Dental implants infection: The battle between metals and germs

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Infections are a pain in the back when it comes to oral health. Gum disease, tooth infections, and bone infections are serious infections threatening the oral health of the patient. But they all occur in the organic tissues. What if you have a metal piece in your mouth? What to do in case of dental implants infection?

In this article, we’re going to talk about dental implants infection, how common dental implants infections are, how they occur, how they proceed, and how to fight against them. So tighten your belts, you’re entering the world of dental infections guide.

Fighting with the germs: Can dental implants get infected?

The answer is yes and no. How? Not directly the implants but the tissues covering them can get infected. Unlike your natural teeth, they are made of inorganic materials so dental implants infection doesn’t happen directly on the metals. But structurally and morphologically they are like your natural teeth. So, they can still be affected by infections. 

For example, your natural teeth have organic living tissues covered with a mineral-based inorganic shell. The shell doesn’t get infected but the inner part of your teeth does. Also, accumulated bacteria and plaque on your teeth, gum line, or tooth roots can spread infections to both bone and gum tissues. Sorry for saying but this is also possible for implants. Don’t worry, it’s not a common case. It is called peri-implantitis. It is just like periodontitis but with dental implants.

Signs of implant infection

In the case of bacterial infections, it’s important to be aware in an early stage before it starts to destroy your gums and bones. And it’s not that hard to see if you have such a problem. If you have implants and observing the symptoms like the followings around them or anywhere else you better see a dental professional:

  • Loose implant
  • Red and swollen gums around the implant
  • Bad breath and a bad taste in the mouth
  • Throbbing pain around the implant
  • Bleeding around the implant when you’re brushing
  • Visible pus
  • Difficulty chewing
  • Fever
  • Receding gums

What are the causes?

Gum infections occur around the implant for several reasons. Dental Having an infection also means that you have gum disease. We’ve mentioned some of them. Now let’s see the detailed reasons lying under this disease and make you understand how serious this situation is. 

Bacterial contamination during the implantation process

Unfortunately, as in all professions, not all dentists are rigorous and professional. You can stumble over some bad examples as well as good ones. That’s why the choice of dentist and clinic is quite important when it comes to dental operations, especially the ones that require surgical interventions.

The clinic and the tools dentists use must be sterile enough. As they open a hole in your body, any microorganism can enter this wound and multiply there. These kinds of infections can be serious. So you have to be sure that you’re getting your surgery in a sterile environment. And also the qualification of the dentist is quite important. A lack of knowledge and experience can result in improperly planted implants.

Poor oral hygiene and inadequate maintenance

We’ve talked about the dentists’ responsibility, now it’s time to talk about yours. The most crucial part of oral health is a good, proper oral hygiene routine. If you follow it, your smile will stay beautiful and healthy. By a good oral hygiene routine, we mean brushing at least twice a day, flossing, rinsing, and using mouthwash. Also visiting your dentist regularly to see if there is anything going on.

Pre-existing gum disease or infection

The implant procedure requires a surgical intervention to place the implant into the jawbone. This kind of operation may cause the existing infections and diseases to spread to surrounding areas. So normally, you can’t and shouldn’t get implants if you have such a disease. You have to get it treated first.

Compromised immune system

Your immune system fights invasive bacteria, viruses, and fungi every day. And your mouth is a real battlefield in this sense. With everything you eat, every time you put something in your mouth you may make your mouth meet new bacteria. And if you don’t have a weak immune system, your body’s defense mechanisms just destroy them. But if you have a weak one, you’re at a higher risk of oral infections.

Smoking and tobacco use

Smoking and tobacco use is one of the greatest factors that increase the risk of peri-implantitis and other oral infections. First of all, smoking causes dry mouth, which creates a better environment for plaque accumulation. The saliva your mouth secretes naturally is also part of your immune system. It cleans up the bacteria and removes the food debris. It also protects the pH balance of your mouth. So, with a dry mouth, bacteria can multiply and form plaque much more easily. 

Smoking also reduces the body’s natural defense mechanisms’ efficacy. It reduces blood circulation so your blood can’t deliver enough supplies to your tissues in enough time when they need. Resulting in making your healing process take longer and much harder.

How common is it?

It can be common but it depends on the patient. The researches show that approximately 20% of patients have peri-implantitis in the first decade of their implants. So let’s say this applies to 1 of every 5 patients. Take a look at the risk factors and see if you can be in this 20% or not. If you think so, just take precautions. It’s not hard to prevent these infections with several steps. If you don’t have any genetic tendencies or immune system problems, the only thing you have to do is to maintain a good oral hygiene routine and quit bad habits. 

Types of implant infections

There are different types of dental implants infection depending on where it occurs or how much has it proceeded. For example, peri-implantitis affects different tissues at different levels in the early and late stages. Furthermore, the infection around the surrounding tissues can spread into other parts of the mouth. Let’s take a look at them briefly. 

Peri-implant mucositis

This is the early stage of peri-implantitis. The symptoms are quite parallel to gingivitis: red and swollen gums, bleeding, and such. In this early stage, the infection doesn’t cause any bone loss yet. However, if it’s left untreated it can progress and become more dangerous for your oral health. 

Peri-implantitis

This is the advanced version. The infection affects both bone and gum tissues. If left untreated, significant bone loss and gum recession can occur. the symptoms of the previous stage also continue in peri-implantitis. 

Abscess formation

When infection destroys soft tissues, pockets full of bacteria can form, which are called abscesses. While your immune system is fighting against bacteria, pus accumulates in the pockets like the wastes of a battlefield as a result. This process may cause pain, swelling, and tenderness.

Implant-associated osteomyelitis

It happens when your bones get infected. The infection spreads from the gums and soft tissues to the bones. Slowly, it destroys the bone structure in the area. It can be painful and can cause fever. If left untreated, tooth loss is inevitable and you may also have serious morphological changes because of the supportive tissue loss around the mouth. 

Can an infection put the implant at risk?

Yes! As we said before, the implant holds its place with the supportive tissues same as your natural teeth. So this kind of disease weakens and even destroys these tissues until there isn’t anything left for your implants to hold, resulting in dental implant failure. And in the case of tissue loss, it may become harder to replace the missing tooth or implant with a new one. 

What to do if your implant is infected?

As for all diseases, you have to consult with a professional to understand the situation better and then get the right treatment. The treatment methods may differ depending on how much of the infection proceeded, and how much damage your hard and soft tissues got. If there is no significant tissue loss, it’s easier to treat it with medicines and good care. If you lost some of your tissues, you may need a gum or bone grafting procedure. 

Diagnosis

You can see what’s going on with your gums if you take a look at them in the mirror. But for a well-done diagnosis, you definitely need a dentist. Only a dentist can tell you what exactly is going on in your mouth, how far it has advanced, and how to treat it correctly. The first thing the dentist will do is an examination to be sure what the problem is. The symptoms generally show themselves in the gums. Then a dental radiologist looks at the inner tissues to see if you have bone loss or not. 

Treating the infection

After the diagnosis is done, the dentist decides which treatment will you go under. Let’s see what are the treatment options for dental implants infection:

  • Antibiotics: With tissue loss or not, antibiotics are generally necessary to treat the disease. As they fight the bacteria, they can clean the infection from your gums and bones. The power of the antibiotic can vary depending on the level of your disease. 
  • Gum Grafting: If you lost a significant part of your gums around the implant, It can become loose. With gum grafting, the doctor stretches the gum to the natural gumline or transplants it from another part of the mouth to the affected area. Then stitches it and the rest is up to you.
  • Bone Grafting: The doctor opens the area and fills it with a special cement that will get harder and more concrete and eventually will fuse with your bones. Bone tissues can not regenerate naturally, so doctors graft them and fill the empty area.
  • Removal of Infected Tissue: In some extreme cases, when tissue is so badly affected by the infection, it may be necessary to remove this tissue in order to protect the healthy tissues. Dentists remove these tissues carefully when you’re under local anesthesia.
  • Implant Replacement: If you already lost your implant or the doctor sees a need for changing it, you’ll undergo an implant replacement. It may be necessary to heal the area better or if you have serious tissue loss you may need to get them grafted for carrying your implants better.

Preventing infection recurrence

The infection can always reoccur and we know why it can: lack of dental hygiene, an unhealthy diet, and bad habits. So if you take the necessary precautions, you can prevent it from happening. Here are the steps you can take to prevent dental implants infection:

  • Brush twice a day
  • Use toothpaste that is specifically good for gum health
  • Floss at least once a day
  • Rinse the debris in your mouth
  • Don’t let your mouth dry, drink water
  • Get regular dental checkups
  • Eat well to support your immune system
  • Don’t smoke!

If you take these precautions and maintain a good oral hygiene routine, you don’t need to worry about peri-implantitis anymore. Don’t forget, your oral health mostly depend on your oral hygiene.

References:

Rokaya D, Srimaneepong V, Wisitrasameewon W, Humagain M, Thunyakitpisal P. Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment. Eur J Dent. 2020 Oct;14(4):672-682. doi: 10.1055/s-0040-1715779. Epub 2020 Sep 3. PMID: 32882741; PMCID: PMC7536094. (link)

Roccuzzo A, Stähli A, Monje A, Sculean A, Salvi GE. Peri-Implantitis: A Clinical Update on Prevalence and Surgical Treatment Outcomes. J Clin Med. 2021 Mar 6;10(5):1107. doi: 10.3390/jcm10051107. PMID: 33800894; PMCID: PMC7962026. (link)

Smeets R, Henningsen A, Jung O, Heiland M, Hammächer C, Stein JM. Definition, etiology, prevention and treatment of peri-implantitis–a review. Head Face Med. 2014 Sep 3;10:34. doi: 10.1186/1746-160X-10-34. PMID: 25185675; PMCID: PMC4164121. (link)

Prathapachandran J, Suresh N. Management of peri-implantitis. Dent Res J (Isfahan). 2012 Sep;9(5):516-21. doi: 10.4103/1735-3327.104867. PMID: 23559913; PMCID: PMC3612185. (link)

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