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Travelling abroad and managing acute Tooth Infections

 

The bottom line:

All travellers looking to depart to their desired destinations should take time off to see a local dentist to check their teeth in order to minimise acute dental infections from occurring before they depart. We cannot stress the importance of good oral hygiene in order to prevent tooth caries.

This will prevent considerable waste of time in seeking help from a foreign dentist, the logistics of such an appointment, frustrations around language barriers, expenses around treatment, the aggravation of ongoing dental pain and the potential of developing serious and systemic infections.

 

Acute tooth infections:

Occur when oral bacteria penetrates the inner (nerve) pulp through carious cavities or traumatised crowns. Breaches of our white dentine and enamel lead to tooth infections. These infections can be more common in people with poor oral hygiene, poor prior dental work, previous tooth trauma, high sugary diets, uncontrolled diabetes and those who are immune compromised tend to get more systemic related infections.

 

More serious infections can occur when pulp infections spread beyond the tooth to surrounding areas, which can result in an abscess forming with bone and soft tissue involvement, causing cellulites that can progress to life threatening airway swelling. Airway swelling can go onto causing breathing problems and if untreated to respiratory cardiac arrest in severe cases.

Abscesses can commonly originate from wisdom teeth.

 

Key dental and related symptoms:

  1. Tooth, mouth and gum pain. Also pain while biting.

  2. Infected tooth and gum areas become painful to touch.

  3. Local swelling within the mouth, gums and around the jaw areas (a warning sign).

  4. Difficulty in opening ones mouth (a warning sign).

  5. Loose tooth or teeth.

  6. Drainage of pus from the effected area.

  7. Unable to eat (a warning sign).

  8. Redness, swelling and heat indicating cellulites soft tissue infection (a warning sign).

  9. Airway swelling related to the tooth infection which can cause abnormal breathing and voice (a warning and life threatening sign).

  10. Systemic symptoms originating from the local dental infection i.e. temperature, shivers, cold limbs, thready pulse, low blood pressure etc. (a warning and life threatening sign).

 

It is important for you the traveller to recognise these signs and symptoms early on before they become serious and to sort the proper medical advice available. People with systemic and severe symptoms (dental symptom points 4, 3, 7, 8, 9) should take urgent note of these warning signs and sort immediate medical advice!

 

Bacterial causes:

The most common bacteria responsible for teeth infections are the streptococci group, which are GM positive bacteria. We also see some of the anaerobic bacteria streptococci, Prevotella species and Fusobacteria species causing tooth infections.

 

Antibiotic Treatment:

The consensus is that early dental surgical intervention is more important

than antibiotics, though they may be indicated when symptoms progress which may be attributed to treatment delay.

These bacteria tend to be susceptible to Amoxicillin or Erythromycin if you suffer from a Penicillin allergy.

The addition of another combination antibiotic i.e. Metronidazole may be necessary only if the bacteria show resistance to a basic penicillin antibiotic e.g. amoxicillin which may present as the medication not having an effect on the infected tooth area. Please get advice from your clinician regarding this matter.

If bacteria show signs of resistance i.e. may have what we call beta lactamase positive, then the likes of Amoxicillin and Clavulanic Acid (Co-Amoxiclav or Augmentum) may be indicated to treat the tooth infection.

 

Clindamycin and Gentamycin may be indicated in cases where patients develop serious symptoms like cellulites or systemic septicaemia.

 

Note: antibiotics may be ineffective in treating pulp pain, where the infection occurs within the tooth; this is where dental intervention may be more effective in achieving dental relief.

 

Diagnosis:

Clinical diagnosis is important in combination with dental X-rays. They use orthopantomograms that gives the clinician a panoramic view of the entire jaw and teeth field. You may have seen this at your dentist some time in the past.

Infections within the pulp of the tooth may cause pressure i.e. what causes the patients pain; you clinical may use hot and cold stimulation to diagnose these symptoms and signs.

Ultrasound and Magnetic Resonance (MRI) may also be helpful in look at cases where the infections may have spread beyond the local tooth area. All these will need to be reported by a specialist radiologist. These tests can prove to be expensive if you have no medical insurance or have made no prior financial provision for them.

Routine blood sampling may be indicated in cases where patients have signs of serious and systemic infections as well as a possible hospital admission.

 

Surgical Treatment:

This may be indicated together with antibiotic treatment and could consist of subsequent dental incision and drainage that may prove beneficial in minimising the local tooth infection.

Treating tooth abscesses with incision and drainage, root intervention and or extraction can be effective and may minimize unnecessary courses of antibiotics if these interventions are applied early.

Some previous randomised trials have shown that acute dental infections respond well to surgical dental treatment without the use of antibiotics. Therefore when travelling quick diagnosis and treatment is essential!

 

Drug and surgical treatment may be required in combination, but often patients may have expectations that a simple course of antibiotics will be all that is required, which may be short sighted. More so when treatment is sort out of working hours, there is likely a local tooth issue occurring that will need to be investigated further so a mere course of antibiotics is usually just a quick fix.

With cases where patients develop serious signs and systemic symptoms a maxillofacial surgeons expertise may be indicated for a surgical opinion.

 

Pain relief is important and non-steroidal drugs (NSAIDS) [e.g. brufen, voltarol] may prove to be very helpful for you providing you do not have any contra indications or vital organ impairments. Paracetemol may also provide you with some analgesia and could be used in combination with your NSAIDS.

 

Conclusion:

With tooth pain, time is of the essence, do not delay and sit while waiting for these warning signs to present themselves. It potentially can complicate your treatment, the duration of it and endanger your life in worse case scenarios.

Good oral hygiene and regular check up’s, especially before leaving may be very important in preventing tooth problems on route, so take the initiative to do so before leaving your town.

 

See more Ref: bmj350:1-36 No8001