Posts for category: Oral Health
Physical pain is unpleasant—but not knowing why you're hurting makes it worse. Thousands of people encounter such as experience when parts of their face suddenly and mysteriously erupt in pain.
Often, though, the mystery can be quickly solved—more than likely, it's a nerve disorder known as trigeminal neuralgia (TN). Typically seen in people over 50 (and in more women than men), TN is a chronic condition that produces brief episodes of acute, spasmodic pain.
The source of this pain is the trigeminal nerve, which courses down each side of the face. Each nerve consists of three distinct branches that serve the upper, middle and lower areas of the face and jaw.
Physicians usually find that a blood vessel has come in contact with the nerve at some point, and the resulting pressure has damaged the nerve's outer insulative layer (myelin sheath). This causes the nerve to become hypersensitive at the point of contact, overreacting in a sense to the slightest touch (even a wisp of wind) on the face and jaw.
TN isn't the only source of facial pain. It can also accompany other conditions like TMD, which is why it's important to undergo a diagnostic examination. If you are diagnosed with TN, there are a number of ways to manage it. The most conservative approach (and the one usually tried first) is the use of medications to block pain signals from the nerve to the brain or to lessen abnormal nerve firing.
If medication proves ineffective or there are other factors related to age and health, you may be a candidate for a surgical solution. In one such procedure, a surgeon inserts a thin needle into the affected nerve and selectively damages some of its fibers to prevent the transmission of pain signals. Another procedure relocates the impinging blood vessel, which then allows the nerve to heal.
These surgical methods are effective but they can cause side-effects in rare cases like numbness or hearing impairment. It's best then to discuss with your doctor which approach would be best for you and your life situation. Ultimately, though, there are ways to relieve you of this painful condition.
If you would like more information on treating facial pain, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Trigeminal Neuralgia.”
While mouth pain can certainly get your attention, what exactly hurts may be difficult to identify. It might seem to emanate from a single tooth, or a group of teeth. Then again, it might not be clear whether it's coming from teeth or from the gums.
Still, it's important to pinpoint the cause as much as possible to treat it correctly. One of the main questions we often want to answer is whether the cause originates from within a tooth or without.
In the first case, tooth decay may have entered the pulp at the center of the tooth. The pulp contains nerve bundles that can come under attack from decay and transmit pain signals. Incidentally, if the pain suddenly goes away, it may simply mean the nerves have died and not the infection.
The decay can also spread into the root canals leading to the root and supporting bone, and then make the jump into the gum tissues. One possible sign of this is the one mentioned earlier—you can't quite tell if the pain is from the tooth or the surrounding gums.
The root canals could also serve as a transportation medium for infection in the other direction. In that case, gum disease has advanced into the bone tissues around a tooth near its roots. The infection can then cross into the tooth. Again, both a tooth and the gum tissue around it can become diseased.
We have effective treatments for individual occurrences of interior tooth decay or gum disease: The former usually requires a root canal treatment to remove infected tissue and fill and seal the tooth from future infection; we alleviate gum disease by removing the dental plaque causing it and helping the gum tissues to heal. But combined tooth and gum infection scenarios are more difficult to treat, have a poorer prognosis and may require specialists.
To reduce the risk of either tooth decay or gum disease developing into this greater problem, it's best to take action at the first sign of trouble. So, see your dentist as soon as possible when you encounter oral pain or if you notice swollen or bleeding gums. The earlier we treat the initial outbreak of disease, be it tooth decay or gum disease, the better your chances of a successful and happy outcome.
If you would like more information on tooth pain, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Confusing Tooth Pain.”
In addition to the usual tooth and gum problems, dentists also see patients with soft tissue infections in and around the mouth. One of the more common of these is the irritation or "cracking" of the corners of the mouth.
Formally known as angular cheilitis (or perleche, a French word, meaning "to lick"), cracked mouth corners are localized irritations made worse by saliva accumulation or an accompanying yeast infection. They're prominent among children and young adults who drool during sleep or while wearing orthodontic braces.
Older adults can also develop cracked mouth corners because of deep wrinkle lines around the mouth ("marionette lines") or tissue irritation from wearing dentures. Teeth loss, especially in the back of the jaws, can weaken facial support leading to collapse of the bite, which can contribute to angular cheilitis.
The condition can cause anything from minor discomfort at the mouth corners to a yeast infection that spreads throughout the mouth and throat. Whatever the symptoms, treatment usually begins with antifungal medication in the form of a mouthrinse or a topical ointment. The dentist may also prescribe a steroid ointment like zinc oxide paste to control inflammation and serve as a barrier against infection.
If the infection has spread beyond the mouth corners, patients may also need to use an antibacterial mouthrinse (usually chlorhexidine) to clear up the infection and help prevent a relapse. Besides cleaning their appliances with chlorhexidine, denture wearers with angular cheilitis should also take their dentures out at night to reduce the chances of a reoccurrence.
Along the same vein, patients who contend with frequent cracked mouth corners and who have missing teeth should have those teeth replaced by some form of restoration. If that involves dentures, it's important to maintain a good fit with them to reduce the chances of tissue irritation. And patients with deep wrinkle lines around their mouth may be able to lessen them through dermatological treatment.
Even though cracked mouth corners rarely pose a major health problem, the discomfort they cause can be a drag on your daily life and activities. Remember that you don't have to suffer—a visit to your dentist could start you on your journey toward relief from this irritating problem.
If you would like more information on angular cheilitis and similar mouth conditions, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cracked Corners of the Mouth.”
Not all toothaches are alike: Some are sharp and last only a second or two; others throb continuously. You might feel the pain in one tooth, or it could be more generalized.
Because there are as many causes as there are kinds of dental pain, you can expect a few questions on specifics when you come to us with a toothache. Understanding first what kind of pain you have will help us more accurately diagnose the cause and determine the type of treatment you need.
Here are a few examples of dental pain and what could be causing it.
Temperature sensitivity. People sometimes experience a sudden jolt of pain when they eat or drink something cold or hot. If it only lasts for a moment or two, this could mean you have a small area of tooth decay, a loose filling, or an exposed root surface due to gum recession. If the pain lingers, though, you may have internal decay or the nerve tissue within the tooth has died. If so, you may require a root canal treatment.
Sharp pain when chewing. Problems like decay, a loose filling or a cracked tooth could cause pain when you bite down. We may be able to solve the problem with a filling (or repair an older one), or you may need more extensive treatment like a root canal. In any event, if you notice this as a recurring problem, don't wait on seeing us—the condition could worsen.
Dull pain near the jaw and sinuses. Because both the jaws and sinuses share the same nerve network, it's often hard to tell where the pain or pressure originates—it could be either. You may first want to see us or an endodontist to rule out tooth decay or another dental problem. If your teeth are healthy, your next step may be a visit with a physician to examine your sinuses.
As you can see, tooth pain can be a sign of a number of problems, both big and small. That's why it's important to see us as soon as possible for an examination and diagnosis. The sooner we can treat whatever is causing the pain, the sooner your discomfort will end.
If you would like more information on treating dental pain, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Pain? Don't Wait!”
Accidents do happen, especially if you or a family member has an active lifestyle. One such risk, especially for someone playing a contact sport, is having a tooth knocked out.
But as extreme as this injury can be, it doesn't necessarily mean the tooth is lost forever. Gum (or periodontal) cells remaining on the tooth root can regenerate and regain their attachment with the periodontal ligament that holds teeth in place. But you have to act quickly—the longer the tooth is out of the socket, the more likely these cells will dry out and die.
So, by doing the following within 5-20 minutes of the injury (and the earlier the better), that knocked-out tooth has a reasonable chance of survival.
Locate and clean the tooth. Your first priority is to find the missing tooth and clean it of any debris with clean water. Be sure not to touch the root of the tooth and only handle the tooth by the crown (the visible part of a tooth when it's in the mouth).
Insert the root end into the empty socket. Still holding the tooth by the crown, insert the opposite root end into the empty socket. Orient the crown properly, but don't worry about getting it in just right—the follow-up with the dentist will take care of that. You will, however, need to apply some pressure to get it to seat firmly.
Secure the tooth. Place a piece of clean gauze or cloth between the reinserted tooth and its counterpart on the other jaw. Then, have the person bite down on the cloth and hold it. This will help secure the tooth in place while you travel to the dentist.
Seek dental care immediately. It's important to see a dentist immediately to adjust the tooth's position and to possibly splint the tooth to better secure it while it heals. If a dentist isn't available, then visit a local emergency room instead.
Taking these actions on the scene could mean the difference between saving and losing a tooth. But act quickly—the sooner you initiate first aid for a knocked-out tooth, the better its chances for long-term survival.
If you would like more information on what to do during dental emergencies, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When a Tooth is Knocked Out.”