Treatment of an abscessed tooth
An abscessed tooth is a pocket of pus, usually caused by some kind of infection and the spread of bacteria from the root of the tooth to the tissue just below or near the tooth.
In general, a tooth that has become abscessed is one whose underlying pulp (the tooth’s soft core) has become infected or swollen. The pulp contains nerves, blood vessels and connective tissue, and lies within the tooth. It extends from the crown of the tooth, to the tip of the root, in the bone of the jaws.
An abscessed tooth can be an extremely painful condition.
In some cases, antibiotics are administered in an attempt to kill an infection. If antibiotics are ineffective and an abscess is shown to be damaging the pulp or lower bony structures, a root canal procedure may be needed to remove the dead pulp and restore the tooth to a healthy state.
Bad Breath (Halitosis)
An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have “chronic halitosis,” which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin.
Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.
What causes bad breath?
Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth – on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting.
Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.
Gum disease is caused by plaque – the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.
Here are characteristic bad breath odors associated with some of these illnesses:
- Diabetes – acetone, fruity
- Liver failure – sweetish, musty
- Acute rheumatic fever – acid, sweet
- Lung abscess – foul, putrefactive
- Blood dyscrasias – resembling decomposed blood
- Liver cirrhosis – resembling decayed blood
- Uremia – ammonia or urine
- Hand-Schuller-Christian disease – fetid breath and unpleasant taste
- Scurvy – foul breath from stomach inflammation
- Wegner`s granulomatosis – Necrotic, putrefactive
- Kidney failure – ammonia or urine
- Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis – extremely foul, fetid odor
- Syphilis – fetid
Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.
Caring for bad breath
Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don’t forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue’s surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.
Controlling periodontal disease and maintaining good oral health helps to reduce bad breath. If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.
Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.
If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.
Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including Zytex, which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.
People with eating disorders can suffer from oral health problems as well. This is because many of the behaviors associated with anorexia nervosa and bulimia nervosa—such as binge eating, self-induced vomiting, and use of diuretics or laxatives—cause changes in the mouth.
For example, repeated episodes of vomiting, which is common in people with bulimia, release harmful stomach acids that pass through the mouth and can erode tooth enamel, causing cavities, discoloration and tooth loss. Other problems, such as poorly fitting fillings and braces, are another byproduct of such eating disorders.
Brushing after episodic vomiting is actually more harmful than one would think. The best practice is to rinse thoroughly with a neutral solution such as baking soda and water.
People sometimes confuse canker sores and cold sores, but they are completely unrelated. Both can be painful, but knowing the differences can help you keep them in check.
A canker sore is typically one that occurs on the delicate tissues inside your mouth. It is usually light-colored at its base and can have a red exterior border.
A cold sore or fever blister, on the other hand, usually occurs on the outside of the mouth, usually on or near the nose or lips. A cold sore is contagious because it is caused by the herpes simplex virus, and it is usually painful and filled with fluid.
In most cases, patience is the best medicine for treating canker sores. A healthy diet and good oral hygiene are usually the best remedy, but some special rinses and anesthetics can help. Cold sores can be treated effectively with some over-the-counter topical creams; sometimes, an antiviral medication will be prescribed by your doctor.
Cavities and Tooth Decay
What Is Tooth Decay?
Tooth decay is caused by a variety of things; in medical terms, cavities are called caries, which are caused by long-term destructive forces acting on tooth structures such as enamel and the tooth’s inner dentin material.
These destructive forces include frequent exposure to foods rich in sugar and carbohydrates. Soda, candy, ice cream—even milk—are common culprits. Left inside your mouth from non-brushing and flossing, these materials break down quickly, allowing bacteria to do their dirty work in the form of a harmful, colorless sticky substance called plaque.
The plaque works in concert with leftover food particles in your mouth to form harmful acids that destroy enamel and other tooth structures.
If cavities aren’t treated early enough, they can lead to more serious problems requiring treatments such as root canal therapy.
The best defense against cavities is good oral hygiene, including brushing with a fluoride toothpaste, flossing and rinsing. Your body’s own saliva is also an excellent cavity fighter, because it contains special chemicals that rinse away many harmful materials. Chewing a good sugarless gum will stimulate saliva production between brushing.
Special sealants and varnishes can also be applied to stave off cavities from forming.
If you have any of the following symptoms, you may have a cavity:
- Unusual sensitivity to hot and cold water or foods.
- A localized pain in your tooth or near the gum line.
- Teeth that change color.
Baby Bottle Tooth Decay
Baby bottle tooth decay is caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby’s mouth.
If left untreated, this can lead to premature decay of your baby’s future primary teeth, which can later hamper the proper formation of permanent teeth.
One of the best ways to avoid baby bottle tooth decay is to not allow your baby to nurse on a bottle while going to sleep. Encouraging your toddler to drink from a cup as early as possible will also help stave off the problems associated with baby bottle tooth decay.
Simple toothaches can often be relieved by rinsing the mouth to clear it of debris and other matter. Sometimes, a toothache can be caused or aggravated by a piece of debris lodged between the tooth and another tooth. Avoid placing an aspirin between your tooth and gum to relieve pain, because the dissolving aspirin can actually harm your gum tissue.
Broken, Fractured, or Displaced Tooth
A broken, fractured or displaced tooth is usually not a cause for alarm, as long as decisive, quick action is taken.
If the tooth has been knocked out, try to place the tooth back in its socket while waiting to see your dentist.
First, rinse the mouth of any blood or other debris and place a cold cloth or compress on the cheek near the injury. This will keep down swelling.
If you cannot locate the tooth back in its socket, hold the dislocated tooth by the crown – not the root. Next, place it in a container of warm milk, saline or the victim’s own saliva and keep it in the solution until you arrive at the emergency room or dentist’s office.
For a fractured tooth, it is best to rinse with warm water and again, apply a cold pack or compress. Ibuprofen may be used to help keep down swelling.
If the tooth fracture is minor, the tooth can be sanded or if necessary, restored by the dentist if the pulp is not severely damaged.
If a child’s primary tooth has been loosened by an injury or an emerging permanent tooth, try getting the child to gently bite down on an apple or piece of caramel; in some cases, the tooth will easily separate from the gum.
People living with diabetes are vulnerable to a host of systemic problems in their entire body. Unfortunately, the mouth and teeth are not immune from such problems, and many diabetics with oral problems go undiagnosed until conditions become advanced.
Infections and other problems such as receding gums and gum disease, or periodontal disease, are common afflictions among diabetics for many reasons; for instance, diabetics often are plagued by diminished saliva production, which can hamper the proper cleansing of cavity-causing debris and bacteria from the mouth. In addition, blood sugar levels that are out of balance could lead to problems that promote cavities and gum disease.
As with any condition, good oral hygiene, including regular brushing, flossing and rinsing, as well as the proper diabetic diet, will go a long way in preventing needless problems.
Saliva is one of your body’s natural defenses against plaque because it acts to rinse your mouth of cavity-causing bacteria and other harmful materials. Dry mouth (also called Xerostomia) is a fairly common condition that is caused by diminished saliva production. People with medical conditions, such as an eating disorder or diabetes, are often plagued by dry mouth. Eating foods such as garlic, tobacco use, and some kinds of medications, including treatments such as cancer therapy can diminish the body’s production of saliva, leading to dry mouth. Other causes are related to aging (including rheumatoid arthritis), and compromised immune systems.
Some of the less alarming results of dry mouth include bad breath. But dry mouth can lead to more serious problems, including burning tongue syndrome, a painful condition caused by lack of moisture on the tongue.
If dry mouth isn’t readily apparent, you may experience other conditions that dry mouth can cause, including an overly-sensitive tongue, chronic thirst or even difficulty in speaking.
If you don’t have a medical condition that causes it, dry mouth can be minimized by sipping water regularly, chewing sugarless gum and avoiding smoking. Of course, there is no substitute for regular checkups and good oral hygiene.
Fluorosis is a condition in which your body has been exposed to too much fluoride. In normal doses (typically found in a safe drinking water system and an ADA-approved toothpaste), fluoride is a healthy compound that promotes strong teeth, which has the ability to fight cavities and other problems.
But sometimes, fluorosis occurs when fluoride-containing toothpastes or rinses are swallowed, instead of expelled.
Fluorosis causes a number of aesthetic problems, including abnormally darkened or stained teeth. While such problems are generally harmless to your health, they can create concerns with your appearance.
Gum Disease (Gingivitis)
Gingivitis is the medical term for early gum disease, or periodontal disease. In general, gum disease can be caused by long-term exposure to plaque, the sticky but colorless film on teeth that forms after eating or sleeping.
Gum disease originates in the gums, where infections form from harmful bacteria and other materials left behind from eating. Early warning signs include chronic bad breath, tender or painful swollen gums and minor bleeding after brushing or flossing. In many cases, however, gingivitis can go unnoticed. The infections can eventually cause the gums to separate from the teeth, creating even greater opportunities for infection and decay.
Although gum disease is the major cause of tooth loss in adults, in many cases it is avoidable.
If gingivitis goes untreated, more serious problems such as abscesses, bone loss or periodontitis can occur.
Periodontitis is treated in a number of ways. One method, called root planing, involved cleaning and scraping below the gum line to smooth the roots. If effective, this procedure helps the gums reattach themselves to the tooth structure. However, not all instances of scaling and root planing successfully reattach the tooth to the gums. Additional measures may be needed if the periodontal pockets persist after scaling and root planing
Pregnancy has also been known to cause a form of gingivitis. This has been linked to hormonal changes in the woman’s body that promote plaque production.
Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.
If wisdom teeth are causing a problem, this could mean that they are impacted. Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: pain, inflammation, and some kinds of infections.
Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one’s ability to properly bite down, speak or eat.
Lacerations and Cuts
Any kind of cut to your face and the delicate soft tissues inside your mouth should be addressed immediately in order to prevent further tissue damage and infection.
If a traumatic injury involves a broken facial bone such as the jaw, nose, chin or cheek, maxillofacial surgery may be required.
With jaw surgery, rubber bands, tiny wires, metal braces, screws or plates are often used to keep a fractured jaw in place following surgery. This allows the bone to heal and stay in proper alignment. Dental splints or dentures may also be required to supplement the healing process following jaw surgery.
Oral cancer is one of the most common cancers today and has one of the lowest survival rates, with thousands of new cases being reported each year. Fewer than half of all people diagnosed with oral cancer are ever cured.
Moreover, people with many forms of cancer can develop complications—some of them chronic and painful—from their cancer treatment. These include dry mouth and overly sensitive teeth, as well as accelerated tooth decay.
If oral cancer is not treated in time, it could spread to other facial and neck tissues, leading to disfigurement and pain.
Older adults over the age of 40 (especially men) are most susceptible to developing oral cancer, but people of all ages are at risk.
Oral cancer can occur anywhere in the mouth, but the tongue appears to be the most common location. Other oral structures could include the lips, gums and other soft palate tissues in the mouth.
In general, early signs of oral cancer usually occur in the form of lumps, patchy areas and lesions, or breaks, in the tissues of the mouth. In many cases, these abnormalities are not painful in the early stages, making even self-diagnosis difficult.
Here are some additional warning signs:
- Hoarseness or difficulty swallowing.
- Unusual bleeding or persistent sores in the mouth that won’t heal.
- Lumps or growths in other nearby areas, such as the throat or neck.
If a tumor is found, surgery will generally be required to remove it. Some facial disfigurement could also result.
Prevention is the key to staving off oral cancer. One of the biggest culprits is tobacco and alcohol use. Certain kinds of foods and even overexposure to the sun have also been linked to oral cancer. Some experts believe certain oral cancer risk factors are also hereditary.
A diet rich in fruits and vegetables is one of the best defenses against oral cancer. Maintaining good oral hygiene, and regular dental checkups, are highly recommended.
Plaque is a film of bacteria that forms on your teeth and gums after eating foods that produce acids. These foods may include carbohydrates (starches and sugars), such as candy and cookies, and starchy foods such as bread, crackers, and cereal.
Tooth decay, commonly known as cavities, occurs when plaque remains on your teeth for an extended period of time, allowing the bacteria to ‘eat away’ at the surfaces of your teeth and gums. Ironically, the areas surrounding restored portions of teeth (where fillings, or amalgams have been placed) are particularly vulnerable to decay and are a breeding ground for bacteria.
Plaque can lead to gum irritation, soreness, and redness. Sometimes, your gums may begin to bleed as a result of plaque. This gradual degeneration can often cause gums to pull away from teeth. This condition is called receding gums.
Long-term plaque can lead to serious problems. Sometimes, the bacteria can form pockets of disease around tooth structures, eventually destroying the bone beneath the tooth.
If you wince with pain after sipping a hot cup of coffee or chewing a piece of ice, chances are that you suffer from “dentin hypersensitivity,” or more commonly, sensitive teeth.
Hot and cold temperature changes cause your teeth to expand and contract. Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits.
At least 45 million adults in the United States suffer at some time from sensitive teeth.
Sensitive teeth result when the underlying layer of your teeth (the dentin) becomes exposed. This can happen on the chewing surface of the tooth as well as at the gum line. In some cases, sensitive teeth are the result of gum disease, years of unconsciously clenching or grinding your teeth, or improper or too vigorous brushing (if the bristles of your toothbrush are pointing in multiple directions, you’re brushing too hard).
Abrasive toothpastes are sometimes the culprit of sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes, may increase tooth sensitivity.
In some cases, desensitizing toothpaste, sealants, desensitizing ionization and filling materials including fluoride, and decreasing the intake of acid-containing foods can alleviate some of the pain associated with sensitive teeth.
Sometimes, a sensitive tooth may be confused by a patient for a cavity or abscess that is not yet visible.
In any case, contact your dentist if you notice any change in your teeth’s sensitivity to temperature.
Teeth Grinding (Bruxism)
Teeth grinding, also called bruxism, is often viewed as a harmless, though annoying, habit. Some people develop bruxism from an inability to deal with stress or anxiety.
However, teeth grinding can literally transform your bite relationship and worse, severely damage your teeth and jaws over long periods of time.
Teeth grinding can cause abrasion to the chewing surfaces of your teeth. This abnormal wear and tear will prematurely age and loosen your teeth, and open them to problems such as hypersensitivity (from the small cracks that form, exposing your dentin). Bruxism can also lead to chronic jaw and facial pain, as well as headaches.
If no one has told you that you grind your teeth, here are a few clues that you may suffer from bruxism:
- Your jaw is often sore, or you hear popping sounds when you open and close your mouth.
- Your teeth look abnormally short or worn down.
- You notice small dents in your tongue.
Bruxism is somewhat treatable. A common therapy involves use of a special appliance worn while sleeping. Less intrusive, though just as effective methods could involve biofeedback, and behavior modification, such as tongue exercises and learning how to properly align your tongue, teeth and lips.
People who grind their teeth can sometimes develop a serious problem with their jaw, which left untreated, can adversely affect the teeth, gums and bone structures of the mouth. One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.
People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.
Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep.
Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint.