Sensitivity vs. Toothache

Even if you are the “perfect” dental patient who flosses thirty times daily, carries a toothbrush in your pocket at all times, and devoutly obeys every word spoken by your hygienist, chances are good that at some point in your life you will experience discomfort or even pain because of a tooth. Other than routine cleanings and checkups or scheduled treatment, tooth pain is probably the most common reason dental appointments are scheduled. When you go to the dentist with tooth pain, one of two conditions will usually be found: tooth sensitivity or a “true” toothache. The purpose of this post is to help you understand each and give some helpful advice if/when you experience either.

Sensitivity

To understand tooth sensitivity, one must know something of tooth anatomy. Teeth are composed of three basic layers. The outermost is a hard, protective covering called enamel which covers an intermediate layer of dentin. Within the dentin is the pulp, a gelatinous core composed of nerves and blood vessels. The middle dentin layer is not as hard as enamel and is filled with millions of small channels or pores that are filled with fluid and a microscopically small nerve branch that comes from the inner pulp layer. Tooth sensitivity occurs when the dentin layer becomes exposed. Usually this happens when the enamel layer is worn away by overly-aggressive brushing, acid erosion, tooth clenching and grinding, etc. Root surfaces, which are lack enamel, can also become uncovered and exposed through gum disease and gum recession. Temperature changes, pH changes (sweet, sour foods), drying of the tooth, and mechanical touch each cause the fluid to move within the tiny dentinal pores or channels, which in turn tugs at the small nerve contained within and the result is a pain signal to your brain.

Fortunately, tooth sensitivity is rarely a serious condition and treatment, which focuses on relieving symptoms, is often quick and relatively inexpensive. All forms of sensitivity treatment are designed to seal the dentin pores, or block the small tooth nerves within from sending pain signals. Toothpastes containing high concentrations of fluoride or potassium nitrate may be prescribed, or commercially available pastes such as Sensodyne (which also contains potassium nitrate and fluoride, but at lower concentrations than prescription pastes) may be recommended. In more severe cases, small fillings to cover the exposed dentin or night guards to prevent grinding and clenching during sleep may be advised.

Toothache

True toothaches arise from many different conditions, among the causes of which are the following: shallow tooth decay (not to the nerve), deep tooth decay (that has penetrated the pulp of a tooth), trauma, cracked teeth, severe grinding and clenching, necrotic or dead teeth (which may have an abscess), and gum infection or disease. One common theme is present in treatment for each: the source of the pain needs to be dealt with; treating symptoms (as is the case with sensitivity) is not enough. Damaged tooth nerves and tooth infrastructures will not repair themselves, and bacterial infection left unchecked, will destroy a tooth (or jawbone). These problems often start small, but over time get larger, more dangerous, and more costly to treat. Fortunately, most painful teeth can be treated with fillings, crowns, and root canals, but if treatment is delayed, a tooth may be rendered non-restorable and extraction may be the only alternative (potentially leading to tooth replacement with dentures, partials dentures, bridges, or implants).

It must also be noted that many conditions can mimic a “true” toothache, among which are teporomandibular joint disorder, wisdom tooth impaction, sinus infection, trigeminal neuralgia, atypical facial pain, heart attack, and tumors. Obviously, some of these conditions are very serious and should receive immediate treatment.

“My tooth hurts; what should I do?”

Ask yourself the following questions in order to determine the next step:   What hurts? Discomfort from cold things, sweets, and sour things may indicate either sensitivity or a “true” toothache. Discomfort from biting usually means something more serious, like an abscess or cracked tooth.

•       Where on the tooth hurts? Discomfort on the tooth surface right by the gums usually indicates sensitivity, whereas discomfort between teeth or in other areas indicates something more serious.

•       How long does it hurt? Discomfort to cold things that doesn’t go away quickly often indicates irreversible nerve damage.

•       Does it hurt when you try to sleep? Teeth needing immediate treatment tend to get more painful when your body relaxes; fewer stimuli are being sent to the brain and so pain signals are harder to ignore. Sensitivity issues rarely hurt at night.

•      Can you see anything wrong in the mirror? Gum recession is very common in sensitive teeth. If you see any noticeable holes, cracks, discoloration, gum swellings, or sores, something more serious is likely to blame.

•       How bad does it hurt? Intense pain requires urgent treatment. Don’t be fooled by minor pain though; dental problems can start small and snowball into a very painful situation.

The purpose of the information in this post is not to cause worry or fear, but to inform. Too often we see problems left untreated for months and even years—sometimes with very costly and significant consequences. If you are experiencing discomfort in your teeth, we’d like to help you resolve your problem and improve your quality of life. If you believe you have sensitivity issues, and don’t have cause to suspect a “true” toothache from the above questions, buy a tube of Sensodyne toothpaste over the counter from any grocery store or pharmacy and try it for two to three weeks. If the problem persists, it is something that you should get checked. Few things can be as bothersome and painful as as a toothache, but please don’t hesitate to schedule an appointment if you see signs of more serious problems. As with most problems, dental or non-dental, early detection and treatment are critical.

Nicolas K. Young, DMD

Osteoporosis Medications

When visiting the dentist, every six months, you might notice certain questions that are consistently asked. One of these questions involves a group of medications called bisphosphonates. This group of medication is used in treating osteoporosis, or decreased density of bone tissue. These are very effective in helping to prolong the strength of weight bearing bones in the legs and hips. Osteoporosis makes these bones more likely to break. Breaking a bone is bad business and can have lasting effects. But breaking the bone of an osteoporotic spine or hip is more serious and can be life threatening. So, these medications are really important.

In some instances there have been reports of a condition called Bisphosphonate-associated Osteonecrosis (BON) of the jaw. This condition is seen in patients taking this type of medication. It is not very common but can be very serious. In almost all cases it is seen in patients taking this medication through an IV, while being treated for cancer. A very small percentage of cases were seen in patients taking the medication by mouth.

Here is a list of medications that are bisphosphonates: alendronate, ibandronate, risendronate and zoledronic acid. If you have had any history of taking any of these medications please inform your dentists. Dental procedures that involve any type of trauma to the bone can result in an increased risk of developing this condition. These include tooth extractions and any type of bone contouring. All other dental procedures are benign relating to this condition.

This definition of BON is taken from the Journal of the American Dental Association, volume 140, page 812.

BON is diagnosed in a patient who:

-has an area of exposed bone that persists for more than eight weeks;

-has no history of receiving radiation therapy to the head or neck;

-is taking, or has taken, a bisphosphonate.

For more information please see the link below.

http://www.ada.org/sections/scienceAndResearch/pdfs/patient_84.pdf

Dental Implants

So, You Need a Dental Implant . . . .

“We will need to take out this tooth.”

Few statements said in our office, or probably any other, are as shocking or seemingly life altering to our patients than this one. We have had grown men and women break down in tears after hearing this proclamation.

Especially if that tooth happens to be a front tooth.

On the other hand, there are very few things that we do that compare to the positive life change that a permanent tooth replacement offers.

Dental implants have become a very popular and predictable way to replace one or more missing teeth. When done correctly they are a relatively simple, painless way to replace teeth. Their use has ballooned over the years into multiple areas. My goal with this post is to address how they can be used to replace teeth with a fixed restoration (i.e. a crown or a bridge) and the advantages of doing so.

When a crown or a bridge is placed on an implant it offers several advantages to other tooth replacement options:

1. Appearance - Because an implant is placed in the bone, the crown that is placed on the implant appears to be growing out of the gums just like a natural tooth. This contributes to a natural look and, consequently, confidence in the appearance of one’s smile.

2. Hygiene - As opposed to other tooth replacement options implant hygiene and maintenance is very simple. Just brush and floss around the implant like you would around a natural tooth.

3. Preservation of Facial Structures - When an implant is placed and properly maintained, the hard and soft tissues around it are stimulated and maintained for the life of the implant. Without an implant these tissues generally melt away over time causing unaesthetic boney contours in the front of the mouth and decreased bone support.

4. Function - When a tooth is missing from someone's mouth one or more things can result:

๏ Supraeruption – This is when a tooth has no other tooth to bite against and it continues to grow until it meets something (the opposing gums? Another tooth?) to stop its growth. This can cause both an unsightly tooth smile line (crooked teeth) &/or problems with biting patterns leading to excessive tooth wear and potential TMJ problems. An implant will hold the opposing teeth in place so this doesn't happen ;

๏ Tipping -- The teeth in front of or behind the empty site can tip forward or backward into the empty site. Along with crooked teeth this can cause problems with biting patterns and the gums. An implant will hold adjacent teeth upright and help avoid these problems ;

๏ Improper Chewing & Digestion – Missing teeth compromise your ability to chew food well, to digest it, and consequently your overall nutritional health. An implant functions just like a natural tooth and restores effective chewing.

Once an implant is placed in the bone and the bone has fused to the implant a crown is fastened to the implant. The implant essentially becomes the “root” of the new tooth.

Please see the Patient Education Pamphlet from Zimmer Dental linked below for more helpful explanations and pictures.

If you have any of those empty spaces in your mouth, or need to have a tooth removed, and would like to consider having one or more implant(s) placed to replace it/them please know that we are very familiar with implants and have been working with them for more than ten years. We would be happy to help guide you through the entire implant process. Please give us a call to set-up an implant consultation to see if implants are right for you.

We hope to see you soon!