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Picture copyright 2006 Martin S. Spiller, D.M.D. In the image above, the patient had an abscess of an upper front tooth. Infections in upper front teeth are within the area of the face known as the "dangerous triangle". The dangerous triangle is visualized by imagining a triangle with the top point about at the bridge of the nose and the two lower points on either corner of the mouth. If your mother ever told you not to pick a pimple on your face or else you would get a brain infection, this is what it would look like if it actually happened
The head is, of course, located higher than the heart. This means that the blood pressure in the head and face is lower than the blood pressure in areas of your body located below the level of the heart. There are a lot of blood vessels and nerves in the face and the anterior of the mouth and nose reflecting the extreme sensitivity of structures in this area. The blood pressure in the arteries that feed this area are at relatively low pressure, but the venous system that drains the area must be at an even lower pressure for the system to work as designed. Normally, the blood flowing in the veins drains into large vessels in the neck, so if you get an infection in which bacteria are released into the bloodstream, the germs are swept into general circulation and are dealt with by the general bodily defenses. The brain's venous flow empties into a fairly large cistern located in the center of the base of the skull, called the cavernous sinus. Venous blood from the cavernous sinus empties into the same vessels that carry venous return from the dangerous triangle area. Normally, the system works as planned, but occasionally, the blood pressure in the cavernous sinus may drop below the blood pressure in the adjoining venous vessels and the blood flow may temporarily reverse allowing blood from the dangerous triangle area to flow backwards into the cavernous sinus. If this blood contains bacteria from an infected area of the face, nose or the anterior upper teeth, the infected blood may cause clotting in the cavernous sinus. If this happens, venous blood may "back up" in the vessels of the brain causing serious repercussions. Without modern antibiotics, this condition can lead to death. See the diagram below to visualize the location of the cavernous sinus and the proximity of the eye sockets. In this view you are looking down into the base of the skull from the top of the head. The brain would normally be sitting in the various depressions in the base of the skull.
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Copyright 2000 Martin S. Spiller, D.M.D. All material on this web site is protected by copyright and is registered with the US Copyright office. All personal uses, including public and academic presentations, are permitted. This fair use permission applies to oral and written reports, dissertations and theses for students in public and private schools, elementary and high schools, colleges and graduate schools. It also applies to teachers wishing to print this material for classroom and course work. Acknowledgement of this website as the source for this material during presentations is not required, but would be appreciated. Any dentist or other professional who finds this material useful is welcome to print and distribute it to patients, or to refer their patients to this website. Written requests for publication on the internet or other mass media (including printed publications) will be considered on a case-by-case basis. Internet and printed publication IS permitted (without permission, but with attribution) if it is part of a qualified academic dissertation, but any other internet or mass media use of this material without written permission is STRICTLY prohibited. Requests for such usage may be forwarded to me using the email button in the right shared border. If permission is granted, you must credit me for the use of the material and link to this website prominently from your own. Dentists and web developers who cut and paste content and/or images from doctorspiller.com into their own websites and claim them as their own are forewarned that this may result in legal action. Click here for more information concerning the copyright on this material. DISCLAIMER: Statements made on this web site are for informational purposes only and are not intended to be substituted for the advice of a medical professional. Information and statements have not been evaluated by the American Dental Association or any federal regulation agency and are not intended to diagnose, or treat any disease or medical condition. This is a personal website written by an individual dental professional whose intention is to enlighten the public with generally accepted, mainstream medical/dental information. I do not claim to represent the opinions of all dental or medical professionals. No website is a substitute for a visit to a living, breathing dentist or physician who can deal with you personally.
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