I sincerely believe that in many countries a large number of people die daily of diseases that originated in the mouth but have resulted in a fatal condition in another part of the body. Physicians are not generally trained or inclined to report that the cause of a person’s death was due to bad oral hygiene. And that is understandable. But the fact remains that more often than anyone wants to believe, people actually die from dental abscesses.

In the majority of cases that a dental infection becomes fatal, the offending tooth is a lower molar. Also, the signs and symptoms are allowed to persist for up to five days without the individual attempting to seek proper medical attention.
The condition known as descending cervical cellulitis is a severe form of diffuse swelling that frequently arises from infections of the lower molars. The roots of the second and third molars reach below the mylohyoid ridge, and an abscess located at the root tip may discharge in the submandibular space and then extend directly to the parapharyngeal space (at the side of the neck).

From there the abscess may spread inferiorly by the way of the fascial planes (found between the muscles) to the mediastinum (sack that contains the heart). It is the consequent decay of this thin fibrous pouch that encloses the heart that results in death.
Undoubtedly, one of the most dreaded, and probably the most lethal form of mediastinitis (infection of the heart sack) is the diffuse necrotising variety that occurs as a complication of an oral infection. Despite the presently available array of drugs, descending necrotising mediastinitis (DNM) remains a highly fatal disease.

Some time ago a 27-year-old man died of this condition at a city hospital. He went to the Emergency Department complaining of having for the past week suffered from progressive neck swelling associated with an inability to open the mouth properly, and painful swallowing. Three days before a physician had diagnosed “tooth abscess” and prescribed ampicillin. The patient’s chief complaint was a sore, swollen, throat; a foul taste in the mouth; and inability to eat.

Seven days after he was admitted to the hospital, the patient died. At the time of admission, his temperature was 101 degrees (normal 97-98), pulse 96 (normal 72) and blood pressure 140/80. His heart rate was normal. Oral examination revealed decayed lower molars.

The X-rays of the neck and chest showed abnormal air collection extending from the parapharyngeal spaces bilaterally at the base of the tongue down to at least the level of the clavicle (collar bone). He was placed on aqueous penicillin G, 2 mega units every four hours. The fever increased the same evening. The patient was taken to the operating room where the decayed molars were removed and the neck abscesses drained of foul smelling pus. Gentamycin was then added to the antibiotic regimen. The following day the patient’s condition deteriorated.

On the fourth day of admission, copious amounts of fluid were drained from the check cavity, and the patient became convulsive (fitting). Eventually, he went into septic shock, his blood pressure fell dramatically and he went into a coma. He then developed metabolic acidosis secondary to kidney failure and died.

The major lesson to be learned is that one should never underestimate the seriousness of dental disease. Because of their anatomical location, the lower molars are the most dangerous teeth in the mouth. Preventative maintenance of these teeth may literally save your life.