What is dental gangrene?

Sepsis can develop from a tooth when an infection in the dental pulp, typically from a gangrenous tooth, spreads beyond the tooth itself and enters the bloodstream.

In the case of dental gangrene, the pulp is already necrotic and filled with bacteria. If this process isn't stopped in time, bacteria can penetrate through the root tip into the surrounding bone and soft tissues. This often results in a dental abscess - a localized collection of pus.

If left untreated, bacteria may eventually enter the bloodstream. The presence of bacteria in the blood is known as bacteremia.

In a healthy person, the immune system can usually manage this situation temporarily.

However, if the bacterial load is high or the immune system is compromised - such as in older adults, people with diabetes, chronic illnesses, or those recovering from surgery - the body may react with an uncontrolled inflammatory response known as sepsis.

Sepsis causes a sudden disruption in vital functions - blood pressure may drop, heart rate increases, high fever can occur, along with confusion and difficulty breathing.

If not recognized and treated promptly in a hospital setting, sepsis can lead to organ failure and even death.

In other words, a tooth that appears harmless but harbors a silent infection can become the source of a serious, potentially life-threatening condition. This is why any suspicion of dental gangrene should be taken seriously and treatment should begin as soon as possible.

Death as a result of dental gangrene is rare but it can occur, usually only when the condition is neglected for a long time and left untreated.

Gangrene of the tooth itself is not directly fatal. What makes it dangerous is its potential to allow the infection to spread beyond the tooth.

If bacteria from the tooth reach surrounding tissues and enter the bloodstream, they can cause an abscess, cellulitis, and in severe cases, sepsis - a serious and potentially life-threatening systemic inflammatory response.

Sepsis can progress rapidly, leading to organ failure, coma, and even death - especially in older adults, individuals with weakened immune systems, or those with chronic conditions such as diabetes or heart disease.

There are documented cases where an untreated dental infection was the direct cause of death, most often because the person did not seek timely care or underestimated the severity of the infection.

This is why it's important to emphasize that, although rare, death from dental gangrene is possible, but entirely preventable with timely dental treatment.

A tooth that no longer hurts doesn't necessarily mean the problem has gone away, it may simply be entering a quieter, but more dangerous phase.

In cases of dental gangrene, antibiotics are not prescribed routinely - they are only indicated when there are signs that the infection has spread beyond the tooth, such as swelling, abscess formation, fever, or a general decline in health.

When an antibiotic is necessary, the most commonly prescribed options include:

Amoxicillin - due to its broad-spectrum activity against the types of bacteria typically involved in oral infections.

In more severe cases, or when there is concern about bacterial resistance, a combination is used:

Amoxicillin with clavulanic acid (e.g. Augmentin, Klavocin) - this enhances effectiveness by overcoming bacterial resistance.

If the patient is allergic to penicillins, alternatives include:

• Clindamycin - a reliable option, especially in more serious infections and deep abscesses.
• Azithromycin - may be used for milder infections, but with caution due to possible resistance and side effects.

It’s important to note that antibiotics are not a substitute for proper dental treatment. In cases of dental gangrene, the tooth must undergo endodontic therapy - the infection must be eliminated from the root canals.

An antibiotic may temporarily reduce symptoms, but it does not address the root cause. If the tooth is not treated, the infection may return or worsen.

For this reason, antibiotics are prescribed only when medically indicated, and treatment decisions are always made by a dentist based on clinical evaluation and symptoms.