Dental Sepsis

Abstract

It is now generally acknowledged by physicians and surgeons that dental sepsis is often the primary and underlying focus of infection and toxin production in many local and systemic disorders. The acute inflammatory dental lesion which progresses and eventually leads to the death of the patient by the involvement of vital centers or general septicemia is well known; likewise, dental sepsis producing empyema of the antrum and sometimes infection of all the accessory sinuses. Further, many observers have proved that certain inflammatory conditions of the eye and skin, degenerative changes in joint structures and the cardiovascular system may be due to absorption from septic teeth. Dr. Leonard Mackey and others have published the histories of patients who exhibited grave systemic disorders and obscure pyrexia, which have cleared on the discovery and eradication of obscure dental sepsis. The earlier medical observers who suspected, and proved to their own satisfaction, that septic teeth were the cause of many obscure illnesses were confronted with the fact that many patients with obvious dental sepsis show little or no disability other than perhaps vague digestive disturbances. The researches of Price indicate that patients with marked pyorrhea and obvious dental sepsis seldom show evidence of the “rheumatic” degenerative disorders, but, on the other hand, these affections are common in patients harboring obscure foci of dental sepsis. The detection of these obscure and hidden foci of dental sepsis is achieved by means of radiography and to radiography the credit should be given. Formerly a medical man who condemned patients' teeth because he regarded them as the source of infection, and asked the dental surgeon to extract them, frequently met with considerable opposition or even refusal, particularly in those cases in which no local evidence could be obtained. Now he can produce radiographic evidence that septic processes are present, but, even armed with this extra evidence, he cannot always induce the dental practitioner to accept his advice. We know that radiographs will not show changes in every septic tooth, but then, acute inflammatory changes are usually obvious to the patient, and the dental examiner often can and usually does deal with the problem without radiography. It can be said, particularly in the acute conditions, that the more obvious the local physical signs and symptoms, the less the radiographic signs. Even where the local dental examination appears to be conclusive, radiography may give much useful additional information. Thus the radiographs may show that the acute lesion is due to a flare-up in an unsuspected chronic focus, a septic tooth which the local examination has not detected.