If left untreated the infected pulp may cause inflammation which also reduces the blood supply to the tooth. The diminished blood supply to the tooth keeps the nerve tissue from recovering. The antibiotics also seem ineffective here. So the infection needs to be manually removed. The infection can also spread to the bone around the tooth leading to formation of abscess which is a collection of pus due to rapidly multiplying bacteria and the infection is pushed beyond the apex. As the pus accumulates in the bone the tooth rises in the socket and pains on biting down. If not treated this infection can further spread to surrounding tissues and nerves causing:

Fever
Nausea
Difficulty in swallowing
Untreated abscesses may get worse and lead to life threatening complications. Possible complications being:
Loss of tooth
 
Mediastinitis - Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum- which is a non-delineated group of structures in the chest surrounded by soft tissue.)

Sepsis - Sepsis is a serious medical condition characterized by a whole-body inflammatory state and the presence of known suspected infection.

Facial Cellulitis, Ludwig’s Angina - Spread of infection to soft tissue. Facial Cellulitis is a diffuse
infection of soft tissue with severe inflammation of dermal and subcutaneous layers of the skin of the face. Cellulitis can be caused by normal skin flora or by exogenous bacteria and is very painful and is usually accompanied by swelling. Ludwig’s angina is a life threatening Cellulitis infection of the floor of the mouth.
 
Steomyelitis of the Jaw - Spread of infection to jaw bone causing the infection of the jaw bone called osteomyelitis of the jaw.

Spread of infection to other areas of the body leading to Brain Abscess, Endocarditis (i.e. inflammation of the hearts inner lining which might turn life threatening), Pneumonia (i.e. inflammatory condition of the lung symptoms of which may include cough, chest pain, fever, difficulty in breathing to name a few)

Other complications
In the absence of root canal therapy the alternative of extraction needs to be done but it’s always better to keep the natural tooth as when a tooth goes missing , adjacent teeth can move out of position. They can also get overstressed for chewing. Keeping our natural teeth helps to avoid implants and bridges also. Once a root canal has been done, it usually lasts for a life time.

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