Dental health

Toothache

Common dental pain problems include toothaches and sensitive teeth. They develop most frequently when the center of a tooth, called the pulp, becomes exposed by tooth decay or a crack or break in the tooth. Teeth also can become sensitive as a result of gum erosion due to aging or gum disease. Toothaches and sensitivity can make it difficult to chew and painful to eat or drink cold foods and liquids.

See your dentist promptly about a toothache or tooth sensitivity to address the problem. If you experience a toothache and can’t see your dentist right away, ease the pain with an over-the-counter pain reliever and apply ice to the affected side of your face. Avoid chewing on the side that hurts. Rinsing your mouth with warm salt water, especially if your gums are sore, also can help.

Some toothpaste brands contain ingredients that help reduce tooth sensitivity. Ask your dentist for a recommendation.

Tooth decay

Tooth decay is caused by certain types of bacteria in your mouth. Fed by sugars, these bacteria release acidic waste products that can dissolve the enamel, or outer layer of your teeth. If not stopped at this stage, decay can penetrate to the dentin, the layer under the enamel, and even reach the pulp in the tooth’s center. Decay is most likely to occur in crevices of molars or between teeth, where both sugars and bacteria can collect.

The earliest sign of tooth decay is a white spot on a tooth, but sometimes this can be seen only on a dental x-ray. With early decay, you don’t have any other symptoms, such as tooth pain and sensitivity, because the tooth’s nerve endings are not yet affected. These symptoms occur in later stages as the decay reaches the tooth’s pulp.

At the white-spot stage, decay often can be stalled and sometimes reversed with fluoride, which helps strengthen tooth enamel. (Fluoride also can protect teeth from future decay.) Most toothpaste and some mouth rinses contain fluoride.

Your dentist can offer highly concentrated fluoride treatments. The fluoride is applied to the tooth as a gel or varnish or given as a mouth rinse. Another treatment option is a protective sealant that your dentist applies to the tooth to block bacteria and acids from causing further damage.

If early decay isn’t stopped, the white spots will turn brown as more enamel erodes, and small holes — called cavities — form. To treat cavities, your dentist removes the decay in the tooth and shapes the area to be filled with a composite resin or silver amalgam.

Unless tooth decay is stopped by treatment, it will continue to advance through the enamel to the dentin. Dentin is more vulnerable to decay than enamel, so decay progresses faster once it reaches this level. Cavities that affect dentin usually require a large filling or a crown.

Cracked, chipped, or broken teeth

Teeth can be chipped, cracked, or broken from an injury, biting into hard foods, or chewing on items like pens. Clenching or grinding your teeth during sleep can also damage them.

Damaged teeth can lead to pulpitis, or inflammation of the tooth’s pulp — the blood vessels that nourish the tooth, and the nerves that enable sensation. Pulpitis can cause pain, especially when chewing, making teeth sensitive to hot, cold, sweet, or sour foods.

There are several options for fixing damaged teeth. Dentists can usually repair small chips with white resin. Otherwise, you may need a veneer, crown, or root canal treatment. If a tooth is damaged beyond repair, it may need to be removed.

Veneers. Veneers are custom-made shells placed over the surface of a tooth to hide damage. They are made from porcelain or composite resin, although porcelain generally provides the best-looking and longest-lasting veneer.

Crown. If a substantial section of a tooth has been damaged or broken, the dentist may need to cover the area with a crown, a cap placed on top of the tooth. Crowns are made of ceramic, metal, or some combination of these. The dentist reshapes the damaged tooth and then makes an impression or mold of the tooth to create the crown. A temporary crown is applied until the custom-made crown is created in the dental lab.

Root canal. If the tooth’s pulp has been irreversibly damaged, your dentist will recommend a multi-step process to remove the pulp and repair the damaged tooth, commonly known as a root canal. The procedure is performed by a general dentist or endodontist.

Periodontal diseases

Periodontal disease, or gum disease, is a bacterial infection of the gums, bone, and other structures that stabilize the teeth. There are two types: gingivitis and periodontitis.

Left unchecked, gum disease also can increase your risk for type 2 diabetes, cardiovascular disease, stroke, and complications during pregnancy. Research also suggests possible links to other conditions, including kidney disease, rheumatoid arthritis, Parkinson’s disease, and cancer.

Gingivitis

Gingivitis is inflammation of the gums and the most common, and mildest, form of periodontal disease, commonly known as gum disease.

Gum disease begins when bacteria form plaque, a sticky film on the teeth. If not removed through daily brushing and flossing, plaque hardens into tartar that can develop above and below the gumline. The bacteria in plaque and tartar cause gum inflammation or gingivitis.

Symptoms of gingivitis include swollen gums that appear darker than usual and bleed during tooth brushing and/or flossing.

Gingivitis can be easily treated with proper dental care. Brush twice a day for two minutes at a time, and floss every night. (Research has found that electric toothbrushes are better than manual ones at removing plaque and reducing the risk of gingivitis.) Use a mouthwash designed to combat gingivitis. Biannual dental cleanings can remove plaque and tartar from under and around the gumline, giving you a fresh start.

Saltwater rinses also help if you are experiencing gum tenderness or swelling. Mix half a teaspoon of salt in a glass of warm water, swish for 20 to 30 seconds, and spit. Once or twice a day is acceptable in the short term (one to two weeks), but be aware that long-term use of salt water rinses can erode tooth enamel.

If left untreated, gingivitis can lead to more severe periodontitis.

Periodontitis

Periodontitis is a serious gum infection that usually starts as gingivitis. If left untreated, the infection can spread deeper and damage the bone and tissues that support your teeth. This can turn into tooth loss.

Severe periodontitis usually requires a series of dental visits, and you may also be referred to a periodontist. Good dental health can protect against periodontal (gum) disease.

Periodontitis has four stages.

Stages I and II. Stage I periodontitis symptoms are similar to gingivitis. The gums are inflamed and bleed during brushing. They also begin to pull away from the teeth, creating pockets. Sometimes you may only see the effects of the disease rather than feel any pain.

At a dental visit, your dentist can measure these pockets with a special tool; the deeper the pockets, the more severe the periodontal disease. Normal pockets are typically no more than 3 millimeters (mm) deep. The probe can be pushed deeper between the tooth and gum as you progress from Stage I to Stage II (and beyond). If periodontal disease is allowed to progress, the bone around the teeth begins to die. This process continues over time, with bone disappearing and gums pulling away from teeth, exposing the roots.

Treatment for Stages I and II involves a procedure called scaling and root planing. Like a dental cleaning, scaling removes tartar and plaque from above and below the gumline that your toothbrush can’t reach. Root planing smooths exposed surfaces of tooth roots, eliminating bacteria and toxins.

Stage III. Stage III periodontitis symptoms involve deeper pockets around teeth and more bone loss from the jaw. The deeper pockets expose tooth roots, causing pain, sensitivity, and discomfort. Bone loss can loosen teeth. As the infection continues, gums bleed easily, and pockets of pus form in the gums. This is the first stage of periodontitis that results in tooth loss.

Stage III treatment involves scaling and root planing, or perhaps surgery to remove areas of infection and reshape the gums and bone.

Stage IV. This is the most severe stage of periodontitis. The gums are dark and swollen and may produce pus. There are deep pockets between the teeth and gums. Other symptoms include bad breath, tooth and gum sensitivity, pain during chewing, and loose or lost teeth. Stage IV requires surgery to remove the infection and reshape the gums and bone. Tooth replacement such as dentures and implants is an option once the infection is under control.

Other dental issues

Dentures

Dentures are sets of removable replacement teeth. They consist of acrylic teeth fused to a gum-colored plastic base. The base may cover a lightweight metal framework for added strength.

Full dentures replace all of a dental arch (upper or lower teeth or both). The layer of saliva between the gums and the denture keeps them in place via suction. Dentures also can be held in by implants placed into the jaw. These are known as overdentures. (Another approach, permanent dentures, are surgically fixed into the jawbone and can’t be removed.)

Partial dentures are an option if only a few teeth need to be replaced. There are two types: Removable partial dentures that you take in and out every day and ones that are fixed into the mouth that aren’t removable. To anchor a partial denture that stays in your mouth, your dentist may reshape some teeth or install crowns (synthetic caps) or implants (a titanium screw that substitutes for a tooth’s root, topped by an artificial tooth).

For full or partial dentures, some teeth may need to extracted.

Denture wearers require at least an annual dental check-up to make necessary repairs or adjust the denture fit, since the jawbone can change shape over time.

Proper cleaning and care help keep dentures looking and feeling their best. For example:

• Wash dentures daily in cold or warm water. Use a special denture brush or a hard toothbrush, denture cleaner, hand soap, or mild dish liquid. Do not use toothpaste, as many are abrasive and can scratch your dentures.
• Soak your dentures in warm water or a denture-cleaning solution when they aren’t in your mouth. Never use hot or boiling water, which could warp your dentures.
• Avoid dropping your dentures or biting into hard foods, as they may break.

Unless instructed otherwise, dentures should be removed during sleep.

Oral cancer

Oral cancer can occur on the lips, tongue, inside surface of the cheeks, hard palate (the front of the roof of the mouth), and gums.

As with most cancers, oral cancer is generally easier to treat and more likely to be successfully treated when detected early.

Symptoms of oral cancer you should be aware of include:

• a mouth sore that doesn’t heal
• an area in your mouth that becomes discolored
• a lump or thickening in your cheek that doesn’t go away
• a persistent sore throat
• changes in your voice
• trouble chewing or swallowing
• difficulty moving your jaw or tongue
• loose teeth
• numbness in your tongue or another part of your mouth
• pain or swelling around your teeth or in your jaw
• pain or irritation in the mouth that doesn’t go away
• unexplained weight loss
• a lump or mass in your neck
• a consistent feeling of something caught in your throat.

During your dental check-ups, your dentist will examine the tissues in your mouth, as well as your lips and tongue, for any signs of oral cancer.

If your dentist or doctor suspects a problem, you may need to see an oral surgeon, periodontist, or an ear, nose, and throat surgeon. To test for cancer, the surgeon will do a biopsy, which involves removing a small piece of tissue from the abnormal area and examining it under a microscope.

Doctors assign oral cancer a stage based on its size and growth.

Treatment depends on where the cancer is located and its stage. If cancer is diagnosed at an earlier stage (stage I and II), the chances of a cure are much better.