Mouth infection

Mouth infections, also known as oral infections, are a group of infections that occur around the oral cavity. They include dental infection, dental abscess, and Ludwig's angina. Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures. In otherwise healthy patients, removing the offending tooth to allow drainage will usually resolve the infection. In cases that spread to adjacent structures or in immunocompromised patients (cancer, diabetes, transplant immunosuppression), surgical drainage and systemic antibiotics may be required in addition to tooth extraction. Since bacteria that normally reside in the oral cavity cause mouth infections, proper dental hygiene can prevent most cases of infection. As such, mouth infections are more common in populations with poor access to dental care (homeless, uninsured, etc.) or populations with health-related behaviors that damage one's teeth and oral mucosa (tobacco, methamphetamine, etc). This is a common problem, representing nearly 36% of all encounters within the emergency department related to dental conditions. Mouth infections, also known as oral infections, are a group of infections that occur around the oral cavity. They include dental infection, dental abscess, and Ludwig's angina. Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures. In otherwise healthy patients, removing the offending tooth to allow drainage will usually resolve the infection. In cases that spread to adjacent structures or in immunocompromised patients (cancer, diabetes, transplant immunosuppression), surgical drainage and systemic antibiotics may be required in addition to tooth extraction. Since bacteria that normally reside in the oral cavity cause mouth infections, proper dental hygiene can prevent most cases of infection. As such, mouth infections are more common in populations with poor access to dental care (homeless, uninsured, etc.) or populations with health-related behaviors that damage one's teeth and oral mucosa (tobacco, methamphetamine, etc). This is a common problem, representing nearly 36% of all encounters within the emergency department related to dental conditions. Patients with mouth infections usually complain of pain at the affected tooth with or without fevers. Inability to fully open one's mouth, also known as trismus, suggests that the infection has spread to spaces between the jaw and muscles of mastication (masseter, medial pterygoid, and temporalis). If an abscess has formed, swelling, redness, and tenderness will be present. Depending on the location of the abscess, it will be visible intraorally, extraorally, or both. Severe infections with significant swelling may cause airway obstruction by shifting/enlarging soft tissue structures (floor of mouth, tongue, etc.) or by causing dysphagia that prevents adequate clearance of saliva. This is a medical emergency and may require endonasal intubation or tracheotomy to protect one's airway. The development of stridor, shortness of breath, and pooling oral secretions may indicate impending airway compromise due to a worsening mouth infection. Other rare but dangerous complications include osteomyelitis, cavernous sinus thrombosis, and deep neck space infection. The anatomy of the oral cavity affects the progression of infection and dictates the severity of disease. In other words, where the infection starts will determine the pattern of its spread and its catastrophic potential based on the surrounding anatomy. The oral cavity serves as the starting point of the digestive track and facilitates breathing as a channel for airflow to the lungs. The borders of the oral cavity include the lips in the front, cheeks on the side, mylohyoid muscle/associated soft tissue below, soft and hard palate above, and the oropharynx at the back. The most important structures within the mouth include teeth for chewing and the tongue for speech and assistance with swallowing. The oral cavity is lined with specialized mucosa containing salivary glands that moisten food, breakdown sugars, and humidify air prior to entering the lungs. The roots of the upper teeth are anchored into a bone called the maxilla, more commonly known as the hard palate, at ridges called the alveolar process. The roots of the lower teeth are anchored into a bone called the mandible, more commonly known as the jaw, at their respective alveolar processes. The surface of the oral cavity between the teeth and the inner side of the lips are called the oral vestibule. Surrounding the oral cavity, there are many different muscles that facilitate chewing, opening the mouth, and swallowing. Each muscle, group of muscles, or separate anatomical compartment is encased in a thin fibrous layer of connective tissue called fascia. Normally, the fascia of adjacent structures are in direct contact with each other. However, air or pus can occupy the space between adjacent fascia, known as fascial planes, and collect over time. As the air pocket or pus enlarges within the fascial planes, the structures surrounding the abnormality can become compressed or shifted out of its normal place. These phenomena of compression and deviation due to a growing infection/air pocket drive the progression of disease into potentially life-threatening situations.