Brushing the teeth before going to bed is a crucial part in keeping the children’s dental health in check
Dental infections are a distressing experience for a child, as well for the parents. These infections in children are usually related to untreated dental caries. The first indication of an infection is usually oral or dental pain — often spontaneous. The offending tooth will often hurt during the night. Any child with a dental infection needs to be promptly evaluated and treated by a dentist. Prompt treatment will prevent the development of serious health complications.
KINDS OF INFECTIONS
• ACUTE INFECTION (FACIAL CELLULITIS): This is a serious and painful problem. The child may have a swollen face, an elevated temperature, appear sick and be dehydrated. This sort of infection can spread to other parts of body such as the deeper structures of the head and neck.
• CHRONIC INFECTION (DENTAL ABSCESS): This problem usually takes longer to develop. An abscess is really a walled-off infection and is usually less serious than a facial cellulitis. A dental abscess feels soft to touch, because it is pus-filled. Often, small and localized, the swelling is seen on the gums next to the offending tooth. The offending tooth may be loose or be painful to the touch.
CAUSES
• Deep dental caries can infect the dental pulp (the center of a tooth) and cause a tooth to die (pulp necrosis).
• When an infection of the dental pulp invades the supporting bone or adjacent areas of the face and neck — it results in a true dental infection. This first step is the inoculation stage of a dental infection.
• A dental infection is usually caused by a number of bacteria acting at the same time. Some of these infectious bacteria need oxygen to survive (aerobic bacteria), and some can’t tolerate oxygen (anaerobic bacteria).
• The first bacteria “on the scene” in a dental infection are usually the aggressive aerobic bacteria. They cause the development of a cellulitis, which is hard, red, tender, warm, and rapidly swelling enlargement.
• From the fourth to the seventh day of an infection, the anaerobic bacteria — which causes a deeper infection — become numerous. This causes a central, softened area to develop — which is called a necrotic abscess. This abscess contains pus — which consists of dead tissue, live and dead bacteria and white blood cells.
HOW DOES A DENTAL INFECTION SPREAD?
• Teeth can carry the infection-producing bacteria deep into the supporting jaw bone, via the outer root surfaces and inner canals of the dental roots.
• Once the bacteria has spread to the outer surface of the tooth’s roots (periapical/interradicular area), the infection will spread along the path of least resistance.
• The most common dental infection in children is the dental abscess, which is less serious than facial cellulitis. The dental abscess is often localized in the area of the mouth where the cheek meets the gums (the oral vestibule).
DIAGNOSIS
• First, the complete history of the illness is obtained, including the child’s symptoms. The symptoms of a dental infections may include: a toothache, a bad taste in the mouth, bad breath, fever, malaise, and general discomfort.
• Next, a physical examination is performed. This can include obtaining the child’s vital signs, examining and palpating the swollen area, performing an intra-oral examination, taking x-rays (radiographs) and developing a preliminary diagnosis.
• The dentist will usually take an x-ray of the roots of the tooth (periapical view) and may also take a dental panoramic radiograph to view all of the child’s upper and lower teeth and jaws (maxilla and mandible).
COMPLICATIONS
• The affected child may be dehydrated, and be in pain.
• The child’s body temperature may exceed 101 degrees Fahrenheit, which indicates a severe infection.
• Trismus may develop. This is the inability to open the mouth widely. It is caused by inflammation of the chewing muscles (muscles of mastication).
• A dental infection can spread deep into the face and neck, and may require surgical drainage in order to resolve the problem.
• Deep (fascial space) infections of the face, head and neck can quickly produce life-threatening complications.
TREATMENT
• The most important step in treating a dental infection is removing the source and cause of the infection. This often means: removing (extracting) the offending tooth. Extracting the offending tooth has the additional benefit of providing a way to drain accumulated pus.
• Any accumulated pus needs to be drained from the infected area. Sometimes, this means that advanced (surgical) drainage procedures will be needed.
• Antibiotics are of secondary importance in treating a dental infection and antibiotics are not automatically used to treat dental infections. Antibiotics are used for treating infections involving: rapidly progressive swelling, diffuse swelling, a medically compromised child, or an infection that has invaded the extra-oral (fascial) spaces.
• If a child with an infection is dehydrated, IV fluids may need to be administered.
• If a child’s temperature exceeds 101 Fahrenheit, hospitalization might be required. Most dental infections in children can be prevented by obtaining regular dental checkups, and by prompt treatment of any dental caries.
Brushing the teeth before going to bed is a crucial part in keeping the children’s dental health in check
