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November 28, 2011
Severe dental condition almost kills Ohio patient
By Dr. Diane Gorgas
COLUMBUS, Ohio — I think I've heard all the reasons people don't go to a dentist.
It's too expensive.
I'm afraid of needles/drills.
I don't want to belittle the problem, but avoiding a dentist is one of the most-illogical decisions in medicine.
Tooth pain almost never gets better on its own or goes away without intervention. Complications inevitably lead to worsening decay, generalized inflammation and overall worse health, not to mention an increased risk of heart disease.
And let's face it, out-of-control dental decay is far scarier than any visit to a dentist.
Nothing demonstrated this to me better than the case of one of my colleagues. He didn't like dentists but realized they were an inevitable part of health maintenance.
Still, when he developed a toothache, he thought he could put off seeing a dentist until he could muster the courage. It took him the better part of a week to pick up the phone and make an appointment.
Four days before he was scheduled to go in, he developed a low-grade fever and started to feel pain when he swallowed. He also had trouble speaking clearly that day and chalked it up to the lower molar, which was causing swelling at the gumline.
He figured the penicillin he had started the day before just needed more time to work.
But that night, his fear of the dentist paled in comparison with the terror he felt when he awoke unable to breathe.
He said he felt as if someone had surgically implanted a softball underneath his tongue. He could not lie flat and he could breathe comfortably only if he was leaning forward, hands on his knees.
My colleague recognized at that moment that he was about to lose his ability to breathe. He called 911, and despite his inability to utter one word to the dispatcher, medics soon arrived and got him to the emergency department.
I nearly didn't recognize him. The swelling in the floor of his mouth made him look more like a bullfrog than my colleague and friend.
His airway was tight, having narrowed dangerously to the width of a pencil.
Intubating him and placing him on a ventilator were going to be challenges at best and a disaster in all likelihood. There was a real risk that I would have to cut a hole in his neck and insert a breathing tube just to get him to the operating room, where an oral surgeon could drain this abscess.
My colleague was showing all the classic signs of something called Ludwig's angina, one of the worst complications of dental disease. It is an infection that starts in the bad tooth's root and spreads under the tongue and across to the opposite side of the jaw.
The infection usually takes the form of an abscess, and, over a few days, causes intense swelling beneath the tongue.
Patients say it feels as if they have a golf ball on the floor of their mouth. They can't talk. They can't eat. And in many cases, they have trouble breathing.
The Greek root of the word angina (usually associated with heart patients) means to strangle or close off.
Both anginas can cause the sense of impending doom, and patients often panic as the brain screams for oxygen.
My friend was lucky that day. He responded well in the emergency department to medications to decrease the swelling in his airway.
He felt more comfortable with supplemental oxygen and was swiftly taken to the operating room, where his abscess was drained. He was placed on a ventilator for a day until the swelling went down, but he made it through the ordeal without needing a tracheotomy.
Today, he's a much bigger fan of dentists and schedules regular visits. And now he is the guy handing out toothbrushes on Halloween.
Dr. Diane Gorgas is an emergency physician at Ohio State University Medical Center.
Copyright 2011 The Columbus Dispatch
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