Poor oral health, often dismissed as a localized problem, can have devastating systemic consequences, according to a new case report. The report described the death of a 65-year-old male patient whose untreated dental caries led to a severe deep neck infection, sepsis, and ultimately heart failure.
The researchers emphasized that oral diseases remain among the most common and preventable health conditions worldwide, yet their complications can be life-threatening when left unmanaged. Global estimates from 2015 suggest dental diseases accounted for more than $350 billion in direct costs and nearly $190 billion in indirect costs, disproportionately affecting low-income and marginalized populations.
The patient in the case report presented with nonspecific symptoms, including malaise and neck stiffness. Initial laboratory testing showed leukocytosis and elevated procalcitonin and D-dimer levels, prompting concern for serious infection, though pulmonary embolism was ruled out. Clinicians considered diagnoses such as meningitis, cervical spine inflammation, and severe osteoarthritis and initiated empiric antibiotic therapy with vancomycin and levofloxacin.
Advanced imaging with computed tomography and contrast-enhanced magnetic resonance imaging revealed extensive inflammation involving the retropharyngeal space, with abscess formation extending into the epidural space and compressing the spinal cord at the craniospinal junction. Despite these findings, identifying the primary source of infection proved challenging. Urosepsis was initially suspected because of catheterization difficulties, but urine cultures were negative.
Otolaryngology surgeons performed drainage of the retropharyngeal abscess and secured the airway with a tracheostomy. Blood cultures later grew methicillin-sensitive Staphylococcus aureus, prompting adjustment of antibiotic therapy. However, the underlying source of infection remained unclear until a preoperative airway evaluation raised concern for dental disease.
A dental consultation revealed extensive caries and poor oral hygiene. Multiple teeth were extracted, and the clinicians concluded that an odontogenic infection was the most likely origin of the deep neck abscess. Despite aggressive medical and surgical management, the patient developed sepsis and died from heart failure.
The case emphasized how untreated dental caries can progress to deep neck infections, epidural involvement, and systemic sepsis. Retropharyngeal abscesses, though uncommon, are recognized complications of dental and pharyngeal infections and can present with vague symptoms such as fever, neck pain, or general malaise, delaying diagnosis.
The researchers noted that delayed recognition of dental involvement was a key factor in the poor outcome. Evidence suggested that many patients with odontogenic emergencies may seek medical care before hospitalization, yet only a minority receive definitive dental treatment prior to developing severe infections.
The researchers called for heightened clinical suspicion of odontogenic sources in deep neck infections of unclear origin and advocated for earlier dental consultations in complex systemic infections. They also highlighted the need for more integrated oral-systemic health care models to prevent avoidable morbidity and mortality.
Source: American Journal of Case Reports