In the News


Published: Tuesday, January 24, 2006


By Dr. Melissa F. Kerg

For The Columbus Dispatch

People often ask what the most common complaints are in the emergency department. They expect to hear about injuries, chest pain and pneumonia and are surprised when I say how many toothaches we see.

There are several reasons people suffering toothaches come through our doors. The most common is that they lack preventive dental care.

Some people don't have insurance. Others don't realize how important regular checkups are, whether it is because of poverty or negligence.

Many of those who don't have dental insurance never see a dentist.
And too many people wait until a tooth becomes a problem and they face extraction rather than restoration.

Unfortunately, health problems can surface when people wait too long.

Teeth can become infected, and decay can spread deep into the tooth where bacteria strike the root. This type of infection often can be treated with antibiotics in the ER. A dental professional then has to perform a root canal or tooth extraction.

A serious complication is Ludwig's angina, an infection that gets into the soft tissues of the throat and under the jaw, It can be life-threatening because the swelling progresses so rapidly that the airway can seal shut.

This infection needs to be treated by an oral surgeon. Patients usually stay on life support for several days until it is safe to remove the breathing tube.

The worst infection I have seen from a toothache occurred when I was in surgery rotation during medical school. A man was started on antibiotics for problem with a lower front tooth.

The next day, he was worse and X-rays of the tooth showed that there was air beneath the skin of his throat.

That was a sign that he had necrotizing fasciitis, a deadly skin infection that spreads so rapidly that you can watch it worsen in front of your eyes.

The treatment involves surgically removing all the infected tissue. This man's infection had spread to his chest. Even some of his neck muscles had to be removed.

When his bandages were removed the next day, it was like looking at pictures in an anatomy book.

I wish I knew how this man fared and how he looks today.

So when people scoff at toothaches in the ER and ask what is the worst that can happen, I tell them more than they can imagine.

Dr. Melissa F. Kerg is an emergency physician at University Hospitals East.