Dental Infections: Plaque, Gingivitis, Periodontitis and Caries

Odontogenic Infections

Bacterial plaque is a biofilm of bacteria, including various layers of streptococci and Gram-positive lactobacilli. Food residues that remain on the teeth and in the mucous membranes form soft deposits that can be removed initially by rinsing. However, in the first stages, bacteria attach to the teeth and affect their surface, and can only be removed by mechanical means such as brushing and the use of dental floss.

Bacterial plaque is classified into two types:

• Supragingival plaque: formed by layers of bacteria located above the gingival margin, and rarely visible.
• Subgingival plaque: when there are many layers of bacteria, it spreads below the gingival margin, penetrating beneath the gum and surrounding the root of the tooth, creating spaces where anaerobic Gram-negative bacteria can cause gingivitis and periodontitis.

Gingivitis

Gingivitis is an inflammation of the gums characterized by redness or bluish discoloration and bleeding. It is caused by the accumulation of subgingival plaque. The main treatment for gingivitis is its prevention through thorough and frequent brushing with fluoride toothpaste and the use of dental floss.

Dental Caries

Dental caries is the first progressive pathology affecting the hard structures of the tooth. It is characterized by:

• Demineralization of the enamel, destruction of the dentin, and proteolysis of proteins by microbial invasion.

Caries is a multifactorial pathology, and its development results from the interaction of different factors:

• Diet, oral flora, and bacterial residues from food.

Teeth more predisposed to caries are found in the following surfaces: occlusal, mesial, distal, buccal, and lingual or palatal.

Factors that favor its appearance: microorganisms that colonize the pulp chamber through the action of caries, iatrogenic factors that cause the teeth to become more susceptible to action, and poor hygiene. Surface areas can become infected or irritate the pulp, and systemic diseases can also favor its appearance.

Pulpitis

Pulpitis refers to the inflammation of the dental pulp, which consists of loose connective tissue with circulatory channels and neurovascular bundles that branch and anastomose.

Periodontitis

All cases of periodontitis are preceded by gingivitis. Periodontitis always precedes gingivitis, starting supragingivally and progressing subgingivally, which allows the entry of Gram-negative periodontal bacteria. The cause is the agglomeration of periodontal tissue around the bacteria, often accompanied by a decrease in the immune response capacity against the infection. There are various types, each caused by different bacteria and occurring preferentially at different stages of life. Symptoms include yellow-grey plaque, gum redness and swelling, painful tooth percussion, and tooth mobility. Treatment consists of eliminating periodontal pockets, performing scaling and root planing both above and below the gum line using a curette instrument.

Dental Abscess

A dental abscess is a collection of pus originating in the tooth. In most cases, it results from suppurative periodontitis that usually localizes in the area around the apex, with symptoms similar to those of periodontitis that has become acute.