Long Root Facial Swelling Dental Infection Pathway
One of the main long root dental infection pathways result in facial swelling. This happens when the dental infection swelling spreads underneath the buccinator muscle.
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THE BUCCINATOR MUSCLE
The buccinator muscle is a "bilateral, square-shaped muscle constituting the mobile and adaptable cheek area", it is a muscle beneficial for mastication due to its compressing forces on the cheeks (Rethee M, Jain P, 2022). It runs along the inforeo-lateral border of the maxilla.
It is positioned deep to the masseter muscle and zygomaticus muscle (3D4Medical Ltd, 2023). It is supplied by the buccal artery, the facial artery, and it drains through the pterygoid plexus (Rethee M, Jain P, 2022).
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PRESENTATIONS OF A FACIAL SWELLING INFECTION
- Facial swelling
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Stages of a Facial Swelling Infection Pathway
(Anatomography, 2012)
Background Information
Initial Infection
Pulp Chamber Invasion
A tooth with long roots such that the apex is positioned above and deep to the buccinator attachment to the bone can cause a facial swelling. This infection starts out in the same way as the short-rooted tooth infection. In this case, however, the root is long and the apex is positioned above the buccinator muscle.
During the initial stages of the tooth infection, the healthy tooth gets invaded by bacteria contained in plaque, which thrive off the carbohydrates in the mouth and produce acid, which slowly destroys the enamel layer.
When the bacteria gain access to the dentine, they invade the dentinal tubules and in this way gain access to the pulp chamber in the middle of the tooth. Within the pulp chamber, the bacteria incite an acute inflammatory reaction which causes an increase in the hydrostatic pressure within the tooth and leads to hypoxia and this leads to destruction of the contents of the pulp and roots canal system, effectively killing the tooth.
Bone resorption
It is here, within the pulp chamber, that most of the bacteria will reside, and having destroyed any access for white blood cells normally carried in the blood vessels, makes eradicating the bacteria difficult without either extracting the tooth itself or at least removing the dead contents of the pulp and root canal system and sterilising this area to kill the bacteria. The presence of bacteria means that their by-products/ toxins can leak out of the apex of the tooth, where the nerve would normally exit, and these insight an inflammatory response in the body, which causes a build-up of pressure within the apical tissues of the periodontal ligament, instigating bone resorption and so a widening the periodontal ligament. The causes the formation of pus (consisting of dead and dying white blood cell and bacteria) which is an abscess.
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Because the apex of the tooth is positioned deep to and above the buccinator muscle, the hydrostatic pressure created due to this bacterial infection triggers an acute inflammatory reaction, erodes through bone and invades the soft tissue above the buccinator, causing a facial swelling.
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Facial Swelling
The infection presents as a facial swelling. This infection is treated in a similar way to short rooted tooth infections, through removal of the tooth by extraction, or removal of the dead contents of the root canal and pulp chamber by an endodontic root treatment, and draining the pressure on the soft tissue by incision and drainage of the pus from the facial swelling to create a path of least resistance for the pus to drain.