Caries, gingivitis, abscesses: taking action against oral infections

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Extract from the article: The two most common dental diseases, caries and periodontal disease, are caused by bacterial infection. But they are different diseases. You can have cavities without periodontal disease, or vice versa. If not properly treated, they can lead to compl

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The two most common dental diseases, caries and periodontal disease, are caused by bacterial infection. But they are different diseases. You can have cavities without periodontal disease, or vice versa. If not properly treated, they can lead to complications, sometimes severe. Prevention of these oral infections is still far from optimal.

Knowing how to recognise these diseases at the first signs allows us to prevent or slow down their progression. Their infectious mechanisms are different, as are the bacteria responsible for them. The mouth is home to more than 700 bacterial species, normally in balance, in symbiosis in the oral environment, whose saliva, through its role as a buffer, helps to regulate fluctuations.

Tooth decay, linked to excess carbohydrates

In tooth decay, certain bacteria, especially streptococci, whose growth is encouraged by sugary and acidic foods, attack the tooth enamel and then the dentin. If the infection progresses, it penetrates into the pulp, the living, vascularised and innervated part of the tooth. This will lead to excruciating pain, especially at night, and ends in necrosis of the tooth and the tooth dies. Bacteria will progress from the dead pulp to the tip of the tooth, where they can cause a dental abscess which is a complication of tooth decay. Hence the importance of a thorough root canal removal, cleaning and filling.

In some cases, tooth extraction may be necessary. But abscesses can also be caused by an infection of the periodontium, the tissues that surround and support the tooth, when the tooth is normal, or by a tooth that is badly positioned. Untreated abscesses can even spread to neighbouring tissues: the infection can spread to the cheek and cause a swollen cheek. This local infection is a potentially serious complication: if not treated properly, death can occur. In some cases, the infection can lead to a brain abscess, osteitis, the infection attacks the jawbone, or thrombophlebitis by spreading to the veins of the face.

Advanced caries and dental abscesses are usually so painful that the patient has to go to the dentist. In other cases, caries infection can have distant effects on vital organs such as the heart, kidneys, digestive system, eyes and joints. This is the case, for example, of a dental stroke.

Periodontal disease, silent and irreversible

Unlike tooth decay, periodontal disease, which generally occurs in adulthood, is not painful and can progress silently until the teeth lose their bony support and finally fall out. At the neck of the tooth, a thin membrane attaches the tooth to the gum. If effective brushing does not sufficiently remove the bacteria that colonise this sulcus, they will multiply and encourage the arrival of other bacteria, and this colonisation will gradually destroy this membrane. Hence the irreversible nature of periodontal disease.

These bacteria spontaneously organize themselves into a "biofilm" which forms the dental plaque. The only way to break down this resistant biofilm sufficiently is to brush your teeth at least twice a day for 2 minutes and to clean the interdental space. The first sign that should alert you is the appearance of bleeding when brushing: this is called gingivitis. This initial gingivitis is still reversible with proper brushing. Regular brushing of the teeth significantly reduces and even prevents this bacterial adhesion. If this bleeding persists, it is essential to see a dentist, who will propose an appropriate treatment. In any case, scaling and polishing every six months will ensure healthy gums and teeth.  Another warning sign of this disease is a bad smell in the mouth, also called halitosis. But people often consult a dentist too late, when the teeth are moving. This is why it is important to have a dental check-up at least once a year to check the condition of the mouth.

The diagnosis of both caries and periodontal disease is based on clinical and radiographic examination of the teeth and their supporting tissues. They are particularly useful in the early detection of tooth disease, the search for dental infection or the accurate measurement of caries.  Caries, abscesses or periodontal disease, when the infection warrants it, must be carefully treated to avoid serious complications.

A global influence on health

The relationship between oral health and overall health is well established. It is also known that there are correlations between cardiovascular disease and periodontal disease, with a higher risk of cardiovascular disease in those with periodontitis.

Diabetes predisposes to periodontal disease. Therefore, diabetic subjects should be closely monitored for dental and periodontal disease to avoid early tooth loss. It is a two-way relationship: diabetes promotes periodontal disease and periodontal disease worsens diabetes. It has been shown that good management of periodontal disease in diabetics promotes better blood sugar control.

Ideally, a routine oral examination should be carried out in any severe chronic disease, to restore the mouth as well.

William O.

Article validated by Dr Georges Tokofai, Dental Surgeon, President of the Togolese Order of Dentists and of the Togolese Association for Oral Health (ATSBD)