PLAIN DENTAL PAIN


 

The most dentistry-challenged person in town knows what to do in the event of a true dental emergency. You get yourself to a dentist as soon as you possibly can. This is self-evident, not debatable, and cannot be ignored. Dental emergencies take command with severe, unrelenting pain and/or other dramatic symptoms, and will not go away no matter what home or over-the-counter remedies are tried.

This is not a discussion of dental emergencies. The subject here is less dramatic, which is a self-imposed problem because dental emergencies are the direct result of our ability to dismiss, ignore, and explain away the many indications our bodies provide to warn us that a true dental emergency is in the pipeline. The plain dental pains are our friends. Let’s get to know them.

COMES AND GOES

One of the features shared by many dental early warning signals is that they are intermittent. The come – often triggered by chewing, drinking, or some other stimulus – and then they go when the trigger is gone. The move on, and so, alas, do we. We shouldn’t.

SENSITIVE TEETH – CAUSES AND EFFECTS

According to the Academy of General Dentistry, about 40 million adults in America endure sensitive teeth. The pain is sudden, sharp, flashing, but subsides almost as quickly. The common triggers are exposure to foods or liquids that are hot, cold, sweet, or acidic, to cool air, or to pressure. Brushing and flossing can spark this pain.

The problem here is that tooth dentin has been exposed to these stimuli. Dentin is the layer of material normally covered and protected by tooth enamel. Enamel is unfeeling, but dentin’s structure has tiny tube-like features that channel into the pulp, where the nerves are. These, as far too many of us know from personal experience, are extremely sensitive nerves. Dentinal tubules act like tiny gun barrels, taking in stimuli at the outer ends and firing them directly at these nerves.

Dentin is exposed when tooth enamel is penetrated or worn away.

Ironically, it’s often our well-intended efforts at dental hygiene that damage the enamel and lead to sensitive teeth. Overly enthusiastic brushing and hard-bristled toothbrushes make us feel as though we’re really giving the teeth a jolly good scrubbing, but our teeth are not stainless steel and the enamel can’t withstand that kind of treatment very well.

Another irony is that some of the same foods that later on remind us we have sensitive teeth are among the culprits that cause the problem in the first place. Acidic foods promote enamel reduction. More irony: so does long-term use of some mouthwashes, which also contain acids.

Irony aside, anything that wears down, digs through, or breaks up tooth enamel exposes the underlying dentin and so opens us up to sensitive teeth. The habits of grinding or clenching teeth, trauma, and of course plain old tooth decay are usual suspects.
Receding gums and gingivitis are the other common gateways to exposing the dentin and root, respectively.

SENSITIVE TEETH – PREVENTION AND TREATMENT

The time to think about prevention is ASAP. For yourself, and for your children.
The steps to take practically suggest themselves, so the challenge is identification of the need and then execution. Learn to brush with a light touch. Use a soft toothbrush, and make sure your toothpaste doesn’t contain abrasives for “whitening power”. It’s your enamel. Don’t wear it out.

The rest of prevention is bundled into the general program of good dental health. Consistent home hygiene, a lifestyle that’s friendly to oral health, and regular dentist checkups and cleanings.

Treatment options are, unfortunately, fairly limited. Eroded enamel will never grow back. Receded gums won’t either, though there is a surgical option called gum grafting that’s tried in very serious cases. Gingivitis is also generally considered irreversible.

There are management tools, however. First, adopting the preventative measures mentioned here to minimize further progression of the problem. And second, consider adopting a toothpaste containing potassium nitrate, which numbs tooth nerves, and stannous fluoride, which bolsters the enamel barrier.

COMES AND STAYS

Now, let’s discuss the kind of dental pain that doesn’t let you dismiss it quite so easily. These are aches and pains which may or may not be triggered by the kinds of stimuli associated with sensitive teeth, but in any case linger on after the stimulus is over or, in the worst case, don’t go away at all until something is done. OTC pain-killers may well work for them for a while, which is not all good news. Be not led into temptation. They won’t work forever.

TOOTHACHE!

By the time you have a toothache, the countdown to a dental emergency has most likely begun. What’s less certain is how much time is left on the clock. It’s very certain it’s time for a trip to the dentist. Sooner, not later.

Tooth decay and caries are the common prologues to toothaches. Once plaque has eaten its way through the enamel, it meets little resistance before hitting the pulp and nerves. Inflammation of the pulp (pulpitis) puts physical pressure on nerves and adjacent soft tissues, and the risk of infection greatly increases. The final chapters in this unhappy story may well include abscess, or worse. People have ended up in the ICU at the end of a cascade that began with a little cavity.

The relentless trajectory of tooth decay can be intercepted early, with less unpleasantness and expense, or late – sometimes with much more of both. Prevention is the ideal cure, and the best prevention is – you guessed it – consistent home hygiene and periodic dentist checkups and cleanings, plus a dental-friendly lifestyle.

ELSEWHERE

Strange but true: things are not always as they seem. Sometimes, what feels like dental pain has nothing to do with anything going on in your mouth.

Referred pain is felt in one part of the body, but is caused by things going on elsewhere in the body. This is possible because of the structure of the human nervous system and the way it functions. It’s sort of a bug.

Sinusitis sometimes causes painful sensations in the upper teeth, because their roots are tucked in very close by and can be subjected to physical pressure from infected and inflamed sinuses.

There are two types of neuralgia, affecting nerves in the face and skull, which sometimes are felt as a toothache.

Maybe the strangest and most serious cases of referred dental pain are symptoms of cardiac and/or pulmonary problems. It’s not very common, but it can happen that the sensation of a toothache is the initial or even the only symptom of a heart attack.

TAKEAWAY

Dental emergencies. Let’s not go there. It’s unpleasant, in the best case. Nothing in our mouths should ever hurt very much, very often, or for very long. Dental pain that is eye-opening-severe, or persists, or recurs is a sign that something is wrong. In a paradise of impeccable hygiene and lifestyle, with checkups and cleanings at intervals precisely tuned to individual’s present and future needs, things would never get to that point.

This is the real world. Stuff happens, even when we take care. The plain dental pains we discussed here are like a second chance to set things right before they head further south. When life offers you a second chance – take it.