July 1st, 2008 by Mylo
What Most People Don’t Know
Ken Michener’s tooth had been hurting off and on for months, and the pain was intense one Monday night in August. So Michener, 31, of Naperville, Illinois, who worked night shifts at a company that manufactures vitamins and dietary supplements, left at 3 a.m., halfway through his shift. At home, he tossed and turned. By the next afternoon, he’d found an oral surgeon to pull his sore molar, and started taking antibiotics to beat the bacterial infection and reduce the swelling. They did neither. By Friday, Michener was still hurting, and his left cheek bulged. At a local hospital, his oral surgeon removed another tooth, drained some pus, gave him painkillers and more antibiotics, and checked him into intensive care.
By the following Monday, when Michener was rushed by ambulance to Loyola University Medical Center, in suburban Chicago, his cheek was so swollen that he couldn’t open his left eye. The infection had invaded the muscles that open the jaw, causing his jaw to clamp shut. It had also spread to Michener’s neck and was squeezing his airway. He couldn’t open his mouth, couldn’t speak and, despite a breathing tube designed to help, struggled to draw each breath.
Few mouth infections grow as menacing as Michener’s. But runaway dental infections can be treacherous. They have eaten through the skin in people’s necks, choked off airways, migrated to the heart, burrowed into brains and, yes, even killed people.
Have we scared you enough yet? Here’s the point: Everyone is vulnerable, because bacteria that routinely lurk in the mouth cause tooth decay and gum disease. The problem: Most people don’t know they have these infections. They often cause no pain and few symptoms, but can lead to far worse. Gum disease may also heighten the risk for heart disease, diabetes, pneumonia and premature birth, according to recent clinical trials. But the good news is that with good old regular brushing and flossing, you may prevent all that. And by seeing your dentist often, you can nip most problems in the bud.
Regular dental checkups can pay off in other ways too. For example, dentists can spot signs of diabetes, heart disease and cancer, along with a variety of rare skin and autoimmune diseases. Since people typically visit their dentists more often than they visit other doctors, that can lead to early diagnosis and early treatment. All of which means that your dentist can do much more than save your teeth and gums. Your dentist can save your life.
An Oral Epidemic
Americans have brighter smiles than ever before, thanks to ubiquitous teeth-whitening systems. But behind those gleaming smiles, all is not well. Oral health has improved some in recent decades: More kids are being treated with dental sealants; the incidence of mild gum disease (gingivitis) has decreased about 40 percent since the 1960s; and untreated tooth decay in permanent teeth has decreased slightly since the late 1980s, according to an August report from the Centers for Disease Control and Prevention. But here’s the bad news: One in three Americans over age 30 still have more advanced gum disease known as periodontitis; more than nine in ten Americans have at least some tooth decay; and nearly three in ten adults over 65 have no teeth at all.
Not getting enough fluoride may be part of the problem. One in three Americans live in communities with insufficient fluoride in their drinking water, and bottled and filtered water often contain little fluoride. Also, 108 million Americans don’t have dental insurance. In fact, one in five low-income children and adolescents have untreated tooth decay, a level twice that of their more affluent peers. Oral disease is still widespread in this country because the will and the money to reduce it have not been there. The result, according to a 2000 Surgeon General’s report, is a “silent epidemic” of oral disease that threatens the health of Americans.
In the operating room at Loyola University Medical Center, oral surgeon Mark Steinberg and two residents made two small incisions inside Michener’s cheek and three on his neck; then they installed flat rubber tubes in each to drain pus. They made a slice the width of a nickel through Michener’s neck into his windpipe, and inserted a six-inch-long curved plastic tracheostomy tube that allowed him to breathe.
Michener remained in intensive care for two more days and in the hospital for the rest of the week. His massive infection began receding. “It was lonely,” Michener remembers. “You couldn’t talk. You couldn’t move. You couldn’t sleep.” Nurses suctioned mucus from his windpipe for four days so he could breathe. “You didn’t want to fall asleep and gag to death, so you had little catnaps and that was it.”
Infections like Michener’s are rare, but not exceedingly so. Between 1996 and 2001, physicians at San Francisco General Hospital, a large public hospital, treated 157 patients with runaway tooth infections that had eaten into their jaws, faces and necks. All the patients recovered. Still, “patients who get a big dental abscess — well, they can die from it,” cautions M. Anthony Pogrel, DDS, MD, co-author of the study and chairman of the oral and maxillofacial surgery department at the University of California, San Francisco.
- Posted in Medicine