Dental Trouble

Intro: This week You! takes a 

look at several tooth problems and how one 

can cure them...

A 'toothache' refers to pain around the teeth or jaws primarily resulting from a dental condition. Its severity in pain ranges from mild to excruciating and may further be aggravated after chewing food. There are several causes of toothache and not all of them are necessarily related to dental health. This is why it's necessary to see a dentist for an accurate diagnosis in order to cure the problem from its root. Following are some of the tooth problems causing toothaches, hand in hand with viable solutions required to get rid of them.

Dental cavities & dental abscess

Dental cavities (caries) are holes in the two outer layers of a tooth called the enamel and the dentin. Both the layers serve to protect the inner living tooth tissue called the pulp, where blood vessels and nerves reside. The acid created from sugars, softens and (along with saliva) dissolves the enamel and dentin, creating cavities. The inner living pulp of the affected tooth can become irritated by bacterial toxins or by foods and liquids that are cold, hot, sour, or sweet, thereby causing toothaches. Severe injury to the pulp can lead to the death of pulp tissue, resulting in tooth infection (dental abscesss).

Treatment:  Treatment of a small and shallow cavity usually involves a dental filling and a crown for larger cavities. Treatment for a cavity that has penetrated and injured the pulp or infected the tooth is either a root canal procedure or extraction. 

Gum disease

The second most common cause of toothache is gum disease (periodontal disease). Gum disease refers to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds and holds the teeth in place. Gum disease is caused by toxins secreted by certain bacteria in "plaque" that accumulate over time along and under the gum line. An early symptom of gum disease is gum bleeding without feeling any pain. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of deep gum pockets. Bacteria in these pockets cause gum infection, swelling, pain, and further bone destruction. 

Treatment: Treatment of gum disease always involves oral hygiene and removal of bacterial plaque and tartar (hardened plaque). Advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called 'scaling and root planing' and 'subgingival curettage'. Scaling and root planning is the removal of plaque and tartar from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.

Tooth root sensitivities

Toothache can also be caused by exposed tooth roots, a condition known as 'recession'. Bacterial toxins dissolve the bone around the roots and cause the gum and the bone to recede, exposing the roots. The exposed roots can become extremely sensitive to cold, hot, and sour foods.

Treatment: Early stages of root exposure can be treated with topical fluoride gels applied by the dentist or with special toothpastes (such as Sensodyne or Denquel) which contain fluorides and other minerals. These minerals are absorbed by the surface layer of the roots to make the roots stronger and less sensitive to the oral environment. Dentists may also apply 'bonding agents' to the exposed roots to seal the sensitive areas. In case of injury of the inner living pulp tissue of the tooth due to root exposure, a root canal procedure or tooth extraction may be required.

Cracked tooth syndrome

'Cracked tooth syndrome' refers to a toothache caused by a broken tooth (tooth fracture) without associated cavity or advanced gum disease. These fractures are usually due to chewing or biting hard objects such as hard candies, pencils, nuts, etc. 

Treatment: Treatment involves protecting the tooth with a full-coverage crown made of gold and/or porcelain. 

Temporomandibular joint (TMJ) disorders

Disorders of the temporomandibular joint (s) can cause pain which usually occurs in or around the ears or lower jaw. TMJ disorders can be caused by different types of problems such as injury, arthritis, or jaw muscle fatigue from habitually clenching or grinding teeth. Sometimes, muscles around the TMJ used for chewing can go into spasm, causing head and neck pain as well as difficulty in opening the mouth normally. 

Treatment: This involves oral anti-inflammatory over-the counter (OTC) drugs like ibuprofen (Motrin or Advil) or naproxen (Aleve). Other measures include warm moist compresses to relax the joint areas, stress reduction, and/or eating soft foods that do not require much chewing. If bruxism is diagnosed by a dentist, a bite appliance (night guard) may be recommended that is worn during the night to protect the teeth. 

Impaction & eruption

Dental pain can come from teeth that are erupting (tooth growing out or "cutting") or are impacted (tooth has failed to emerge into its proper position and remains under gum and/or bone). When a molar tooth erupts, the surrounding gum can become inflamed and swollen. Impacted teeth cause pain when they put pressure onto other teeth or bone and are inflamed and/or infected. 

Treatment: This involves pain medication, antibiotics (for infections), and surgical removal.