Many people make the mistake of only visiting the dentist when they feel they have a problem. However, instead of coming in for only “crisis treatment,” visiting your dentist regularly and receiving preventative treatment will save you time and money in the long run.
What patients don’t realize is that most dental problems don’t start to hurt until they reach an advanced stage. For example, a cavity can be detected three to four years before any symptoms appear but usually isn’t because early tooth decay does not hurt, and therefore the patient sees no need to go to the dentist. However, pain happens only once the decay reaches the nerve of the tooth. At that point, a root canal and crown are usually necessary, where if the problem was detected earlier, only a small filling would have been required.
Dental Pain ~ What to Do
The most common oral diseases are those of the hard tissues (caries of enamel, dentine and cementum) and soft tissues and supporting bone (gingivitis, periodontitis) and are usually easily treated by a thorough dental examination and radiographs performed by a dental practitioner. However, other conditions, such as the ones asterisked below, can cause acute, recurring pain that may need the assistance of a pain management clinic.
Common acute dental pain conditions include:
Dental pulpitis (“toothache”) is an aching, throbbing pain that usually worsens following food or fluid intake. It is commonly caused by dental caries or a leaking dental restoration and may also result from a crack in the tooth if the patient experiences a sharp pain when pressure is applied to the tooth cusps. If the pulpal inflammation continues for any length of time and is followed by acute abscess (swelled jaw and painful throbbing), it is likely the cause of pain is an acute infection.
Gingivitis and periodontitis are two common gum diseases. Where gingivitis (bleeding gums caused by plaque buildup) is usually painless, periodontitis can cause an occasional, dull pain.
Pericoronitis is infected tissue that causes periodic pain and usually occurs with an impacted or erupting lower third molar.
Premature contact (“high bite”) is a recent tooth restoration that is “higher” than the normal occusion, causing a sharp pain that may dull after a period of time.
Exposed cementum or dentine is caused by excessive or incorrect brushing that results in the exposure of the tooth root surface (a thin layer of cementum overlaying dentine) and causes tooth sensitivity to cold fluids or air.
Alveolar osteitis (“dry socket”) occurs several days after a tooth extraction when the blood does not clot well and leaves the bone and the nerve endings exposed. The pain is experienced as a deep ache in the extraction socket.
*Post endodontic surgery pain is severe aching pain following endodontic treatment, such as root canal therapy or apicetomy. Most patients’ pain improves over a few weeks; however, a few endodontic patients develop persistent, chronic pain.
*Maxillary sinusitis is a continuous aching pain in the maxillary teeth that usually worsens when bending forward. Similar symptoms are commonly found in TMD or neuropathic pain.
Toothache may be indicative of many things from minor gum disease to more serious conditions. Therefore the type and nature of the pain are important factors in determining and pinpointing the source of the pain. Most toothaches can usually be categorized under one of these five types of pain:
Sharp pain, which usually follows contact of the tooth with hot or cold liquids, is likely caused by a hole in the tooth or filling through which the liquid travels and stimulates the nerve. The pain will stop within a few seconds to a minute during the early stages of decay. The problem is usually fixed with drilling and filling the tooth, but can be relieved in short notice with a temporary filling that stops the stimulation of the nerve.
Dull pain usually results from chemicals released from immune system cells in response to bacteria that are attacking living nerve cells. The chemicals stimulate the nerves, causing an aching pain that is not prompted by a stimulus, such as a cold drink. Pain also worsens in bed at night because blood pressure increases in the tooth when lying down. Treatment usually involves root filling the tooth, which cleans away the dead pulp tissue and bacteria, or tooth extraction for severe decay.
Sharp pain only when biting generally happens when there is a small fracture in the enamel of a tooth, which allows the tooth to flex during biting and stimulate the nerve. The pain normally involves only one cusp, usually a molar.
Sharp pain when brushing near the gums happens when gums recede with age and wear and expose the root surface of a tooth. The thin layer of cementum that covers the root quickly dissolves, exposing the dental tubules and resulting in pain when brushing. The problem may be solved by either brushing with Sensodyne toothpaste or having a dentist apply a special fluoride varnish to protect the root surface.
Pain Killers Ibuprofen is the best over-the-counter drug for dental pain. However, if the pain is persistent, avoid chronically taking painkillers and seek a dentist to remedy the situation.
Putting aspirin on the gum next to the painful tooth will not remedy the pain and may result in a chemical burn on the gums if left in contact for too long. Also avoid giving aspirin to children, especially those under 12, to prevent a possible reaction in those who suffer from Reyes syndrome.
Dental Swelling ~ What to Do
Gum swelling, whether it is one area of the gums surrounding a tooth or the entire gums, is quite common and can be due to anything from minor causes, like hypersensitivity to chewing gum, reactions to prescription medications, or a stuck popcorn kernel, to more serious ones, such as gum disease or health problems.
Gum, or periodontal, disease is quite common, and research shows nearly one in three US adults between the ages of 30 and 54 have some form of it. The most minor type of periodontal disease is gingivitis. Signs of gingivitis include red, swollen gums that bleed easily when brushing or flossing. It is caused by a buildup of plaque and can be taken care of with professional cleaning followed by continued attentive oral care at home. However, sometimes gum swelling does not indicate a problem within the mouth, but rather a more serious health condition, such as leukemia or diabetes.
In either case, it is best to receive a complete examination from your dentist or periodontist as soon as you experience swollen gums, bleeding while brushing or flossing or any other abnormal symptoms in your mouth.
Gum Disease ~ Silent and Deadly
Because gum disease is often painless and requires specific examination procedures to detect it, a patient may unknowingly have it for years. Unless it is in an advanced stage, gum disease cannot be detected with just a visual oral examination. The dentist must perform a special examination that measures the pockets (the space between tooth and gum) with a periodontal probe to discover early-stage gum disease. Other signs of gum disease include bleeding gums, redness of gum tissue, gum swelling around teeth, bad breath, receding gums and loose teeth.
The procedure to correct the problem is short, simple and painless. It is important to detect and treat gum disease in its early stages to prevent tooth loss and disfigurement.
Dental Care for Seniors
Seniors tend to have less saliva and take more medication, both of which dramatically affect their oral health. Some health conditions as well as particular medications can cause “dry mouth.” Saliva is important to lubricate, flush out plaque and neutralize the acid plaque produces. Plaque buildup accelerates tooth decay and gum infections cause the teeth’s bone support to weaken. As a result, daily brushing, a healthy diet and using fluoride is more important than ever.
Other oral changes seniors face are darker teeth due to long-term plaque exposure and changes in the dentin in the tooth, receding gums that uncover roots susceptible to decay, and darker, decaying fillings from deterioration over time.
Dentures that do not fit correctly or are not properly cleaned, illness and some medications can also exacerbate oral problems.
Please call our office if you have any questions or for more information regarding senior oral health problems and care.