City Dental Clinic - Kerala, India - Cases and Pathologies Guide & Dictionary

Abscessed tooth - A painful infection at the root of a tooth or between the gum and a tooth. These problems can cause openings in the tooth enamel, which allows bacteria to infect the center of the tooth (called the pulp). The infection may also spread from the root of the tooth to the bones supporting the tooth.
Causes: It's most commonly caused by severe tooth decay. Other causes of tooth abscess are trauma to the tooth, such as when it is broken or chipped, and gingivitis or gum disease.
Symptoms: A toothache that is severe and continuous and results in gnawing or throbbing pain or sharp or shooting pain are common symptoms of an abscessed tooth. Other symptoms may include: fever, pain when chewing, sensitivity of the teeth to hot or cold, bitter taste in the mouth, foul smell to the breath; swollen neck glands; general discomfort, uneasiness, or ill feeling; redness and swelling of the gums; swollen area of the upper or lower jaw; an open, draining sore on the side of the gum.
If the root of the tooth dies as a result of infection, the toothache may stop. However, this doesn't mean the infection has healed; the infection remains active and continues to spread and destroy tissue. Therefore, if you experience any of the above listed symptoms, it is important to see a dentist even if the pain subsides.
Diagnosis: The dentist will probe your teeth with a dental instrument. If you have an abscessed tooth, you will feel pain when the tooth is tapped by the dentist's probe. Dentist will also ask you if your pain increases when you bite down or when you close your mouth tightly. In addition, he may suspect an abscessed tooth because your gums may be swollen and red. He may also take X-rays to look for erosion of the bone around the abscess.
Treatment: Strategies to eliminate the infection, preserve the tooth, and prevent complications are the goals of treatment. To eliminate infection, the abscess may need to be drained. Achieving drainage may be done through the tooth by a procedure known as a root canal. Root canal surgery may also be recommended to remove any diseased root tissue after the infection has subsided. Then, a crown may be placed over the tooth. The tooth may also be extracted, allowing drainage through the socket. Finally, a third way to drain the abscess would be by incision into the swollen gum tissue.
Antibiotics are prescribed to help fight the infection. To relieve the pain and discomfort associated with an abscessed tooth, warm salt-water rinses and over-the-counter pain-reducing medication like ibuprofen (Advil or Motrin) can be used.
Prevention: Following good oral hygiene practices can reduce the risk of developing a tooth abscess. Also, if your teeth experience trauma (for example, become loosened or chipped), seek prompt dental attention.

Bad Breath - look for Halitosis

Bruxism - Bruxism means grinding and/or clenching of teeth. It is considered a non-functional habit that can occur while awake or asleep. Grinding your teeth while asleep is more of a problem since most people will grind their teeth much harder than they ever would while awake.
Causes: No one knows why we grind our teeth. However, it does seem to increase during times of stress.
Diagnosis: Your dentist can look for signs of wear. Other symptoms can be jaw tightness or soreness, headaches, ear pain, and the like.
Treatment: Chronic night time grinding can be controlled with a night guard such as the NTI device.
Important Note: Recent evidence indicates that use of selective serotonin reuptake inhibitors (SSRI's Paxil, Prozac, Zoloft, etc) can significantly increase bruxism and even result in TM Disorder symptoms.

Canker sores - Canker sores are small shallow ulcers that appear in the mouth and often make eating and talking uncomfortable.
There are two types of canker sores:

Simple canker sores. These may appear three or four times a year and last up to a week. They typically occur in people between 10 and 20 years of age.
Complex canker sores. These are less common and occur more often in people who have previously had them.

These sores are often confused with Cold sores, but they are not the same. Cold sores, also called a fever blister or herpes simplex type 1, are groups of painful, fluid-filled blisters. Unlike canker sores, cold sores are caused by a virus and are extremely contagious. Also, cold sores typically appear outside the mouth – usually, under the nose, around the lips, or under the chin while canker sores occur inside the mouth.
Causes: The exact cause of most canker sores is unknown. Stress or tissue injury is thought to be the cause of simple canker sores. Certain foods – including citrus or acidic fruits and vegetables (such as lemons, oranges, pineapples, apples, figs, tomatoes, strawberries) – can trigger a canker sore or make the problem worse. Use of nonsteroidal anti-inflammatory drugs is another common cause. Sometimes a sharp tooth surface or dental appliance, such as braces or ill-fitting dentures, might also trigger canker sores.
Some cases of complex canker sores are caused by an underlying health condition, such as an impaired immune system; nutritional problems, such as vitamin B-12, zinc, folic acid, or iron deficiency; and gastrointestinal tract disease, such as Celiac disease and Crohn's disease.
Symptoms:

A painful sore or sores inside your mouth – on the tongue, soft palate (the back portion of the roof of your mouth), or inside your cheeks
A tingling or burning sensation prior to the appearance of the sores
Sores in your mouth that are round, white, or gray in color, with a red edge or border
In severe attacks, you may also experience:
Fever
Physical sluggishness
Swollen lymph nodes

Treatment: Pain from a canker sore generally lessens in a few days and the sores usually heal without treatment in about a week or two. If sores are large, painful, or persistent, your dentist may prescribe an antimicrobial mouth rinse, a corticosteroid ointment, or a prescription or nonprescription solution to reduce the pain and irritation.
Prevention: Although there is no cure for canker sores and they often reoccur, you may be able to reduce their frequency by avoiding foods that irritate your mouth – including acidic or spicy foods; avoiding irritation from gum chewing; brushing with a soft-bristled brush after meals and flossing daily, which will keep your mouth free of foods that might trigger a sore.
You should call your dentist if you have:

Unusually large sores
Sores that are spreading
Sores that last 3 weeks or longer
Intolerable pain despite avoiding trigger foods and taking over-the-counter pain medication
Difficulty drinking enough fluids A high fever with the appearance of the canker sore(s)

Cracked Tooth - Occasional cold sensitivity is sometimes present. Pain on biting hard foods (pretzels, carrots, etc.) is the hallmark of the condition. This biting pain is inconsistent and usually occurs when the involved cusp is contacted in a certain way. Involved tooth can be difficult to localize.
It is a very common problem, most often found in the posterior teeth. Hairline cracks in the tooth can make teeth very cold sensitive.
Causes: Hairline fracture in tooth caused by trauma, bruxism, habits, large fillings, decay etc. Biting on hard food causes crack to open and close slightly irritating the pulp. Cold is more readily transmitted to the pulp as well. Decay is often found along the fracture deep in the tooth contributing to the symptoms via a reversible pulpitis. Cracked tooth syndrome can be confirmed by your dentist doing a bite test and examining the tooth with a fiber optic transilluminator, a bright light which shows fractures.
Diagnosis: Transillumination and a bite test done by your dentist. Symptoms are irregular bite and/or cold sensitivity. Hard foods like pretzels are the most common trigger of the bite pain.
Treatment: A crown is indicated in many cases, though a filling or onlay can work if a single tooth cusp is determined to be the culprit and no deep cracks are found. Sometimes a root canal is needed to treat teeth not resolved by the crown alone.

Decay - Tooth decay takes place in a tooth when the tooth's enamel has been damaged or has dissolved, resulting in a hole or tooth cavity. Tooth decay is the other most common cause of sensitivity. Early decay is often asymptomatic but as it penetrates the tooth further many people will begin to develop cold sensitivity (see the Toothache for more information).
Causes: Tooth decay is caused by different reasons, but overall the damage is caused by bacteria living in the mouth as a result of poor dental hygiene. These bacteria eat the same food as we do and thrive on sugars in our food and drinks. These same bacteria release acids, responsible for the breakdown of minerals in our teeth.
The most common causes for tooth decay are:

Food Containing Carbohydrates - Carbohydrates coming from sugars or foods high in starch content, leave traces on and in between teeth, and settle in cavities. They are broken down by bacteria, feeding on these sugars. Acids, created by the bacteria in this process, attack and damage the teeth, damaging them severely.
Accumulation of Plaque and Bacteria - Plaque contains up to 400 different kinds of bacteria, and starts to form on and in between teeth when bacteria and food and sugar remains are not effectively cleaned from the teeth. This accumulation of bacteria is one of the main causes of tooth decay, and will slowly break down the enamel of the tooth, after which it will attack the pulp in the tooth.

People who suffer from diabetes are, due to ever changing blood sugar levels, more prone to dental caries. For these people it is overly important to take good care of the teeth and gums to prevent any accumulation of plaque.
Symptoms:

Halitosis - the decaying food and bacteria produce a sulphur compound, causing bad breath
Toothache - as tooth decay develops and remains untreated, an infection will occur in the soft tissue inside the tooth (the pulp). As the infection grows and pus is formed, you will experience a throbbing and very uncomfortable pain.

Types of Tooth Decay:

Occlusal Caries – A form of dental carries in fissures on the surface of the tooth that we use to chew food. This area is called the occlusal surface of the tooth. This process of tooth decay starts slowly and can remain unnoticed for over a year. The tooth is attacked by bacteria living on sugars and the enamel of the tooth is damaged.
Facial Caries - A late or untreated tooth decay process may lead to complications such as facial swelling and the passing on of pus coming from an infection in the mouth, to another area in the body, usually the face or a cavity in the facial area.

If tooth decay, or caries, is not treated properly, it may lead to other painful side effects such as inflammation of the pulp inside the tooth and the bacteria in pus coming from infections could possibly spread to organs in the body.
Diagnosis: This needs to be done by a dentist. Large cavities visible to the patient are usually quite advanced. Caries can take up to 7 years to cause a cavity in a tooth and can therefore go unnoticed for a long period of time. Tooth decay prevention is of the utmost importance, from a young age onwards. A hard diagnosis even for your dentist can be decay developing under old fillings or crowns. These are difficult to detect both clinically and with x-rays. One clue that your sensitivity might be decay is when it does not go away after a few weeks of desensitizing toothpaste use.
Treatment: A filling, crown, or other appropriate restoration. If the decay has advance deep enough into the tooth a root canal may be indicated.
Prevention: A good standard of oral hygiene is the best way to keep tooth decay at bay. Regular brushing, flossing and checkups with a dentist cannot be underestimated. Brushing the teeth after sweet snacks such as dried fruit or candy will help prevent the forming of plaque.
Note: Untreated decay in a tooth cavity could spread to other teeth and surrounding bone. The pulp in the tooth will be affected and this could cause more damage and possible loss of the tooth. The tooth or gums could get infected, resulting in bacteria possible spreading throughout the body of the patient, fever and loss of teeth.

Dentin - Dentin (root) Sensitivity see Sensitive Teeth

Dry Mouth - see Xerostomia

Gingivitis - Gingivitis is an infection of the gums. It is usually painless and most people do not realize they have it until their dentist or hygienist tells them. Bleeding of the gums during brushing or flossing is sometimes apparent to the patient, but this is not always the case. The gums do become reddened and puffy due to the infection.
An important aspect of gingivitis to remember is that it is reversible. This reversibility is in contrast to Periodontitis, a more severe gum disease which affects the bone that support the teeth. The damage to the bone in periodontitis is irreversible and can only be arrested in an attempt to control further damage to the support of the teeth.
Causes: The infection of gingivitis is caused by the bacteria found in dental plaque, the stuff you try to remove with brushing and flossing. It is a thin film of bacteria that forms almost as soon as you remove it. With daily oral hygiene this plaque film is disrupted enough to not be able to cause harm to your gums. If it is not removed properly once every 24 hours it begins to become more pathologic, setting up the infection of the gums. This can happen in the whole mouth but more often than not it occurs locally around certain teeth where adequate hygiene may be more difficult. Tartar build-up can irritate the gums and harbor bacteria as well.
Certain medical conditions can aggravate gingivitis. Reduced immunity due to chemotherapy, AIDS, diabetes, and the like will worsen gingivitis. Many medications cause problems for the gums. For example, calcium channel blockers and seizure medications cause the gums to grow excess tissue. Any medication causing dry mouth will effect the gums too. Pregnancy, birth control pills, and puberty often cause a condition known as "hormonal gingivitis".
Treatment: Thorough professional cleaning and irrigation of gums with antibacterial mouthwash. Personalized instruction in home care which may include brushing, flossing, special plaque removal devices (Braun Oral B, Sonicare, etc) and use of Listerine/prescription mouthwash and/or antibiotics. Timely follow up to evaluate healing and determine a recall period that suits your particular situation.

Gum Recession - Gum recession is one of the gum problems that patients can frequently identify. When the recession is in the front of the mouth, it may be readily seen - especially if it is on the upper front teeth. However, recession may occur on any of the teeth, and on either the lip/cheek side of the teeth or the tongue side or roof-of-the mouth side of the teeth.
There are two different types of recession:

Thin, Fragile Tissue
Bacterial Infection - seen by patients who have gum disease that is a bacterial infection resulting from the bacteria that are normally in the mouth. This involves not only gum recession, but also the destruction of the underlying bone which supports the teeth.

Receded gum tissue is one of the most common causes of tooth sensitivity. Exposed root surfaces have no enamel and are much more sensitive to temperature.
Causes: Periodontal disease, toothbrush abrasion, malocclusion (bad bite), bruxism (teeth grinding), frenum pull, poor oral hygiene.
Diagnosis: Look for a gum line that has receded below where adjacent teeth have. Exposed roots are usually a bit darker than the adjacent crown as well. Sometimes the tooth will have a notched appearance as well.
Treatment: Sensitivity toothpastes work well after about two weeks of use in most cases. However once treatment is stopped the sensitivity often returns. Dentists have a host of desensitizing medicaments that have improved recently and are quite effective. If the tooth is notched or worn a filling is often indicated as well. Severe recession may need a gingival graft procedure to help replace lost gum tissue.

Halitosis - The unpleasant smell that so many people suffer from comes from bacteria caused by decaying remnants of food in the mouth, causing caries.
Causes: Halitosis is a common problem with many causes. This vexing problem can be broken down into three main sources, the determination of which is needed in order to resolve: external, intraoral, and extraoral.
External Causes - This is the most widespread cause of transient bad breath. Many foods and drinks can cause mild to severe halitosis (garlic, onions, cheeses, alcohol, etc). Most people are aware of these culprits and they cause little chronic problem. Smoking is a real breath killer, which can only be controlled by quitting.
Intraoral Causes - The mouth itself is by far the most common source of halitosis. The culprits here are bacteria producing Volatile Sulfur Compounds (VSCs). These bacteria are found throughout the mouth but are most common on the surface of the tongue and in the tissue pocket below the gum line adjacent to each tooth. These bacteria thrive with poor oral hygiene and gum disease states (periodontitis and gingivitis). Dry mouth conditions can aggravate halitosis as well.
Extraoral Causes - Many medical problems can have bad breath as a side effect. These include but are not limited to diabetes, gastric reflux, sinusitis, tonsillitis, liver disease, colds, lung disease, and esophageal disease.
Treatment: Controlling the mouth bacteria that produce VSCs is the key to tackling halitosis. Regular dental care is paramount to controlling bad breath. Once periodontal contributors are controlled or ruled out, an effective daily oral hygiene program is simply the only way to control most cases of bad breath. The steps below must be performed every day.
If these regimens are strictly followed and no resolution of the halitosis is achieved, a medical consultation would be prudent to look into possible medical causes. The great majority of bad breath is caused by bacteria in the mouth, but medical causes play a role in a significant number of cases.

Impaction & Eruption - An impacted tooth is any tooth that is prevented from reaching its normal position in the mouth by tissue, bone, or another tooth. As the molar teeth erupt, the nearby tissues can become inflamed and swollen.
Causes: The teeth that most commonly become impacted are the third molars, also called wisdom teeth. These large teeth are the last to develop, beginning to form when a person is about nine years old, but not breaking through the gum tissue until the late teens or early twenties. By this time, the jaws have stopped growing and may be too small to accommodate these four additional teeth. As the wisdom teeth continue to move, one or more may become impacted, either by running into the teeth next to them or becoming blocked within the jawbone or gum tissue. An impacted tooth can cause further dental problems, including infection of the gums, displacement of other teeth, or decay. At least one wisdom tooth becomes impacted in nine of every ten people.
Symptoms: The movement of an erupting wisdom tooth and any subsequent impaction may produce pain at the back of the jaw. Pain may also be the result of infection, either from decay in any exposed portion of the tooth or from trapped food and plaque in the surrounding gum tissue. Infection typically produces an unpleasant taste when biting down and bad breath. Another source of pain may be pericoronitis, a gum condition in which the crown of the incompletely erupted tooth produces inflammation, redness, and tenderness of the gums. Less common symptoms of an impacted tooth are swollen lymph nodes in the neck, difficulty opening the mouth, and prolonged headache.
Diagnosis: Upon visual examination, the dentist may find signs of infection or swelling in the area where the tooth is present or only partially erupted. Dental x rays are necessary to confirm tooth impaction.
Treatment: Because impacted teeth may cause dental problems with few if any symptoms to indicate damage, dentists commonly recommend the removal of all wisdom teeth, preferably while the patient is still a young adult. A dentist may perform an extraction with forceps and local anesthetic if the tooth is exposed and appears to be easily removable in one piece. However, he may refer a difficult extraction to an oral surgeon, a specialist who administers either nitrous oxide-oxygen (commonly called "laughing gas"), an intravenous sedative, or a general anesthetic to alleviate any pain or discomfort during the surgical procedure. Extracting an impacted tooth typically requires cutting through gum tissue to expose the tooth, and may require removing portions of bone to free the tooth. The tooth may have to be removed in pieces to minimize destruction to the surrounding structures. The extraction site may or may not require one or more stitches to help the incision heal.
Prognosis: The prognosis is very good when impacted teeth are removed from young healthy adults without complications. Potential complications include postoperative infection, temporary numbness from nerve irritation, jaw fracture, and jaw joint pain. An additional condition which may develop is called dry socket: when a blood clot does not properly form in the empty tooth socket, or is disturbed by an oral vacuum (such as from drinking through a straw or smoking), the bone beneath the socket is painfully exposed to air and food, and the extraction site heals more slowly.

Malocclusion - This term means "bad bite". The proper Occlusion is where all of the teeth are straight and the top teeth line up with the bottom teeth. Sometimes when the teeth do not bite together in harmony with the shape and position of the joints it can place pressure on the joints. Missing teeth can sometimes contribute to this as well. The misalignment can also put strain on the jaw muscles. This factor can be mild to severe.
Types of Malocclusion:

Class I. Although the upper and lower molars are properly positioned, the teeth are crowding together or have too much space. Crossbites, rotations, and overlapping can also occur in severe cases.
Class II. The lower molars fit the upper molars but are positioned toward the throat, drawing the chin back (retrognathia). This is also called an "overbite" or "buck teeth".
Class III. The lower molars are far forward and do not fit into their corresponding upper molars. This arrangement creates a jutting jaw (prognathia) and jutting lower front teeth, which are in a crossbite with the upper teeth. This is also called an "underbite".

Causes: Malocclusion is usually caused by problems in the shape or size of the jaw or teeth. If children have a small jaw, their teeth may grow into a space that is too small. Under these crowded conditions, teeth will push each other out of proper position. Other causes of crooked teeth include thumb-sucking, pacifier use, and tooth loss.
A common cause is teeth that have too much or too little room in the jaw. As a result, teeth may grow or drift out of place. Some people refer to it as having crooked teeth or a “poor bite.”
Symptoms: The most obvious sign of malocclusion is crooked or protruding teeth. Malocclusion can range from mild to severe. The condition is so severe in some people that they can't eat or speak properly. In most people, however, a poor bite doesn't cause these problems. Rather, most cases of malocclusion pose a cosmetic concern, meaning that people are concerned about how their teeth look.
Diagnosis: A dentist typically looks for malocclusion in children during routine dental visits. If the jaw or teeth are out of alignment, the dentist may suggest a visit to an orthodontist. It’s recommended all children get a checkup with an orthodontic specialist by age 7. He will ask questions about your or your child's medical and dental history, conduct a clinical exam, take dental and facial X-rays, photograph the face and teeth and create a plaster model of the teeth.
Treatment: Malocclusion is corrected with orthodontic treatment. Orthodontists are dentists who are specially trained to correct malocclusion. Orthodontist may remove (extract) certain teeth of children or teens to make room for incoming teeth. Next, he will attach braces (fixed or removable) to teeth to create a proper bite. In addition to straightening teeth, the braces can help move the jaw into a proper position.
Teeth have a tendency to move forward as you age, even after treatment with braces. Retainers are devices that keep teeth from moving. Some people need to use retainers for many years after treatment. Other people may need to use a retainer on an ongoing basis.
Though most people have orthodontic treatment as children, adults can successfully straighten their teeth with braces. However, surgery is the only way to adjust an adult’s jaw.

Necrotic Toth - Pain from irreversible pulpitis may subside almost completely. Eventually tooth may abscess where the infection of the pulp leaks from the tooth into the periodontal ligament and jaw bone below. At this point the pain can become quite severe. Biting pain is evident, often resulting in avoidance. As the abscess worsens swelling may arise in the tissues adjacent to the tooth. Left untreated this swelling can become visible on the patients face. At this point fever, swollen lymph nodes, and malaise may occur. General sepsis and/or swelling of dangerous areas may result, resulting in a true emergency.
Causes: Bacteria from the infected pulp infiltrate the periodontal ligament and then the jaw bone proper.
Treatment: Root canal or extraction. Additional surgical intervention is sometimes needed to drain the infection. Antibiotics are rarely indicated , but may be useful in some severe infections.

Oral Cancer - Oral or mouth cancer most commonly involves the tissue of the lips or the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinomas. These are malignant and tend to spread rapidly. Fortunately, it can be detected in the early stages.
Symptoms: While an annual screening for oral cancer is important, you are the most important factor in an early diagnosis. You should always contact your doctor or dentist immediately if you notice the following symptoms in yourself or a loved one:

A sore or lesion in the mouth that does not heal within two weeks.
A lump or thickening in the cheek.
A white or red patch on the gums, tongue, tonsil, or lining of the mouth.
A sore throat or a feeling that something is caught in the throat.
Difficulty chewing or swallowing.
Difficulty moving the jaw or tongue.
Numbness of the tongue or other area of the mouth.
Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.

These symptoms may be caused by other, less serious problems, but they also indicate the possible presence of oral cancer.
Diagnosis: Only a professional will be able to tell you definitively. Dental hygienist and dentists are trained to detect abnormalities. If there are any abnormal tissue changes, the dentist or oral pathologist can take a biopsy to confirm a diagnosis. Most lesions are not cancer, but it is best to be safe if anything looks unusual.
Be sure to tell the doctor if you have been a tobacco user in any form. Tobacco use is implicated in more than 75% of all oral cancers. After the physical examination of your mouth, if your doctor finds any areas that are suspicious, he may recommend a biopsy. This is simply taking a small portion of the suspicious tissue for examination under a microscope.
Treatment: Treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation and restorative specialists. The actual curative treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis, to sensitize the malignant cells to radiation, or for those patients who have confirmed distant metastasis of the disease.

Pericoronitis – Impacted Tooth - Pericoronitis is a dental disorder in which the gum tissue around the molar teeth becomes swollen and infected. This disorder usually occurs as a result of wisdom teeth, the third and final set of molars that most people get in their late teens or early twenties.
Symptoms: Pain, infection, swelling in the gum tissue (caused by an accumulation of fluid), a "bad taste" in the mouth (caused by pus leaking from the gums), swelling of the lymph nodes in the neck and difficulty opening the mouth. If the pericoronitis is severe, the swelling and infection may extend beyond the jaw to the cheeks and neck.
Causes: It can develop when wisdom teeth only partially erupt (break through the gum). This allows an opening for bacteria to enter around the tooth and cause an infection. In cases of pericoronitis, food or plaque (a bacterial film that remains on teeth after eating) may get caught underneath a flap of gum around the tooth. If it remains there, it can irritate the gum and lead to pericoronitis.
Diagnosis: Your dentist will examine your wisdom teeth and how they are coming in, and see if any are partially erupted. He may take an X-ray periodically to determine the alignment of the wisdom teeth. He will also take note of any symptoms such as swelling or infection, and will check for the presence of a gum flap around a wisdom tooth.
Treatment: If the pericoronitis is limited to the tooth (for example, if the pain and swelling has not spread), treat it by rinsing your mouth with warm salt water. You should also make sure that the gum flap has no food trapped under it. If your tooth, jaw and cheek are swollen and painful, see your dentist right away. He can treat the infection with antibiotics (usually penicillin, unless you are allergic). You can also take pain relievers such as aspirin, acetaminophen, or ibuprofen. The dentist may also prescribe a pain medication.
If the pain and inflammation are severe, or if the pericoronitis recurs, oral surgery to have the gum flap or wisdom tooth removed may be necessary. Your dentist can make the appropriate referral to the oral and maxillofacial surgeon.

Periodontitis - Periodontitis is a form of gum disease. It is a chronic infection of the gums which is characterized by a loss of attachment between the tooth and the jawbone. It is the leading cause of tooth loss among adults in many countries. Teeth are attached to the jaw by a series of very strong ligaments. The gums are also connected to the tooth by a complex series of microscopic fibers; and the gums lay over the tooth-bone attachment like a protective cover. Periodontitis begins in the shallow pocket where the tooth and gum meets, usually as a milder form of gum infection known as gingivitis. Bacteria can grow in this pocket, usually due to inadequate oral hygiene. The gum begins to pull away from the tooth deepening the pocket, making it harder to clean and encouraging the formation of tenacious tartar deposits below the gumline.
Over time this infection can cause inflammation in the bone, causing it to slowly disappear, undermining the attachment to the tooth. This loss of bone is what distinguishes periodontitis from gingivitis, where no bone loss occurs. After many years this can lead to tooth loss.
Diagnosis: Periodontal disease is diagnosed with a thorough periodontal exam. A small, blunt probe is used to measure the depth of the gum pockets around every tooth in the mouth. Measurements are taken at six sites on each tooth. This depth gives an objective gauge of the health of the gums. If the pockets bleed easily during probing this is noted as well. This bleeding is a sign of inflammation of the pocket. The appearance of the gums is noted; infected gums appear red and puffy. The amount of tartar, or calculus, is determined. The mobility of all teeth is checked and the bite is evaluated. X-rays of all teeth are needed to evaluate the condition of the bone around each tooth and show calculus deposits below the gumline.
Types: It is important to realize that periodontitis is chronic, insidious, and episodic in nature:

Chronic - Periodontitis is typically a slow moving condition, taking many months or even years to develop. Once the disease develops and is diagnosed, it is never really cured. Instead it is managed, much like other chronic conditions like high blood pressure or diabetes.
Insidious - Periodontitis is usually silent until its later stages. That is, patients typically have no symptoms until the disease has progressed very far. It must be diagnosed through a thorough periodontal exam. Symptoms which do occur late in the disease are bleeding gums, sore or itchy gums, loose teeth, change in bite, bad breath, and acute gum abscesses.
Episodic- The actual disease activity of infection causing bone loss does not occur at all times in all places in the mouth. Instead, the active stages occur in an on/off fashion at various locations in the mouth. This can only be determined by accurate exams initially and at recall.

Treatment: These above factors are important to understand the treatment of periodontitis. The goal is to control the current active infection and then closely monitor for signs of disease activity on a regular basis. Once susceptible to this disease it must be monitored for the rest of the patient's life. The ultimate goal is to prevent further bone loss and keep the teeth involved for as long as possible.
The actual treatment regimen is determined on an individualized, case by case basis. Most treatments follow the same basic pattern. First the infection is disrupted by thorough cleaning below the gumline by the doctor or hygienist. This cleaning is called "scaling an root planing" and may take one to four or more appointments. Local anaesthesia is often used for patient comfort.
The goal is to remove the tartar and bacteria from the root surfaces to allow healing and reattachment of the gums. An individualized home care regimen is devised for the patient to control plaque. Plaque contains the bacteria which cause the disease and plaque hardens to become tartar. Controlling plaque levels through proper home care is critical to the success of the treatment.
The gums are given time to heal once scaling is done (2-4 weeks) and the mouth is re-examined to evaluate the success of the treatment and determine the need for further care. At this point laser treatments can be used to reduce localized pocketing. Laser treatments of pockets kills many of the offending bacteria, removes diseased tissue, and encourages gum reattachment to the teeth. This can often be done without anaesthesia and can reduce the need for more extensive periodontal surgery. Severe cases are often referred to a dental specialist known as a periodontist, whose sole job is to treat gum disease.
A recall interval is determined. Regular recall visits are crucial for managing this disease over the long term. Frequent recall allows regular, early removal of tartar accumulations, disruption of bacteria in deeper pockets, and close monitoring of disease activity throughout the mouth. Any further treatment needs can be addressed as soon as possible.

Pulpitis - Pulpitis is painful inflammation of the tooth pulp, the innermost part of the tooth that contains the nerves and blood supply.
Causes:The most common cause of pulpitis is tooth decay; the second most common cause is injury. Mild inflammation, if relieved, may not damage the tooth permanently. Severe inflammation may cause the pulp to die.
Symptoms: Cold sensitivity to liquids and sometimes air, less often to hot liquids. Short duration with no lingering or spontaneous pain. Pulpitis can cause intense tooth pain. No biting pain. Cavity in tooth may be visible but this is unlikely. (note similarity to Dentin Sensitivity)

Diagnosis:To determine if the pulp is healthy enough to save, a dentist can perform certain tests. For example, a dentist can apply a hot or cold stimulus. If pain persists after the stimulus is removed or if pain occurs spontaneously, the pulp may not be healthy enough to save. A dentist may also use an electric pulp tester, which indicates whether the pulp is alive but not whether it is healthy. If the person feels the small electrical charge delivered to the tooth, the pulp is alive. Sensitivity to tapping on a tooth often means that inflammation has spread to the surrounding tissues.
Treatment:The inflammation stops when the cause is treated. When pulpitis is detected early, a temporary filling containing a sedative can eliminate the pain. This filling can be left in place for 6 to 8 weeks and then replaced with a permanent filling. Often a permanent filling can be put in immediately.
When pulp damage is extensive and cannot be reversed, the only way a dentist can stop the pain is by removing the pulp by root canal treatment or tooth extraction.

Sensitive Teeth – Dentin (root) Sensitivity - Painful reaction in one or more teeth triggered by hot, cold, sweet, or sour foods and drinks. This pain can be sharp, sudden and shoot deep into the nerve endings of your teeth. Normally, the dentin (the second, more sensitive layer of the tooth) is surrounded and protected by your enamel, cementum (special root covering) and gums. The mechanism of dentinal sensitivity is still not well understood. It is believed that the little tubes that connect the dentin to the nerve or pulp serve as sensory conductors.
Symptoms: Cold sensitivity to liquids and sometimes air, less often to hot liquids. Short duration with no lingering or spontaneous pain. No biting pain. Root surface usually visible due to gum recession.
Causes: Apart from a cavity or a missing filling, the most common cause of tooth sensitivity is exposed dentin on the roots of your teeth. Exposed dentin (root) surface due to gum recession, trauma, bruxism, erosion or abrasion.
Causes of exposed root surfaces which may result in dentinal sensitivity:

Brushing too hard - Over a period of time, brushing too hard or using a hard-bristled toothbrush may wear away enamel or cementum and cause the dentin to be exposed.
Recession of the gums - Movement of gums away from the tooth due to periodontal disease will expose the root surface
Cracked teeth - Chipped or broken teeth may fill up with bacteria from plaque and enter the pulp causing an inflammatory reaction.
Grinding your teeth - Grinding or clenching your teeth may wear down the enamel and expose underlying dentin.
Plaque - The presence of plaque on the root surfaces can cause sensitivity.

Treatment: Use desensitizing toothpaste for two weeks. If no resolution have dentist examine tooth to rule out decay. Dentist can treat with in office desensitizing treatments. Dental restoration may be needed if tooth has lost tooth structure. Usually responds to treatments though some teeth can be very resistant to therapies.

Snoring - Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age.
Snoring can be more than just an annoyance. It occurs when the tongue relaxes and falls back, blocking the air passage. The body reacts to the smaller airway by breathing harder, thus causing the tongue to vibrate against the palate. It deprives the body of proper oxygen and puts people at risk for elevated blood pressure, heart attacks and strokes.
Causes: A variety of factors can lead to snoring, including:

Your mouth anatomy. Having a low, thick soft palate or enlarged tonsils or tissues in the back of your throat (adenoids) can narrow your airway. Likewise, if the triangular piece of tissue hanging from the soft palate (uvula) is elongated, airflow can be obstructed and vibration increased. Being overweight contributes to narrowing of your airway.
Alcohol consumption. Snoring also can be brought on by consuming too much alcohol before bedtime. Alcohol acts as a sedative, relaxing throat muscles.
Nasal problems. Chronic nasal congestion or a crooked partition between your nostrils (deviated nasal septum) may be to blame.
Snoring may also be associated with obstructive sleep apnea. In this serious condition, your throat tissues obstruct your airway, preventing you from breathing. Sleep apnea is characterized by loud snoring followed by periods of silence that can last 10 seconds or more. Eventually, the lack of oxygen and an increase in carbon dioxide signal you to wake up, forcing your airway open with a loud snort or gasping sound. This pattern may be repeated many times during the night.

Treatment: Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids.
Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist-head and neck surgeons.
Self-Help for the Light Snorer:
Adults who suffer from mild or occasional snoring should try the following self-help remedies:

Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
Establish regular sleeping patterns
Sleep on your side rather than your back.
Tilt the head of your bed upwards four inches.
Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny, and it’s not hopeless.

Thrush - Thrush is an infection of the mouth caused by the candida fungus, also known as yeast. Candida infection is not limited to the mouth; it can occur in other parts of the body as well, causing diaper rash in infants or vaginal yeast infections in women.
It can affect anyone, though it occurs most often in babies and toddlers, older adults, and people with weakened immune systems.
Causes: Small amounts of the candida fungus are present in the mouth, digestive tract, and skin of most healthy people and are normally kept in check by other bacteria and microorganisms in the body. However, certain illnesses, stress, or medications can disturb the delicate balance, causing the fungus candida to grow out of control, causing infection.
Medications that upset the balance of microorganisms in the mouth and may cause thrush include corticosteroids, antibiotics, and birth control pills. Illnesses or medical situations that make candida infection more likely to develop include uncontrolled diabetes, HIV infection, cancer, dry mouth, or pregnancy (caused by the hormonal changes). People who smoke or wear dentures that don't fit properly also are at increased risk for thrush. In addition, babies can pass the infection to their mothers during breast-feeding.
Symptoms: Thrush usually develops suddenly, but it may become chronic, persisting over a long period of time. A common sign of thrush is the presence of creamy white, slightly raised lesions in your mouth – usually on your tongue or inner cheeks – but also sometimes on the roof of your mouth, gums, tonsils, or back of your throat. The lesions, which may have a "cottage cheese" appearance, can be painful and may bleed slightly when you scrape them or brush your teeth. In severe cases, the lesions may spread into your esophagus, or swallowing tube, causing pain or difficulty swallowing, a feeling that food gets stuck in the throat or mid-chest area, also fever, if the infection spreads beyond the esophagus. Thrush can spread to other parts of the body, including the lungs, liver, and skin. This happens more often in people with cancer, HIV, or other conditions that weaken the immune system.
Diagnosis: Your dentist can make the diagnosis by examining your mouth. A microscopic examination of tissue from a lesion can confirm the diagnosis.
Thrush that may extend into your esophagus may require other tests to make the diagnosis. Such tests might include taking a throat culture (swabbing the back of your throat with sterile cotton and studying the microorganisms under a microscope), performing an endoscopy of your esophagus, stomach, and small intestine (examining the lining of these body areas with a lighted camera mounted on the tip of a tube passed through these areas), or taking X-rays of the esophagus.
Treatment: While healthy children and adults can be effectively treated, the symptoms my be more server and difficult to manage in those with weakened immune systems. Antifungal medications, which are generally taken for 10 to 14 days, are often prescribed to treat thrush. The dentist will have a specific treatment approach designed for you based on your age and the cause of the infection. Because the presence of candida infection can be a symptom of other medical problems, your dentist may suggest you seek care from a medical doctor as well so that any underlying health problems you may have can be treated.
Prevention: The following practices can help minimize your chance of developing thrush:
- Follow good oral hygiene practices. Brush your teeth at least twice a day and floss at least once a day.
- Avoid mouthwashes or sprays. These products can destroy the normal balance of microorganisms in your mouth. - See your dentist regularly. Especially if you have diabetes or wear dentures.
- Limit the amount of sugar and yeast-containing foods you eat. Foods such as bread, beer, and wine encourage candida growth.
- If you smoke, quit. Ask your doctor or dentist about ways to help you kick the habit.

TMJ Tempero Mandibular Joint Diseases/Disorders - "TMJ" stands for Temporo Mandibular Joint, or the jaw joint. The joints allow movement up and down, side to side, and forward and back—all the mobility necessary for biting, chewing and swallowing food, for speaking and for making facial expressions. Temporomandibular joint diseases and disorders, commonly called TMJ, are a collection of conditions characterized by pain in the jaw and surrounding tissues and limitations in jaw movements.
Causes: Not all causes are known. Some possible causes or contributing factors are injuries to the jaw area, various forms of arthritis, dental procedures, genetics, hormones, low-level infections, auto-immune diseases, stretching of the jaw as occurs with inserting a breathing tube before surgery, and clenching or grinding of the teeth.
Symptoms: Pain is the most common symptom. TMJ pain is often described as a dull aching pain in the jaw joint and nearby areas, including the ear, which comes and goes. Some people, however, report no pain, but still have problems using their jaws. Other symptoms can include:

Being unable to open the mouth comfortably
Clicking, popping or grating sounds in the jaw joint
Locking of the jaw when attempting to open the mouth
Headaches
A bite that feels uncomfortable or “off”
Neck, shoulder and back pain
Swelling on the side of the face

Additional symptoms may include: ringing in the ears, ear pain, decreased hearing, dizziness and vision problems.
Diagnosis: Diagnosing TMJ diseases and disorders can be difficult and confusing. For example, facial pain can be a symptom of many conditions, such as sinus or ear infections, decayed or abscessed teeth, various types of headache, and facial neuralgia (nerve-related facial pain).
At present, there is no widely accepted, standard test to correctly identify all TMJ conditions. In most cases, however, a complete evaluation, including a detailed medical history, the patient’s description of symptoms, and physical examination of the head, neck, face and jaw provide information useful for making a diagnosis.
Keep in mind that occasional discomfort in the jaw joint or chewing muscles is common, and is not always a cause for concern. Many people with certain TMJ problems get better without treatment. Often the problem goes away on its own in several weeks to months. However, if the pain is severe and lasts more than a few weeks, see your healthcare provider.
Treatment: Because most common jaw joint and muscle problems are temporary, lasting only weeks or months, simple care is all that is usually needed to relieve the discomfort. Self-care practices, for example, eating soft foods, applying ice or moist heat, and avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing) are useful in easing symptoms.
See for more: http://www.tmj.org/

Toothache - A toothache is any pain or soreness within or around a tooth, indicating inflammation and possible infection.
Symptoms: It may feel like a sharp pain or a dull ache. The tooth may be sensitive to pressure, heat, cold, or sweets.
Causes: Many conditions can cause pain in the teeth:
- Cracked Tooth Sindrome
- Dentin (root) Sensitivity
- Irreversible Pulpitis
- Necrotic Tooth
- Reversible Pulpitis
- Abscesses
- Gum disease, including periodontitis
- Loose or broken filling
- Exposed tooth root
- Food wedged between teeth or trapped below the gum line
- Tooth nerve irritated by clenching or grinding of teeth (bruxism)
- Pressure from congested sinuses
- Traumatic injury
Conditions which may MIMIC a Toothache:
- Temperomandibular Disorder
- Trigeminal Neuralgia
- Atypical Facial Pain
- Heart Attack
- Tumor
Diagnosis: Most of the time dental diagnoses are straightforward, but the exact cause of the tooth pain is not always evident. One of the difficulties doctors face in diagnosing is that patients present with a variety of pain perception, thresholds, and tolerances. The importance of a proper diagnosis can not be overstated.
Diagnosis includes identifying the location of the toothache, as well as the cause. The dentist begins by asking the patient specific questions about the toothache, including the types of foods that make the pain worse, whether the tooth is sensitive to temperature or biting, and whether the pain is worse at night. He then examines the patient's mouth for signs of swelling, redness, and obvious tooth damage. The presence of pus indicates an abscess or gum disease. The dentist may flush the sore area with warm water to dislodge any food particles and to test for sensitivity to heat. He may then dry the area with gauze to determine sensitivity to touch and pressure and he may probe tooth crevices and the edges of fillings with a sharp instrument, looking for areas of tooth decay. Finally, the dentist may take x rays, looking for evidence of decay between teeth, a cracked or impacted tooth, or a disorder of the underlying bone.
Treatment: Toothaches should always be professionally treated by a dentist. Some methods of self-treatment, however, may help manage the pain until professional care is available:
- Rinsing with warm salt water
- Using dental floss to remove any food particles
- Taking aspirin or acetaminophen (Tylenol) to relieve pain; the drug should be swallowed--never placed directly on the aching tooth or gum
- Applying a COLD compress against the outside of the cheek; do not use heat, because it will tend to spread infection.
- Clove oil (Syzygium aromaticum) may be rubbed on sensitive gums to numb them or added to a small cotton pellet that is then placed into or over a hole in the tooth. The herb corydalis (Corydalis yanhusuo) may also help
Professional care: Prompt dental treatment provides a positive outcome for toothache. In the absence of active infection, fillings, root canal treatments, or extractions may be performed with minimal discomfort to the patient.
Treatment will depend on the underlying cause of the toothache. If the pain is due to tooth decay, the dentist will remove the decayed area and restore the tooth with a filling of silver amalgam or composite resin. Loose or broken fillings are removed, new decay cleaned out, and a new filling is placed. If the pulp of the tooth is damaged, root canal therapy is needed. The dentist or a specialist called an endodontist removes the decayed pulp, fills the space left behind with a soothing paste, and covers the tooth with a crown to protect and seal it. If the damage cannot be treated by these methods, or if the tooth is impacted, the tooth must be extracted.
Prognosis: When a toothache is left untreated, a severe infection may develop and spread to the sinuses or jawbone, and eventually cause blood poisoning. Prevention: Maintaining proper oral hygiene is the key to preventing toothaches. People should visit their dentist at least every six months for oral examinations and professional cleaning.

Xerostomia - Xerostomia = Dryness of the mouth due to a decreased function of the glands that produce saliva. Having a decreased flow of saliva has some serious consequences. This can lead to tooth decay and gum disease.
Saliva is the body's self-cleansing mechanism. It helps remove food, debris, and plaque from the tooth surfaces, which helps protect against oral diseases. Saliva also protects against cavities. It cleanses the tooth surfaces and neutralizes acids, and in this way, protects the tooth surface from tooth decay. People who have dry mouth are very susceptible to cavities, especially on the roots of their teeth.
Causes (some): A permanent feeling of dry mouth or decreased saliva flow can be caused by:

Biological aging - this is a contributing factor, but probably does not cause it
Systemic diseases such as rheumatoid conditions (example: Sjogren's Syndrome), dysfunctional immune system (example: AIDS), hormonal disorders (example: Diabetes), neurologic disorders (example: Parkinson's disease), decreased chewing ability- resulting in a liquid diet and soft food choice which tend to decrease the flow of saliva, surgical removal of salivary glands
Radiation therapy - radiation can result in permanent damage to the salivary glands.
Drugs or medications - over 400 drugs cause dry mouth as a side effect. The more common drugs are decongestants, diuretics, antihypertensives, antidepressants, antihistamines

Symptoms:

Burning sensation of the tongue
Difficulty eating, especially dry foods
Difficulty with speech
Often thirsty
Difficulty wearing dentures
Dry, cracked lips, and at the corners of the mouth
Impaired taste

Xerostomia can result in oral discomfort and can have serious consequences. If you feel you have this symptom, please see your oral health professional.
Treatment: Frequently sip water. Keep fluids at bedside at night. Chew sugarless gum. Avoid tobacco, alcohol and foods high in sugar. Adjust the air humidity in your home. Use a saliva substitute - this is a commercial product which attempts to "wet" the mouth like saliva does; it can be found in most pharmacies. Establish a good plaque control program - since heavy plaque accumulations occur with oral dryness. Use fluoride - toothpaste, rinse, or gel.

Dental Cases: we are The Key