Cavities, 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 not the same thing. You can have cavities without periodontal disease, or vice versa. If left untreated, they can lead to sometimes

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

Knowing how to recognise these diseases at the earliest signs can prevent or slow their progression. Their infectious mechanisms are different, as are the bacteria responsible. The mouth is home to more than 700 bacterial species, normally in equilibrium, in symbiosis in the oral environment, where 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 sugars and acids, attack the tooth enamel and then the dentine. If the infection progresses, it penetrates the pulp, the living, vascularised and innervated part of the tooth. This leads to excruciating pain, especially at night, and ends with necrosis of the tooth and its death. 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 dental caries. That's why it's so important to remove the root canal, clean it and fill it thoroughly.

In some cases, tooth extraction may be necessary. However, abscesses can also be caused by infection of the periodontium, the tissues that surround and support the tooth, when the tooth is normal, or by a tooth that is incorrectly positioned. Untreated abscesses can even spread to neighbouring tissues: the infection can spread to the cheek, resulting in a swollen cheek. This loco-regional infection is a potentially serious complication: if left untreated, it can lead to death. In some cases, the infection can lead to a brain abscess, osteitis (where the infection attacks the jawbone) or thrombophlebitis (where it spreads to the veins in the face).

Advanced tooth decay and dental abscesses are usually so painful that the patient is obliged to consult a dentist. In other cases, caries infection can have long-distance repercussions 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 eventually fall out. At the neck of the tooth, a thin membrane attaches the tooth to the gum. At the neck of the tooth, a thin membrane attaches the tooth to the gum. If effective brushing does not sufficiently remove the bacteria colonising this groove, they will multiply, encouraging the arrival of other bacteria, and this colonisation will gradually destroy this membrane. Hence the irreversible nature of periodontal disease.

These bacteria spontaneously organise themselves into a ‘biofilm’ that forms 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 warning sign is the appearance of bleeding when brushing: this is known as 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 suggest an appropriate treatment. In all cases, scaling and polishing every 6 months will ensure healthy gums and teeth. Another warning sign of this disease is a bad odour in the mouth, also known as halitosis. But people often seek help too late, when their teeth are moving. Hence the importance of a dental check-up at least once a year to check the condition of the mouth. 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 for the early detection of tooth disease, the search for dental infection or the precise measurement of decay. Cavities, abscesses and periodontal disease, when the infection warrants it, must be rigorously treated to avoid serious complications.

A global influence on health

The relationship between oral and dental health and overall health is well established. We also know that there are correlations between cardiovascular disease and periodontal disease, with a higher risk of cardiovascular disease in subjects suffering from periodontitis.

Diabetes predisposes to periodontal disease. Diabetic subjects must therefore be closely monitored from a dental and periodontal point of view to prevent them from losing their teeth prematurely. It's a two-way street: diabetes promotes periodontal disease, and periodontal disease aggravates diabetes. It has been shown that good management of periodontal disease in diabetics promotes better glycaemic control.

Ideally, any serious chronic illness should be followed up by a systematic oral examination, so that the mouth can also be restored to health.

Abel OZIH