Know Your Common Toothache!! (Part 2)

Our lesson regarding toothache covered the most commonly caries and pulp infection on the first part. This week, I see another three patients complaining the main problem of pain from tooth. The previous sentence means nothing but to tell you that toothache is somehow annoying and very common occur. So beware if the signs of toothache arise suddenly or may slowly creeping in, as it may indicates some problems over your tooth.

Remember this?

Here are the common cause of toothache:

• Dental caries or cavity
• Infected dental pulp that required some form of root canal treatment or extraction (removal)
• Gum disease
• Emergence of wisdom tooth
• Cracked tooth
• Jaw disease
• Exposed root of tooth
• Dry socket following removal of tooth

This part we will look at the causes from the bold one above - Gum disease and emergence of wisdom tooth.

GUM DISEASE

Gum disease in the mild to moderate condition is known as gingivitis. Gingivitis is the inflammation or swelling that occurs around your gum which primary induced by dental plaque. Commonly people with gingivitis will complained of swelling gum, mouth sores or ulcers, severe oral odour, painless gum except when pressure is applied and, bleeding gum occurs easily especially when brushing and flossing. Gingivitis is a preventable disease and curable as well. To prevent gingivitis, make proper oral hygiene that includes toothbrushing and flossing daily. Mouthwash is optional, usually using (saline) salt water or chlorhexidine. If gingivitis is not treated, it can progress to cause periodontitis, a even more severe form of gum disease.

EMERGENCE of WISDOM TOOTH

Wisdom tooth or third molar is not actually wisdom. As wisdom it maybe, as painful it will be to endure the process of it to come out. The reason behind the pain is that it is the last to erupt, having relatively inadequate space to squeeze itself out from the jaw and may have many problems in terms of positioning.

Because of these, the third molar especially the lower one will always cause impaction on the adjacent tooth. Impaction can be classified into mesioangular, distoangular, vertical or horizontal.
Diagnosis depends on the way the position of the third molar, for example...the radiograph below, it looks like the third molar is in a horizontal position in relative to all the teeth. Thus, it is known as horizontal impaction of third molar.

Another problem arise with regards of the wisdom tooth is pain due to failure to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean in which allow accumulation of debris which may cause pericoronitis, a common infection problem in young adults with partial impaction.

In removing the wisdom tooth, there are guidelines in which we can determine in which condition we can or we cannot remove the impacted wisdom tooth. The list is in here. So the preferable treatment for this condition is to remove it but the patient should always be aware of the possible complications due to the treatment.