Can Oral Infections be Life Threatening?

If we know anything about a toothache it’s that as painful as it might be (can we say ‘root canal’) at least it’s not life threatening.

At least that’s what most people think. The truth, however, is that not only are tons of people running to the ER every year for treatment for their dental infections, but these infections can also turn lethal.

A case in point is 24 year-old Cincinnati father Kyle Willis and his wisdom tooth that started hurting. When dentists told him it needed to be pulled, he decided to forgo the procedure for financial reasons. The tooth infection spread, causing his brain to swell and then he died within weeks of his toothache first appearing.

12-year-old Deamonte Driver

In Maryland, 12-year-old Deamonte Driver also died of what began as a toothache. By the time Deamonte’s aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, he died. The picture of the boy included in this piece, shows the long scar across the top of his head from his brain surgery that ultimately failed in an effort to save his life.

Kyle Willis and Deamonte Driver aren’t alone. Death from tooth infection while low in numbers is nonetheless more common than we think. A study conducted by researchers in Boston found that between 2000 and 2008 a total of 66 patients died in hospitals as a result of oral infections.

One problem is that the brain is only about three inches from the tooth roots and a dental infection caused by a tooth abscess can spread to the brain through the veins in the head.

The heart and lung can also implicated in life threatening situations. Inflammation of the inside of the heart can be caused by bacteria from a tooth abscess. As bacteria attach to the inside of the heart, they grow and can damage the heart permanently. If the bacteria enter the lungs, they can cause pneumonia.

Far more common, however, are the huge numbers of people hospitalized every year because of dental infections. A study conducted by the Pew Charitable Trusts estimates that preventable dental conditions were the primary reason for 830,590 ER visits by Americans in 2009 – a 16 percent increase from 2006.

Shelly Gehshan, director of the Pew Children’s Dental Campaign, warns us about having tooth problems treated at a hospital: “The care provided in an ER … generally doesn’t solve dental problems. Most hospital ERs are not staffed with dentists, and the medical personnel who work there are not trained to treat the underlying problems of patients with untreated dental issues.”

Commenting on the large and growing number of people using the hospital (instead of their dentist) for their oral infections, Dr. Mark Wong, the chairman of oral surgery at the University of Texas Health Science Center at Houston, says “To call this an epidemic of dental infections we are seeing in major hospital environments and in our emergency rooms — it’s not an overstatement.”

The good news is that the ER visits and even the deaths are avoidable if we act in a timely manner. “It’s better to have it treated when it’s treatable than to wait until it gets out of hand and is possibly life-threatening,” says Dr. Gary R. Hartwell, the president of the American Association of Endodontists

Given that tooth decay is the single most common chronic childhood disease—5 times more common than asthma – Dr. Hartwell’s warning is especially important for all parents.

Dental Students are at Risk for Increased Exposure to MRSA: What does this mean for their Patients?

Dental student are at a much greater risk of being exposed to methicillin-resistant Staphylococcus aureus (MRSA), the potentially lethal bacteria often found in hospitals and now increasingly in the general community. Known as one of the superbugs due to its ability to resist multiple antibiotics, the mortality rate for a MRSA bloodstream infection is about 20-30%.1 The findings of a recently published study in The Journal of Hospital Infection entitled “Higher prevalence of methicillin-resistant Staphylococcus aureus among dental studentshttp://www.journalofhospitalinfection.com/article/S0195-6701(14)00009-7/abstract lead to the inevitable conclusion that greater consideration for infection control and prevention is needed for both dental clinicians and their patients.

The study undertaken in Mexico City comparing 100 dental students (exposed to patients for 5-6 years) with 81 non-dental students found that the dental students had a significantly higher rate of carriage of MRSA. The study found that 20% of the dental students versus 6% of non-dental students were colonized with MRSA (odds ratio: 4.04; 95% confidence interval: 1.6–12.6; P = 0.0033). The conclusion of the study is that the dental students were occupationally threatened by exposure to this highly antibiotic resistant pathogen with implications that greater steps are needed to try to address this potential risk to their health. The other worrisome implication of this study is that these dental clinicians are also likely to be vectors for MRSA transmission to their patients if the proper precautions are not undertaken.

A key observation from this Mexican study underscores how widespread MRSA is in Mexico. If our data is to be trusted, North American and UK rates of MRSA colonization are significantly lower than in Mexico…. 2-3% versus the 6% found in the study’s non-dental student population. People colonized with MRSA are at a greater risk of self-infection, especially when immunocompromised as in the case of a surgery or major illness. 20-60% of patients identified as being colonized with MRSA in hospital subsequently develop an MRSA infection 2

Until recently, most antibiotics in Mexico were available over the counter and not by prescription. The ability of patients to self-prescribe (not matching the appropriate antibiotic to the prevailing infection) combined with standard non-compliance practices (taking sub-lethal doses) led to the emergence of high antibiotic resistance rates as evidenced by the finding of this study. Fortunately, there are greater controls over how antibiotics are now dispensed in Mexico which should help to lower antibiotic resistance rates in the Mexican public in the future. A reduction of the overuse and abuse of antibiotics in Mexico should, in the future, contribute to lowering the risk of MRSA colonization in the dental clinician population. In the meantime, however, the results of this study are shocking and must be taken as sign that more must be done to protect the dental clinician and their patients from this potentially deadly superbug.

1. http://jcm.asm.org/content/48/6/2307
2. http://www.ammi.ca/pdf/MRSApositionpaper.pdf

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