Dental foci

Many of us will have encountered the phenomenon that our doctor is unable to establish the cause of our disease, an existing disease is reluctant to resolve, or following an interim period of healing our complaints reappear, or the treating specialist has no explanation for the “behaviour” of our disease. A conscientious and experienced doctor will suspect hidden dental foci in the background and refer the patient for a localisation of dental foci of infection A focal infection is a pathological process in course of which an inflammatory disease of a given organ (the tooth, for instance) or group of organs gives rise to a secondary disease at a remote point in the body. The chronic infection triggering the disease is called the focus of infection. The dental focus itself tends to be asymptomatic, causes no pain, but insidiously “blends in” with its environment and triggers a long-enduring “dormant” inflammation in which different bacteria dwell releasing toxins which are transferred by the blood and the lymphatic system to distant regions of the body. The dental focus of infection finds its way to our “weak spot”, organs less capable of defence, and gives rise to a disease. As regards its behaviour, it is best likened to a dog which attacks a group of people and charges at the one most afraid of it, as it detects the scent of fear.

Due to its asymptomatic nature a focus of infection may often go undetected for years. It is crucial, therefore, to report for regular dental check-ups, have a follow-up panoramic radiograph recorded and undergo scaling every 1 or 2 years. The point of timely observation is to easily deal with issues before they go out of control and cause irreversible damage. A pus pocket or a cyst on a long-neglected root-canal treated tooth detected too late can cause massive bone decay which may present only as a fistula in the oral cavity occasionally excreting pus, while the gums, on the other hand, may hide a sizeable abscess. If the infection is eliminated too late, the extent of bone decay having developed may hinder the success of a dental implant. If a bone graft (sinus lift) is required, that may prolong the process of tooth restoration by months and render it more expensive.

What gives rise to dental foci?
Dental foci of infection:

• necrosis of a tooth due to deep caries
• in an overly neglected mouth the crown of the tooth has disappeared leaving only carious root remains behind
• due to an inappropriate root canal filling (too short or too long), or an infection remaining in the root canal in the wake of an unprofessional root canal extension, a granuloma or cyst forms on the tooth
• an infected piece of the root remains in the jaw bone or in the maxillary sinus that goes unnoticed by the dentist or is not removed
• Untreated tooth having chipped off in an accident
• pockets having formed around a wisdom tooth or residual cyst having developed from the dental sac left behind in the course of pocket removal
• unerupted teeth remaining partially or fully under the gums (impacted teeth)
• pockets having formed due to untreated periodontal disease
• bone- or bone marrow infection
• inflammation around the implant (periimplantitis)

Other adverse effects of dental foci

Focal infections may induce a vast variety of diseases in the body. At times we would not imagine just how many problems we could “get rid” of by eliminating the focal of infections.

Focal infection related complaints most commonly arise in the following organs:

• the cardiovascular system: pericarditis, vasoconstriction
• dermatological disorders: the skin is the region second most prone to focal infections (eczema, hair loss, bald patches)
• kidney and liver complaints
• eye: inflammation of the iris, cyclitis (inflammation of the ciliary body)
• respiratory system: lung abscess
• nervous system disorders: meningitis, brain abscess
• locomotor system: arthritis, rheumatic pains
• digestive system: gastric and duodenal ulcers, Crohn’s disease
• preterm birth

Regular check-ups are crucial in diagnosing focal infections. If diagnosed timely, dental foci cause less severe damage and their treatment is less radical. By the treatment/elimination of dental foci other problems will see rapid movement too. In the course screening for foci of infection a clinical examination and a radiograph are necessary. Indication for localising foci of infection include signs of a focal infection, planned transplantation, oncological treatment.

How to treat different dental foci?
Different dental foci require different treatments spanning an array from basic to radical solutions:

• scaling (tartar removal)
• root canal treatment, cleaning the root canals, preparation of root fillings
• tooth extraction
• the cleaning of the maxillary sinus (chronic sinusitis) with the involvement of otorhinolaryngologist
• administration of antibiotics

CT scan of chronic sinusitis with the maxillary sinus “half filled up”

Remember to not only see your dentist in the event of a problem but also to undergo regular follow-up examinations. A completely pain-free clinical examination and a panoramic radiograph may shed light on problems that are easier and simpler to remedy at an early stage.