From Dental Decay to Systemic Failure: The Overlooked Consequences of Poor Oral Health

BACKGROUND Oral diseases, though largely preventable, continue to affect billions of people worldwide and impose a significant economic burden. Global estimates from 2015 are over $350 billion in direct costs and nearly $190 billion in indirect costs to dental diseases, which disproportionately impact low-income and marginalized populations. Despite effective preventive measures such as fluoride application and minimally invasive dentistry, untreated dental caries remains the most common oral pathology. Left unmanaged, these conditions can lead to severe complications, including infective endocarditis and deep neck infections (DNIs), with systemic implications ranging from sepsis to cardiovascular events. CASE REPORT A 65-year-old man was admitted with malaise and neck stiffness. Laboratory analyses revealed leukocytosis, elevated procalcitonin, and D-dimer levels, although pulmonary embolism was excluded. The differential diagnosis included meningitis, severe osteoarthritis, and acute cervical spine inflammation. Empiric treatment with vancomycin and levofloxacin was initiated, while further evaluation with CT and contrast-enhanced MRI revealed extensive inflammation: a retropharyngeal abscess extending into the epidural space and compressing the spinal cord at the craniospinal junction. Initially, urosepsis was suspected due to catheterization challenges; however, urinary cultures were negative. A preoperative airway assessment led to a dental consultation, revealing extensive caries and poor oral hygiene. Multiple extractions confirmed an odontogenic source, but the patient ultimately developed sepsis from the abscess, leading to heart failure and death. CONCLUSIONS This case underscores the critical impact of neglected oral health and the necessity for timely dental intervention. It reinforces that early recognition and integrated oral-systemic healthcare are essential in preventing the progression of odontogenic infections into life-threatening complications.