria to enter and cause infections. This is particularly concerning if the pulp is exposed.
• Dental Procedures: If proper sterilization protocols aren't followed during dental procedures, bacteria from instruments or equipment can be introduced into the oral cavity, increasing the risk of dental infection.
• Compromised Immune System: Conditions like diabetes, HIV, or autoimmune disorders weaken the body's ability to fight infections. This can make the oral environment more susceptible to bacterial growth and infection.
• Dry Mouth: Saliva plays a crucial role in rinsing away food particles and bacteria. Reduced saliva flow, often due to medications or certain medical conditions, can lead to a dry mouth, allowing bacteria to thrive and increasing the likelihood of infections.

While an uncomfortable prospect at first, everyone has naturally occurring bacteria in their mouths that naturally form. Alongside protozoa, archaea, fungi, and some viruses, bacteria naturally form due to your mouth both remaining in a wet environment and regularly featuring food particles. Each form in our saliva while also gaining entry through air, food, and liquids. (3) This is why it is important to seek treatment if you or a child get bitten by another, as it has a high chance of developing a skin infection.

While it is considered relatively low risk, oral sex can be the source of dental problems by either exacerbating a dental infection or by passing on a sexually transmitted disease or sexually transmitted infection. In addition to being transferred from the genitals, someone with an active gum or tooth infection can also run the risk of transferring the bacteria in their mouth to the genitals. (4) The most common STIs and STDs to be wary of can include: 

• Chlamydia: Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. While chlamydia primarily affects the genital and reproductive systems, it can also be transmitted through oral sex, leading to oral chlamydia. Oral chlamydia can potentially cause infections in the throat and mouth, resulting in symptoms such as sore throat, redness, and discomfort. (5)
• Gonorrhea: Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. While gonorrhea commonly affects the genital and reproductive systems, it can also be transmitted through oral sex, leading to oral gonorrhea. Oral gonorrhea can result in infections of the throat and mouth, causing symptoms such as sore throat, difficulty swallowing, and inflammation. (6)
• Herpes: Oral herpes, caused by the herpes simplex virus (HSV), is a common viral infection that manifests as cold sores or fever blisters around the mouth and lips. The virus can be transmitted through direct contact, such as kissing or sharing utensils. While oral herpes is usually not considered medically serious, it can cause discomfort and pain during outbreaks, with symptoms like tingling, itching, and the development of fluid-filled blisters. These blisters can be painful and unsightly. While most cases of oral herpes resolve on their own, the virus remains dormant in the body and can reactivate periodically, causing recurrent outbreaks. (7)
• Syphilis: Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. While syphilis primarily affects the genital and reproductive systems, it can also be transmitted through oral sex, leading to oral syphilis. Oral syphilis can manifest as sores, ulcers, or lesions in the mouth and throat, which can be painful and highly contagious. If left untreated, syphilis can progress through different stages, potentially causing more serious complications, including damage to organs such as the heart and brain. (8)
• Urethritis: While not causing any symptoms orally, organisms and bacteria having to do with urethritis have been found in patients who came into contact with the STI. (9) While uncommon, a commonly occurring bacteria in the mouth known as Haemophilus influenzae can also be a cause of urethritis. (10)

Yes, it is possible to contract bacterial infections from someone's mouth, especially through close contact or activities that involve direct exchange of saliva. The mouth contains a diverse range of bacteria, some of which can be harmful to the oral microbiome outside of its own. Dental bacterial infections that can be transmitted through contact with someone's mouth include:

• Streptococcal Infections: Streptococcal bacteria, such as Streptococcus pyogenes, can cause infections like strep throat. These bacteria can be transmitted through respiratory droplets from coughing or sneezing, as well as direct contact with saliva. Close contact, sharing utensils, or kissing someone with an active streptococcal infection can increase the risk of transmission, leading to throat and tonsil infections.
• Periodontal Bacteria: Bacteria associated with gum disease, such as Porphyromonas gingivalis, can be present in saliva and can potentially be transmitted through close contact or activities that involve the exchange of saliva. If someone has active gum disease, close contact or activities that introduce their saliva into your mouth could potentially increase the risk of gum infections.
• Oral Cavity Infections: Bacterial infections that affect the oral cavity, such as dental abscesses or oral thrush, can be transmitted through close contact or sharing of utensils. Direct contact with infected saliva or oral fluids can introduce bacteria or fungi into your mouth, potentially leading to similar infections.
• Open Sores or Wounds: If there are open sores, cuts, or wounds in the mouth, contact with someone else's saliva could introduce bacteria into those areas. These microorganisms can potentially lead to infections in the compromised tissues.

Dental infections can manifest with a range of symptoms, and the specific symptoms can vary based on the type and severity of the infection. Common symptoms of dental infections include:

• Pain: Dental infections are often characterized by pain, which can vary in intensity. The pain might be a dull ache, throbbing sensation, or sharp discomfort. It is usually localized to the infected tooth or the surrounding area.
• Swelling: Inflammation due to the infection can lead to swelling in the gums, face, or jaw area near the infected tooth. Swelling might be visibly noticeable and can cause discomfort or pressure.
• Redness and Warmth: Inflamed tissues can appear red due to increased blood flow, and the affected area might feel warmer than usual due to inflammation. This redness and warmth are signs of the body's immune response to the infection.
• Pus or Drainage: Dental infections can lead to the accumulation of pus, which is a thick, yellowish fluid composed of dead white blood cells, tissue debris, and bacteria. Pus can collect around the infected tooth, leading to the formation of a dental abscess. If the abscess ruptures, pus might drain from the area, resulting in an unpleasant taste in the mouth.
• Tooth Sensitivity: Infections can irritate the tooth's pulp, which contains nerves and blood vessels. This can lead to increased sensitivity to temperature changes and sweet foods. Hot or cold liquids and foods might trigger sharp, transient pain.
• Fever: In more severe cases, especially when the infection has spread beyond the oral cavity, the body's immune response can lead to fever. Fever is a systemic response indicating that the body is fighting an infection.
• Bad Breath: Bacteria that contribute to the infection can release foul-smelling byproducts, leading to bad breath or a persistent unpleasant taste in the mouth.
• Difficulty Chewing: Pain and discomfort while chewing or biting down can occur when the infected tooth comes into contact with opposing teeth. This can make eating difficult and uncomfortable.
• Enlarged Lymph Nodes: The body's immune system responds to infections by activating the lymph nodes. Swollen and tender lymph nodes in the neck or jaw area might accompany a dental infection, indicating that the infection might have spread beyond the localized site.
• General Malaise: As with many infections, a dental infection can lead to a general feeling of malaise. This might include fatigue, aches, and a sense of being unwell.

Dental infections can encompass a range of conditions that involve bacterial or fungal infections affecting the teeth, gums, and surrounding oral tissues. Here are some common types of dental infections:

• Dental Abscess:
  • Periapical Abscess: This type of abscess occurs when bacteria enter the tooth's pulp, usually through untreated tooth decay or a crack in the tooth. It can cause severe toothache, swelling, and sometimes the formation of a pimple-like bump on the gums called a gum boil.
  • Periodontal Abscess: Resulting from gum infection, a periodontal abscess forms in the gum pocket next to a tooth. It can be triggered by food debris getting trapped in the pocket or by the progression of a gum infection. It can cause pain, swelling, and the release of pus.
• Gingivitis: Gingivitis is the earliest stage of gum disease. It's characterized by inflammation of the gums due to the accumulation of dental plaque and bacteria at the gumline. Symptoms include redness, swelling, bleeding while brushing or flossing, and bad breath.
• Periodontitis: If gingivitis is left untreated, it can progress to periodontitis. In this stage, the infection extends beyond the gums to affect the supporting bone and ligaments. It can lead to gum recession, deep pockets between teeth and gums, and even tooth mobility and loss.
• Tooth Abscess: A tooth abscess can form when bacteria invade the dental pulp (nerve) due to untreated tooth decay, cracks, or fractures in the tooth. It can cause severe, throbbing pain, sensitivity to hot and cold, swelling, and even fever.
• Cellulitis: If a dental infection spreads beyond the tooth or gum tissues, it can lead to cellulitis. This is a bacterial infection characterized by redness, swelling, warmth, and pain. It can sometimes cause difficulty in opening the mouth, swallowing, or breathing.
• Oral Thrush: Oral thrush is a fungal infection caused by Candida yeast. It often affects infants, older adults, and individuals with weakened immune systems. It presents as creamy white patches on the tongue, inner cheeks, or roof of the mouth, which can be wiped away.
• Ludwig's Angina: This is a rare but serious infection that affects the floor of the mouth, usually arising from an infected tooth, especially the lower molars. It can cause severe swelling, pain, difficulty swallowing, and can potentially lead to airway obstruction.
• Necrotizing Periodontal Disease: This severe form of gum disease usually occurs in individuals with compromised immune systems or systemic health conditions. It can cause rapid tissue destruction, leading to ulcerations, bleeding, pain, and foul odor.
• Herpetic Gingivostomatitis: Caused by the herpes simplex virus, this infection leads to painful sores and ulcers in the mouth, including the gums, lips, and inside the cheeks. It can cause discomfort, difficulty eating, and fever.

In the instance of directly identifying a dental infection, many medical providers catch dental infections through the initial consultation that can be conducted in person or online. The process will include: 

• Examination: Dentists and healthcare providers perform a thorough examination of the oral cavity, including the teeth, gums, tongue, and other oral tissues. They look for signs of infection, such as swelling, redness, and visible pus.
• Patient History: Obtaining a comprehensive medical and dental history is essential. Patients are asked about symptoms they are experiencing, the duration of discomfort, recent oral hygiene practices, and any past dental or medical conditions.
• Evaluation of Dental History: Providers consider a patient's history of previous dental work, treatments, and oral hygiene practices to better understand the context of the infection.
• Symptom Assessment: Providers assess the patient's symptoms, such as pain, swelling, sensitivity, bad breath, and any difficulties in chewing, speaking, or swallowing.

In the instance that there is a suspicion of a dental infection, but the initial steps of increased focus to hygiene and antibiotics don’t work, a doctor will take further steps to identify the problem by doing the following: 

• Diagnostic Imaging: X-rays and other imaging techniques are commonly used to visualize the teeth, roots, and bone structures. These images help identify areas of infection, such as abscesses, bone loss, and cavities.
• Periodontal Probing: For gum infections, dentists use periodontal probing to measure the depth of gum pockets around teeth. Deeper pockets can indicate gum disease and potential infections.
• Percussion and Palpation: Providers may gently tap teeth and surrounding areas to assess pain and discomfort. Palpation (touching and feeling) can identify tender or swollen areas.
• Oral Swabs or Cultures: In cases of suspected bacterial infections, swabs or cultures might be taken to identify the specific type of bacteria causing the infection. This helps guide appropriate treatment.
• Laboratory Tests: In more severe cases or cases with systemic involvement, blood tests might be ordered to assess inflammatory markers and the overall health status of the patient.

A gum or tooth infection has symptoms that can be identified by untrained professionals. On top of pain, swelling, and sensitivity, those who suspect a dental infection should watch out for discharge from the gums, a gum near or on the pain, and a bad taste or odor coming from the mouth that seemingly is unaffected by dental care products. 

Dental infections often develop over time, starting when a harmful bacteria gains entry into the gums, teeth, or other parts of the mouth. How long it takes to become noticeable depends on the person, their pain tolerance, and how fast the infection develops. In the case of a tooth abscess, for example, development varies based on several factors, but it then takes weeks to months to spread and invade other parts of the body. (11) 

Yes, dental infections can be effectively treated and cured with appropriate dental care. The specific treatment approach depends on the type and severity of the infection. Here are some common treatments for dental infections:

• Antibiotics: In cases of mild infections, antibiotics might be prescribed to help control the spread of bacteria and reduce inflammation. However, antibiotics alone might not completely cure the infection without addressing the underlying cause.
• Drainage: For dental abscesses, drainage is often necessary to remove the accumulated pus. This can be done through a procedure called incision and drainage, where the dentist makes a small incision to allow the pus to drain out.
• Root Canal Treatment: If the infection has reached the pulp of the tooth, a root canal procedure might be necessary. During a root canal, the infected pulp is removed, the inside of the tooth is cleaned, and the space is filled and sealed. This eliminates the source of infection and preserves the tooth.
• Tooth Extraction: In cases where the infection is severe, the tooth might need to be extracted. This is typically a last resort when other treatment options are not feasible.
• Scaling and Root Planing: For gum infections like periodontitis, a deep cleaning procedure called scaling and root planing is performed to remove plaque and tartar buildup from below the gumline. This helps control the infection and promotes gum healing.
• Surgical Procedures: In some cases, surgical interventions might be necessary to address deeper infections, bone loss, or gum tissue abnormalities.
• Maintenance and Follow-Up: After the infection is treated, follow-up appointments and ongoing maintenance are important to ensure the infection doesn't return. Regular dental check-ups, proper oral hygiene practices, and addressing any underlying factors that contributed to the infection are crucial.

• Amoxicillin: Amoxicillin is an antibiotic commonly used to treat dental infections. It works by interfering with the growth and multiplication of bacteria responsible for the infection. Amoxicillin is effective against a wide range of bacteria commonly found in the mouth, including those that cause dental abscesses, gum infections, and other oral bacterial infections. (12)
• Augmentin: Augmentin is an antibiotic medication often prescribed for dental infections. It contains a combination of amoxicillin and clavulanic acid. Amoxicillin targets bacteria responsible for the infection by interfering with their growth and replication, while clavulanic acid helps prevent certain bacteria from becoming resistant to amoxicillin's effects. (13)
• Chlorhexidine Gluconate: Chlorhexidine gluconate is an antiseptic mouthwash often used to manage and prevent dental infections. It works by killing or inhibiting the growth of bacteria in the mouth. When used for dental infections, Chlorhexidine helps reduce the bacterial load in the oral cavity, including the gums and teeth, which can contribute to infection development. It's commonly prescribed for gum disease (gingivitis and periodontitis) to control bacterial plaque, promote healing, and prevent further infection. (15)
• Clindamycin: Clindamycin is an antibiotic used to treat dental infections when other antibiotics might not be suitable. It works by inhibiting the growth and replication of bacteria causing the infection. Clindamycin is effective against a broad spectrum of bacteria, including those resistant to other antibiotics. (12)
• Metronidazole: Metronidazole is an antibiotic commonly used to treat dental infections, particularly those caused by anaerobic bacteria and certain parasites. It works by disrupting the DNA of these microorganisms, inhibiting their growth and ability to reproduce. Metronidazole is effective against a range of bacteria that can cause gum infections, dental abscesses, and other oral infections.  (12)

While there are some over-the-counter products and home remedies that might offer temporary relief for mild dental discomfort, dealing with a dental infection on your own is generally not advisable. Dental infections can be complex and potentially lead to serious complications if not properly treated by a qualified dental professional.

• Practice Good Oral Hygiene:
  • Brush your teeth gently using a soft-bristle toothbrush to prevent further irritation of the infected area.
  • Be cautious around the infected tooth or gum to avoid aggravating the sensitive tissues.
  • Continue flossing, but do so carefully to avoid causing pain or bleeding.
• Rinse with Warm Salt Water:
  • Prepare a warm salt water solution by dissolving about half a teaspoon of salt in a glass of warm water.
  • Gently swish the solution around your mouth for about 30 seconds, then spit it out. Do this several times a day.
  • Salt water rinses can help soothe the area, reduce bacteria, and promote healing.
• Over-the-Counter Pain Relievers:
  • Non-prescription pain relievers like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage pain and reduce inflammation.
  • Follow the recommended dosage instructions on the label and consult a healthcare professional if you have any concerns, allergies, or medical conditions.
• Avoid Trigger Foods:
  • Stay away from foods and beverages that could trigger discomfort, such as extremely hot or cold items, spicy foods, or crunchy snacks.
  • Opt for softer foods that are easier to chew and won't put additional stress on the infected area.
• Stay Hydrated:
  • Drinking plenty of water helps keep your mouth hydrated and supports overall oral health.
  • Adequate hydration promotes saliva production, which has natural antibacterial properties.
• Elevate Your Head:
  • If you're experiencing facial swelling due to the infection, try sleeping with your head slightly elevated. This can help reduce fluid accumulation in the affected area.
• Avoid Smoking and Alcohol:
  • Smoking and alcohol consumption can weaken the immune system's ability to fight infections and slow down the healing process.
  • Many alcoholic drinks are made with excessive sugar or are acidic in nature, making them a factor in promoting harmful bacterial growth.
  • Smoking tobacco products boosts the chances of gum disease, causes bad breath, and stains the teeth. Making the habit both harmful and causing greater difficulty in the detection or monitoring of a dental infection. 

• Brush Regularly: Brush your teeth at least twice a day with fluoride toothpaste. Use a soft-bristle toothbrush and make sure to clean all tooth surfaces, including your tongue.
• Floss Daily: Flossing helps remove food particles and plaque from between your teeth and along the gumline. Flossing is essential for preventing gum infections.
• Rinse with Fluoride Mouthwash: Using fluoride mouthwash can help strengthen your teeth and reduce the risk of cavities. Antiseptic mouthwash can help control bacteria and prevent gum infections.
• Eat a Balanced Diet: Consume a diet rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Limit sugary and acidic foods and beverages that can contribute to tooth decay.
• Stay Hydrated: Drinking water helps maintain saliva production, which plays a crucial role in oral health by neutralizing acids and washing away food particles and bacteria.
• Avoid Tobacco Products: Smoking and using tobacco products increase the risk of gum disease, tooth decay, and oral cancer. Quitting tobacco is beneficial for your oral and overall health.
• Limit Alcohol Consumption: Excessive alcohol consumption can contribute to dry mouth and oral health issues. Drink alcohol in moderation.
• Protect Your Teeth: If you play contact sports or grind your teeth at night, consider using a mouthguard to prevent injuries and enamel wear.
• Address Dental Issues Promptly: Attend regular dental check-ups for professional cleanings and early detection of dental problems. Promptly address cavities, cracked teeth, and other dental issues to prevent infections.
• Practice Safe Oral Hygiene: Be gentle when brushing and flossing to avoid damaging your teeth and gums. Avoid using your teeth to open packages or chew on hard objects.

When it comes to avoiding dental infections, CallonDoc recommends getting checked out on a regular basis by a local dentist. Doing so is your best bet at avoiding problems like cavities, tooth infections, and gum disease while remaining healthier for longer. If you do get a dental infection, reach out to our team today. We can get you a consultation and deliver to you or your nearest pharmacy the needed medications in the same day!

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