Select Your Current Condition:
- Swelling Pressure Under a Tooth
- Gum Tissue Swellings -Periodontal Disease
- Wisdom Teeth Swelling Pericoronitis
- Rapid Swelling within Minutes (Allergic Reaction)
- Rapid Swelling under Tongue & Jaw Onset 1 – 2 days
- Poorly Localized Expanding Infections 1-2 days
- Slow Moving Swelling of Head-Neck + Multiple Abscesses
Intro
Rapid Facial Swelling Can Be Potentially Life Threatening.
Swelling is considered rapid if the chin and oral mucosa including the tongue swell within minutes to an hour. If it proceeds rapidly it can lead to airway obstruction and suffocation and is therefore a medical emergency. Often there has been recent exposure to an (allergen i.e. peanuts or bee sting) and hives develop at the same time. The swelling is itchy. If you suspect swelling in response to an allergen go to the emergency room immediately.
Some untreated dental infections can quickly change course and rapidly spread into dangerous areas of your head or neck. It should be noted that any infection which is rapidly expanding can become life threatening and should be considered a medical emergency.
Rapid Swelling under Tongue & Jaw (Onset: 1 – 2 days). This Is A Medical Emergency, Go To The Emergency Room.
A little education about how bone infections spread is necessary in order to understand terms used to describe bone infections. In general, infections in the bone occur as:
Rate of Spread
- Acute-Rapid Onset: i.e. spread rapidly through jaw bone into soft tissue and adjacent fascial spaces.
- Chronic Slower to Develop: usually confined to root tip region with little tendency to spread from local area.
Path of Spread
- Cyst; can be contained or walled off. This is very similar to the most common formation of facial acne. As with facial acne, infections of bone may form an abscess (tissue lined path) to the surface. The infection will drain to relieve the pressure.
- Defuse: not walled off, poorly localized infection that spreads in all directions (path of least resistance).
As with all infections the type of organisms, location of the infection, and an individual’s ability to resist the infection are all factors to consider.
1. Swelling Pressure Under a Tooth
CLINICAL PRESENTATION
Causes:
Swelling pressure under your tooth usually is a result from infection in the bone originating from your tooth.
- The most common reason is a Large Cavity which has spread into the tooth nerve.
- Swelling may also be a result of Traumatic Injury which resulted in death of the tooth nerve & subsequent decomposition (rotting tissue). This rotting tissue dissolves into the jaw bone and subsequently an infection forms.
- Failing Root Canal Therapy or Root Fracture: It should be noted that the success rate for root canal therapy is 93-95%. Another way to interpret these numbers is to realize that a bit more than 1 in 20 root canal treated teeth will result in failure. This 5% failure rate is largely due to the fact that clinically undetectable and expanding vertical root cracks can be present.
You should also consider reviewing:
- Tooth Ache
- Common Mouth Sores
Possible Symptoms
- Dull, throbbing, intense pain
- Continuous pain
- The Tooth may be Loose
- Lingering pain with thermal changes (esp. cold)
- Percussion sensitivity (tap your finger nail on each tooth)
- Slight elevation of the tooth out of the socket
- Pus drainage around the tooth
- Grey colored tooth with a history of trauma
- Intra-oral or extra-oral “pimple-like” draining pump or sore.
- Possible swollen Lymph nodes
- Possible low-grade fever
TREATMENT
- Warm packs appropriate only if infection is already close to skin and skin drainage is likely.
- Call our office as soon as you can for an appointment. If the infection is from the tooth you will likely need a Root Canal therapy or an Extraction.
Rx: Analgesics
Rx: Antibiotics
Swelling Pressure under Your Tooth which usually originates from your tooth is difficult to differentiate from swelling which originates from Gum tissue Infections – Periodontal Disease. Please review the following section.
#2 Gum Tissue Swellings (Periodontal Disease)
CLINICAL PRESENTATION
- Gingiva is red and swollen near the tooth to gum junction
- Pus may be draining from tooth-gum junction
- Pain, localized to gingiva and underlying bone.
- Afflicted tooth may be tender to tapping
- Swelling usually localized in the area near gums
- Possible Lymph node swelling and/or low-grade fever
Cause of Gum Swellings
A pre-existing gum-tooth pocket which has become occluded with bacterial pus or foreign body (i.e. food) leading to abscess formation.
Swelling which originates from Gum tissue Infections (Periodontal Disease) is difficult to differentiate from Swelling Pressure under Your Tooth which usually originates from your tooth. See previous section.
NOTE: Gum Swellings can be:
- Acute
- Arise rapidly
- Produce large, red and painful swellings
- Chronic
- Little swelling
- Little or no color change
- Little or no pain
Patient Treatment for Food Impaction: Something Stuck Between Your Teeth
First, try using dental floss, very gently and carefully, to remove the object. If you tie a small knot in the middle of the floss and pull that through the contact area, often you can dislodge most small pieces of food or debris. Do not poke between your teeth with a pin or similar sharp, pointy object; it can cut your gums or scratch the tooth surface. If you can’t get the obstruction out, call our office for an appointment.
If the infection dissipates, you should still call for an appointment and have the area checked.
PROFESSIONAL TREATMENT
- Drainage by your dentist, usually achieved after numbing the area and providing a deep cleaning.
- See Antibiotics Indications and Contraindications
- Rx: Analgesics
- Rx: Antibiotics — Adult Dosage
- Warm saline rinse 2x/day
- Antibacterial Rinse (i.e. Peridex or PerioGard) for 7-days.
Make an appointment at our office (suggested time 12-24 hours). The pocket must be reduced or abscess will likely reoccur.
#3 Wisdom Teeth Swelling (Pericoronitis)
CLINICAL PRESENTATION
- Presence of partially erupted tooth. Usually mandibular wisdom tooth (last molar).
- Redness/u> of tissue overlying or covering the wisdom tooth.
- Swelling of tissue surrounding partially erupted tooth (can spread)
- Pus may exude from around tooth
- Possible Jaw Close lock
- Bad taste
- Swollen Lymph nodes and/or low-grade fever
TREATMENT
Avoid the area and call our office for an appointment as soon as you can.
At Our Office Your Clinical Treatment Options Will Include one of the following:
- Irrigate with sterile saline or antibacterial dental rinse to Flush out all debris (food and/or Bacteria) under tissue flap around wisdom tooth.
- Reshaping of the gum tissue and drainage of the infection
- Tooth Extraction
Rx: Antibiotics — If fever and/or swelling of lymph nodes.
#4 Rapid Swelling within Minutes (Allergic Reaction)
This Is A Medical Emergency, Go To The Emergency Room.
Angioneurotic edema (allergic reaction)
Rapid swelling of the chin and oral mucosa including the tongue within minutes to an hour. If it proceeds rapidly it can lead to airway obstruction and suffocation and is therefore a medical emergency. Often there has been recent exposure to an (allergen i.e. peanuts, bee sting) and hives develop at the same time. The swelling is itchy.
This Is A Medical Emergency, Go To The Emergency Room.
#5 Rapid Swelling under Tongue & Jaw (Onset: 1 – 2 days)
This Is A Medical Emergency, Go To The Emergency Room.
The Most Common Presenting Features Of Ludwig’s Angina
- Symptoms may persist for several days before the patient seeks medical attention.
- Rapid swelling of the floor of the mouth
- Elevation and posterior displacement of the tongue
- Respiratory difficulty (airway obstruction may be imminent)
- Oral And Neck Pain
- Neck Swelling
- Dental Pain
- Speech may be difficult
- Drooling because of painful swelling
- Systemic toxicity
- Fever, anorexia, malaise
- Trismus (Difficultly Opening Mouth)
Ludwig’s angina is an infection of the under jaw & under tongue region. The infection is manifested by the swelling of the floor of the mouth, and elevation and posterior displacement of the tongue. A brawny swelling and spread of the infection into the neck region develops later.
Ludwig’s angina occurs most often in young adults with dental infections. The potentially life-threatening, rapidly expanding diffuse inflammation invades the submandibular (lower Jaw bone) and sublingual (under tongue) spaces. Deep neck abscesses such as Ludwigs Angina are less common now than 50 years ago because of the development of effective antibiotics and improved dental care. Deep neck infections in the antibiotic era most commonly result from untreated dental disease.
Common Causes
- Untreated Tooth Cavities Which Lead To Bone Infections
- Untreated Periodontal Disease
- Trauma Which Results From Lower Molar Extractions
Uncommon Causes
- Upper Respiratory Infections
- Floor-Of-Mouth Trauma
- Lower Jaw Fractures
- Salivary gland infection-necrosis
Risk Factors Include
- Untreated Dental Disease in Young Adults*
- Diabetes Mellitus
- Malnutrition
- Alcoholism
- Neutropenia
- Lupus Erythematosus
- Aplastic Anemia
*All age groups may be affected, but young adults have the highest prevalence rates. The disease is unusual in children.
Untreated Tooth Cavities Which Lead To Bone Infections
The second and third mandibular molars (wisdom teeth) roots commonly grow deep into the jaw bone and can be adjacent to or below the level of the submandibular space (the mandible is the lower jaw bone). Infections are acidic in nature and over time can dissolve bone. Untreated infections of these lower molars may perforate the mandible bone barrier and spread into the submandibular spaces (under jaw bone). The Mandibular space is like an open room with few barriers to stop the spread of poorly localized, rapidly expanding infections. In other words, once the infection has spread through the bone into the submandibular space, it can spread rapidly.
Treatment
This is a medical emergency, go to the Emergency Room.
The patency of the airway is the main concern with Ludwig’s angina. Intravenous antibiotic therapy and selective application of surgical drainage are the other two treatment measures.
Other possible cause of suppurative lesions of the face includes
- Foreign Bodies
- Osteomyelitis
- Branchial Cleft Or Thyroglossal Fistulas
- Granulomatous Diseases (i.e. Actinomycosis, Tuberculosis Cutis, Blastomycosis)
- Dacrocystitis
- Salivary Gland Or Duct Fistulas
- Pyogenic Granuloma
- Basal Cell Cancer
#6 Poorly Localized Expanding Infections (1-2 days)
It should be noted that any infection which is rapidly expanding can become life threatening and should be considered a medical emergency.
Poorly Localized infections can exist in the bone or the soft tissues or both.
Osteomyelitis = poorly localized infection in the bone
Cellulites = poorly localized infection in the skin and/or under lying connection tissues
Osteomyelitis (Non Localized Bone Infections)
Osteomyelitis is the term medical professionals use to describe a poorly localized infection in hard tissues (i.e. bone). Infections in the bone move fast or slow and can exist with or without pain. If left undiagnosed, these bone infections may spread into the soft tissues of the body. Once infections reach the soft tissue, our body’s immune response will handle these infections in one of two ways. The infections in soft tissue may be walled off by “skin like” tissue which forms a tract to the skin surface for drainage (cyst). In other situations infections will spread in a non-localized fashion (not walled off). A “Non” or “poorly” localized infection which is spreading into soft tissues is considered “Cellulitis”.
Osteomyelitis (Non Localized Bone Infection) can initially develop from the contamination of an extraction site or progressive invasion of bone following nerve exposure from deep dental caries. Osteomyelitis may also arise from non-dental causes.
RULE OUT:
- Alcoholism
- Irradiation
- Malnutrition syndrome
- Myeloproliferative disease
- Paget’s disease
- IV drug abuse
- Osteopetrosis
- Diabetes Mellitus
- Chemotherapy
- Corticosteroid therapy
Acute Suppurative Osteomyelitis (ASO)
- Dental infection is most frequent cause.
- Most common organisms are staph aureus, staph a/bus, & various streptococci
If you suspect that you have a bone infection please See section:
- “Swelling Pressure Under a Tooth”
- “Tooth Ache”
- You should also continue to read about Cellulitis.
Cellulitis (Non localize soft tissue Infections)
Clinical Presentation
- Indiscreet, Warm Swelling, Firm (swelling & expansion like a balloon)
- Mild Case: Swelling has a “Doughiness” To Palpation
- Severe Case: “Board-Like” Hardness To Palpation
- Fever
- Malaise
- Pain
- Swollen Lymph Nodes
- Dysphagia (Effects Speech)
Cellulitis is a poorly localized, rapidly expanding inflammation (swelling) of the connective tissue of the skin and underlying tissues, caused by infection with staphylococcus, streptococcus or other bacteria.
The skin normally has many types of bacteria living on it, but intact skin is an effective barrier that keeps these bacteria from entering and growing within the body. When there is a break in the skin, or if bacteria gains access though a cavity (hole in a tooth), the bacteria can enter the body and grow. This elicits infection and inflammation. The skin tissues in the infected area become red, hot, irritated and painful.
Risk Factors For Cellulitis Include:
- Untreated Dental Disease
- Salivary gland disorders
- Insect bites and stings; animal bite or human bite
- Injury or trauma with a break in the skin (skin wounds)
- History of peripheral vascular disease
- Diabetes-related or ischemic ulcers
- Recent cardiovascular, pulmonary (lung)
- Use of immunosuppressive or corticosteroid medications
Treatment
Cellulitis treatment may require hospitalization if it is severe enough to warrant intravenous antibiotics and close observation. At other times, oral antibiotics and close outpatient follow-up is sufficient. Treatment is focused on control of the infection (antibiotics and drainage when possible), prevention of complications, and treatment of the reason of the infection.
Locate Source Of Infection:
- Caries
- Parotitis (Salivary gland disorders)
- Periodontitis
- Skin infection
Antibiotics are given to control infection, and analgesics may be needed to control pain.
Elevate the infected area, usually higher than the heart, to minimize swelling. Apply warm, moist compresses to the site to aid the body in fighting infection by increasing blood supply to the tissues. Rest until symptoms improve.
Call Our Office For Immediate Care.
#7 Slow Moving Swelling of Head/Neck + Multiple Abscesses
ACTINOMYCOSIS
Actinomycosis
Chronic (slow moving) granular swelling of the lower head and/or neck. The overlying skin can be red to purplish characterized by multiple abscesses and sinus tracts (lumpy jaw). The symptoms of this infection are characteristic of the bacteria actinomycetes. Actinomycetes is prominent among normal oral flora. While this bacteria is not normally able to overcome bodily defense mechanisms, it can occur following oral surgery, facial/oral trauma, and in patients with severe gum disease.
CLINICAL PRESENTATION
- Gradual swelling of lower face and/or neck
- Fever
- Malaise
- Pain
- Multiple sinus tracts to the skin surface (may be visible)
- Indurated, nodular and sometimes fluctuant swelling
- Overlying skin red to purplish
Professional Treatment
Oral antibiotics and close outpatient follow-up usually sufficient. In some cases IV antibiotics are indicated. Treatment is focused on control of the infection (antibiotics and drainage when possible), prevention of complications, and treatment of the reason of the infection.
Locate Source Of Infection
- Caries
- Parotitis
- Periodontitis
- Skin infection
*Lab tests –culture to determine type of organism
Antibiotics are given to control infection, and analgesics may be needed to control pain.
Elevate the infected area, usually higher than the heart, to minimize swelling. Apply warm, moist compresses to the site to aid the body in fighting infection by increasing blood supply to the tissues. Rest until symptoms improve.
