Teeth fractures, disease and infection

Teeth as hotbeds of infection: the problem of local infection is so old, already Rush in 1819 drew attention to it. However it was earlier in the century when the relationship between fever and local infection was confirmed so that the location of teeth relative to the infection was of concern.

These diagnoses: endocarditis, glomerulonefronitis, ophthalmopathy, and dermatosis, were directly related to the existence of a granuloma tooth. However, outside of the presence of dental bacteria considered infectious, we must not forget the existence of blood vessels that give way to toxins. The vessels can also unleash allergic reactions with harmful effect.

Other alterations can intervene: teeth, bone condensation areas, etc. But on the other hand, it is harder still for the dentist to specify whether this injury is acting as a focus tooth. Only proof of the demise of phenomenology overall after extraction would confirm the diagnosis.

Faced with this patients must maintain a cautious attitude. We must use all possible means of diagnosis, including clinical and radiological techniques, to make a conservative elimination of the risk factors.

Malignancies can radiate to teeth in all, including in its protocol radiotherapy, and is the possible emergence of osteoradionecrosis, as a complication post-irradiation. This injury is more common at the jaw. To avoid infection of this necrotic bone we recommend removing previously infected teeth and even healthy teeth if they are in the radiation field.

Teeth in hotbeds of fractures: a much-debated question has been regarding teeth involved in some way after a maxillofacial trauma. Classically these teeth were included as an absolute indication for extraction, not altered by the physiological mechanisms of bone repair. Today the chance of preventing infection, always under custom channels, allows the preservation of a tooth if it is not infected and is usable for proper occlusion of bone segment later.

Finally, the presence of vegetative and sensory nerves inside the granuloma give rise to phenomena reflexes, and trophic vegetative alterations such as plates or alopecia areas of hyperaesthetics.

All of these considerations brought an attitude of drastic extraction. Any tooth with periapical injury, granuloma, devitalization, rightly or wrongly was removed. Actually this attitude is very questionable: it is very difficult to link a particular type of injury with the overall process.