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.

Know Your Common Toothache!! (Part 1)

Toothache can be a very annoying experience and sensation that ones can get. Unfortunately, everyday in my clinic I always see many cases of patient coming into the dental clinic to seek for dental treatment to relieve their toothache. In some stage of our life, toothache may occur due to certain conditions pretty much related to our teeth or general health, where they can be avoided.

Simply looking at its meaning, toothache or also known as odontalgia is the pain of the tooth and around it. As annoying as it is, we should know a little bit regarding its causes, so that you will know what to expect and how to deal about it. For the first part, we will look at the pain due to caries and infected pulp.

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

Dental caries and infected dental pulp are two very common condition. I see it everyday. Some other form of toothache are also caused heart disease (heart attack, chest pain)

CARIES or CAVITY

Dental caries is a very common mouth disease that affected over 90% of the adults worldwide. Dental caries involved damaging the tooth structures that may resulting holes on the tooth. The damage occurs first at outer hard layer called enamel, which then goes into dentin and cementum.

If left untreated, the cavity which mainly contain bacteria will continue to destroy more tooth structures until when it reach the dentin. The dentin consists of tubules that connect deep into the pulp. The tubule is sort of like a tunnel and when the cavity passes through it into the pulp, where the nerves are, the nerve inside the pulp will inflammed or swollen to cause pain. As for this, i recommend you to get it treated by removing the infected caries and placing some filling material to fill the tooth.

INFECTED DENTAL PULP

When the dental pulp is affected usually due to caries process, the pulp will undergoes changes into inflammatory (swelling) status accompanied with pain. The pain is usual because the inflamed pulp cause increase in pressure and the surrounding tissue. The pain can spread to adjacent tooth, thus we may feel pain but confused to pin point the exact pain location. This is called pulpitis.

Pulpitis can be divided into two condition - reversible pulpitis and irreversible pulpitis.

When I get reversible pulpitis?

• When you have sharp and transient pain but does not disturb your sleep
• Pain occurs with taking cold, sweet or sour food
• Caries or cavitated tooth
• Upon examination, the dentist will notice that your infected tooth is not tender to percussion (when the dentist lightly knocking your tooth), respond to cold and hot test, respond to tooth vitality (still alive) and no tooth mobility (loosening)

How we deal it? Simple, we relieve pain with prescribing medication, remove the caries and do pulp capping...we seal the pulp basically.

When I get irreversible pulpitis?

• When you have sharp, throbbing and lingering pain that truly disturbs your sleep
• Pain occurs spontaneously but get worsen with hot, sweet and sour food - some get comfort from taking cold food
• Upon examination, the dentist will notice that your infected tooth may or may not have localized swelling, not respond well to cold and hot test, not respond to tooth vitality (stage of dying tooth)
• and no tooth mobility

How we deal it? Because the tooth is in dying stage, it should be manage accordingly. Pain control, do root canal treatment or optionally extraction (removal). Do forge out more money for the former option and do prepare to lost a tooth for the latter option.

That's all for now...next time...the series will continue with toothache from other causes....