Dental Injuries overview
Bringing a Claim
Dental Procedures
Dental Caries
Dental Abscesses
Periodontal Disease
Dental Caries
Dental caries is the process of tooth decay which leads to the development of dental cavities. It is caused by a build-up of plaque, which thickens, especially in the presence of sugars such as sucrose, and ultimately causes demineralisation (breakdown of the surface of the tooth).
Once the enamel and dentine become demineralised a cavity is formed. Bacteria break down the mineralised tissues and the cavity becomes deeper until it enters the pulp chamber of the tooth. Once the pulp chamber is infected with bacteria, an inflammatory process occurs, which causes the death of the tooth.
The tissues within the pulp chamber and root canal then becomes necrosed and this leads to abscess formation in the surrounding bone.
Dental Abscesses
Usually if a dental abscess is formed it will cause severe pain, swelling, malaise and pyrexia. Treatment is by either:
- Extraction of the tooth; or
- Drilling through the crown of the tooth to expose the nerve chamber and root canal;
- Incision and drainage of the swelling.
An expanding dental abscess may well eventually spread through the exterior wall of bone into the nearby tissues and then into the oral cavity or into the face.
If there is a communication between the abscess and the face, it becomes a “sinus” and the abscess may discharge, sometimes reducing the swelling.
Periodontal Disease
Chronic periodontitis is progressive disease of the tissues supporting the teeth. Ultimately, if left untreated, the teeth will be lost. Gum abscesses may occur, causing swelling, pain and pus formation. Usually, however, the condition is painless, and for this reason the process may go undetected over a long period and dental practitioners may miss the diagnosis.
Periodontal disease begins with gingivitis (inflammation of the gingivae). Over time, the gingivae become detached from the teeth, forming a pocket in which plaque can continue to form. Since the pocket will not be accessible to oral hygiene methods, the disease process continues, leading to loss of ligament and bone.
In the early stages of the disease, adequate oral hygiene removes the plaque and this will lead to resolution of the inflammation.
There is an obligation on every dentist to inform the patient of and record the presence of periodontal or gum disease at an initial consultation or at any subsequent check-up. If there are signs of such disease there is an obligation to perform a full charting and report of periodontal status. This involves measuring pocket depths and recording them on a separate grid, kept with the main dental records.
Non-surgical treatment of chronic periodontal disease should include both extensive oral hygiene instruction, full re-evaluation and full periodontal charting. There is an onus on the dental practitioner in this situation to keep a patient under constant review.
