Dental Implant Infection: The Signs to Act On
Implants do not get cavities, but the gum and bone around them can get infected. Caught early it is treatable. Caught late it costs the implant. Here is what to watch for.
An implant is titanium; it cannot decay. The tissue around it is the same gum and bone that surrounds a natural tooth, and it can develop the same kind of infection. Around an implant that infection is called peri-implantitis, and the reason it deserves its own article is that it tends to move faster and hurt less than gum disease around a tooth. People notice it late.
It is also common. A meta-analysis by Derks and Tomasi in the Journal of Clinical Periodontology found inflammation confined to the gum in roughly 43 percent of patients with implants, and peri-implantitis, the stage that has reached bone, in roughly 22 percent.
What Is Normal, and When
In the first week after placement, soreness, swelling, a little bleeding, and bruising are expected and improve daily. In the first months, the gum around the healing cap (the temporary cover on the implant) can look slightly red. After the crown is on, a healthy implant site looks like a healthy gum: pink, firm, and it does not bleed when you brush or floss it.
Early Signs of Trouble
- Bleeding when you brush or floss around the implant, especially if it is new or getting worse.
- Redness or puffiness of the gum around the crown, or a gum edge that looks darker than its neighbors.
- Bad taste or bad breath that seems to come from that spot.
- The gum pulling back so you see a gray edge of the implant or the abutment (the connector under the crown).
- Tenderness when you press on the gum beside the implant, even if chewing is fine.
None of these means the implant is lost. All of them mean it should be looked at within a couple of weeks, because at this stage the problem is often confined to the gum and is treated with cleaning and a change in home care.
Signs That Mean Call the Same Day
- Pus from around the implant, or a bump on the gum that drains.
- Swelling of the face or jaw, or swelling that is getting worse rather than better.
- Looseness of the crown or of the implant itself. A loose crown may just be a loose screw; a loose implant is urgent.
- Pain on biting that is new.
- Fever with any of the above.
Why It Goes Unnoticed
A natural tooth has a ligament full of nerve endings that reports trouble early. An implant sits directly in bone with no ligament, so the warning signal is weaker. Bone loss around an implant can be well advanced by the time it aches. This is the reason implants need regular maintenance visits with X-rays, alternating between your dentist and the periodontist who placed it, even when nothing feels wrong.
What Treatment Looks Like
Early peri-implant mucositis, inflammation confined to the gum, resolves with professional cleaning around the implant and better home care. The American Academy of Periodontology describes the same two stages, and names previous periodontal disease, poor plaque control, smoking, and diabetes as the risk factors for developing peri-implant disease. The review prepared for the 2017 World Workshop rates the evidence behind the first two as strong and found the data on smoking and diabetes inconclusive, which is worth knowing before either is treated as decisive. Established peri-implantitis with bone loss needs surgery to clean the implant surface and, where possible, to rebuild bone. Severe bone loss sometimes means removing the implant, grafting the site, and placing a new one later. Implant problems goes through each option. Austin Periodontal Associates treats implants placed elsewhere as well as its own, and second opinions are welcome.
The Two Habits That Prevent Most of It
Clean around the implant every day the way the hygienist shows you, with floss or a small interdental brush, and keep your maintenance visits. Most peri-implantitis seen in this office traces back to one of those two habits slipping, or to something fixable such as retained cement. In a five-year follow-up by Costa and colleagues of patients who already had gum-level inflammation around an implant, peri-implantitis developed in 18 percent of those who kept preventive maintenance and 43.9 percent of those who did not.
Getting It Checked
An implant has no nerve, so it will not warn you the way a tooth does. Bleeding when the area is cleaned is reason enough for an appointment, even when nothing hurts. Request a consult or call (512) 346-6097.
Frequently Asked Questions
What are the early signs of an infection around an implant?
Bleeding when the area is cleaned is the first and most reliable sign. Others are gum that looks puffy or has changed shape, tenderness that does not settle, a persistent bad taste, and food catching where it did not before.
What warrants a same-day call?
Swelling of the face or gum, pus, an implant or crown that has become loose, or pain that is escalating rather than easing.
Why do infections around implants go unnoticed?
Because an implant has no nerve, so it does not warn you the way a tooth does. Peri-implantitis is usually painless until it is advanced, which is why it is found by probing and periodic X-rays rather than by symptoms.
Is it treatable?
At the gum-level stage, cleaning around the implant and better home care usually resolve it. Once bone is involved, surgery is needed to decontaminate the implant surface and, where possible, rebuild bone. Severe bone loss can mean removing the implant, grafting, and placing a new one later.
Does maintenance prevent it?
It changes the odds substantially. In a five-year follow-up by Costa and colleagues of patients who already had gum-level inflammation around an implant, peri-implantitis developed in 18 percent of those who kept preventive maintenance and 43.9 percent of those who did not.