Not just a Toothache

[Dustdevil]

Now, the next question for others.....How can this type of infection develope to the point that it's life threatening?

There are a few different ways. In this woman's case, it was probably because she had already seen the dentist, was already on antibiotics, and therefore felt it was under control. Consequently, she never really considered that the dental problem might have been the source of her problems. Not to mention that the sx certainly are not typical of a dental problem. So she blows them off, figuring it's just bad gas or something. The same denial that affects all chest pain victims.

Many times, it begins with a simple toothache (as this woman's did), but in a person with no dental insurance who doesn't think she can get help and tries to put it off or tough it out. Then they wait too long.

Of course, in this particular case, she did seek help, but there was a failure of the antibiotic she was prescribed, which is not an uncommon occurrence. Again, patient figures they are on meds, so everything will be okay if they just wait. It isn't. That's why we instruct patients to return for a recheck if they don't see significant results after three days on antibiotics, or if the sx worsen.

I've only seen it one time, and that was in Iraq. Took the guy to the dental clinic, where the dental officer's eyes got wide, and his face went pale as he realised what was going on. He said there was a good chance that we didn't even have time to wait for a helo to get us to Baghdad. Pretty scary.

[spenac]

Actually knew( he was in high school when I was in Junior High and I had not seen him in 20 years when I learned of this ) a guy that died from a toothache. His was not caught in time and infection got his brain as well as airway. Family had to take him off life support. I do not have more details, sorry. Good dental health plays a big part in over all health. Actually not a bad idea to take a quick look at dental condition when doing our exams.

[steph1030]

i know tonya googled this previously but i found the wilkipedia definition and i think it needs posted it is very informative ...albeit long

Ludwig's angina, otherwise known as angina ludovici, is a serious, potentially life-threatening infection of the tissues of the floor of the mouth, usually occurring in adults with concomitant dental infections. It is named after the German physician, Wilhelm Frederick von Ludwig who first described this condition in 1836.

Ludwig's angina should not be confused with angina pectoris, which is also otherwise commonly known as "angina". The word "angina" comes from the Greek word ankhon, meaning "strangling", so in this case, Ludwig's angina refers to the feeling of strangling, not the feeling of chest pain, though there may be chest pain in Ludwig's angina if the infection spreads into the retrosternal space.

[edit] Causes

The cause is usually a bacterial infection, most often streptococci or staphylococci, although other bacteria can also cause this(occurring mainly in the submandibular space which is followed by infection entering into the submaxillary space and further). Since the advent of antibiotics, Ludwig's angina has become a rare disease.

The route of infection in most cases is from infected lower third molars or from pericoronitis, which is an infection of the gums surrounding the partially erupted lower third molars. Although the wide-spread involvement seen in Ludwig's is usually seen to develop in persons with a state of lowered immunity, it can develop in otherwise healthy individuals also. Thus, it is very important to obtain dental consultation for lower third molars at the first sign of any pain, bleeding from the gums, sensitivity to heat/cold or swelling at the angle of the jaw.

[edit] Symptoms

The symptoms include swelling, pain and raising of the tongue, swelling of the neck and the tissues of the submandibular and sublingual spaces, malaise, fever, dysphagia (difficulty swallowing) and, in severe cases, stridor or difficulty breathing. Swelling of the submandibular and/or sublingual spaces are distinctive in that they are hard and classically 'boardlike'. Important signs include the patient not being able to swallow his/her own saliva and the presence of audible stridor as these strongly suggest that airway compromise is imminent.

[edit] Treatment

Treatment involves appropriate antibiotic medications, monitoring and protection of the airway in severe cases, and, where appropriate, urgent maxillo-facial surgery and/or dental consultation to incise and drain the collections. A nasotracheal tube is sometimes warranted for ventilation if the tissues of the mouth make insertion of an oral airway difficult or impossible. In cases where the patency of the airway is compromised

skilled airway management is mandatory. This entails management of the airway according to the American Society of Anesthesiologists' "Difficult Airway Algorithm" and necessitates fiberoptic intubation.

[Dustdevil]

Now y'all know why I have so little tolerance for those wankers who whine about getting called out at 0200 for a toothache.

[brock8024]

I know from now on when I have a person with a tooth ache I am checking for this. Even with pts with chest pain I am going to check for this. ALot of people may not mention a tooth ache because they think ti is chest pain when it is not.

[firedoc5]

My brother-in-law had something similar. He really didn't have too serious tooth/jaw pain, but did have chest pain. He was diagnosed with paracarditus. More or less tracked infection to abscessed wisdom tooth. In the long run, no MI occurred.