Mouth infection
Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures.
In cases that spread to adjacent structures or in immunocompromised patients (cancer, diabetes, transplant immunosuppression), surgical drainage and systemic antibiotics may be required in addition to tooth extraction.
The inability to fully open one's mouth, also known as trismus, suggests that the infection has spread to spaces between the jaw and muscles of mastication (masseter, medial pterygoid, and temporalis).
Severe infections with significant swelling may cause airway obstruction by shifting/enlarging soft tissue structures (floor of mouth, tongue, etc.)
The development of stridor, shortness of breath, and pooling oral secretions may indicate impending airway compromise due to a worsening mouth infection.
Other rare but dangerous complications include osteomyelitis, cavernous sinus thrombosis, and deep neck space infection.
Individuals with long-standing infections may lose significant weight because pain blunts their desire and impairs their ability to eat food.
[5] Although rare, mouth infections may also spread through the nasal and facial veins that drain into a reservoir of deoxygenated blood called the cavernous sinus.
However, certain situations, like a decaying tooth root or a penetrating puncture wound from a fish bone, can generate an environment that disrupts the normal oral microbiome and promote the growth of pathogenic bacteria.
Consequently, the obligate and facultative anaerobes present within the oral cavity flourish and outcompete the other bacteria at the site of tooth decay, causing the dental caries to escalate into a mouth infection.
The oral cavity serves as the starting point of the digestive track and facilitates breathing as a channel for airflow to the lungs.
The oral cavity is lined with specialized mucosa containing salivary glands that moisten food, breakdown sugars, and humidify air prior to entering the lungs.
The roots of the lower teeth are anchored into a bone called the mandible, more commonly known as the jaw, at their respective alveolar processes.
As the air pocket or pus enlarges within the fascial planes, the structures surrounding the abnormality can become compressed or shifted out of its normal place.
These phenomena of compression and deviation due to a growing infection/air pocket drive the progression of disease into potentially life-threatening situations.
[1] Swelling within the oral cavity or cheeks, along with a history of progressively worsening tooth pain and fevers, is usually enough evidence to support the diagnosis of a mouth infection.
Other lab tests may include a complete blood count with differential, serum electrolyte concentrations, and other routine assays for an infectious workup.
[1][2] Although mouth infections can present in many different ways, they are managed according to the same guiding principles - protect the airway, drain the abscess, and treat with antibiotics if necessary.
[2] To pre-emptively protect a patient's airway, placing flexible plastic tubing through the nasal cavity and into the trachea, called endonasal intubation, is typically the first option.
It can be performed with or without direct visualization with laryngoscopy, a small camera with a live video feed to ensure the tubing is placed in the proper location.
If attempts to intubate through the nasal cavity are unsuccessful or if the airway must be re-established quickly, then an incision can be made through the front of the neck to gain access into the trachea, also known as a tracheotomy.
Since most mouth infections are polymicrobial, penicillin is an appropriate initial choice of antibiotic because of its activity against Streptococcus and gram negative anaerobes.
