MANAGEMENT OF TOOTHACHE

Learning Resource Materials

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Severe

Self-instructional Program on Toothache

PHYSICAL EXAMINATION OF THE TOOTH

GUIDELINES

GENERAL NOTES

NOTES ON DENTAL HEALTH

Notes compiled by Dr. Reynaldo O. Joson, 1995

From:

Teeth, Gums, and Oral Mucosa

Walker WB

In Clinical Methods

Walker HR, Hall WD, hurst JW

2^nd ed USA, Butterworth (Publishers) Inc. 1980

Your Health Guide, 1994/1995

DENTAL HEALTH AND OVERALL HEALTH

A normal health dentition functioning in a healthy oral cavity is critical to the patient’s nutritional well-being.

Anything that interferes with mastication at the beginning of the digestive process only makes function of the patient’s other systems more difficult.

Early recognition of this fact can often be the critical factor in rectifying future problems. This often falls to the physician since many patients never visit a dentist or seek dental care until it is too late both for their dentition and certain aspects of overall health.

TEETH FOR A LIFETIME

In the old days, old age was associated with toothlessness and the wearing of dentures. This is no longer true. All you need is to take good care of your teeth and they will last a lifetime.

Permanent teeth are meant to last a lifetime. So take good care of them.

There are 32 permanent teeth, 12 more than the primary teeth. As early as the age of 6 years, the first permanent molars erupt behind the second temporary molars. Because they don’t replace the primary or temporary teeth, these first permanent molars are mistaken for temporary teeth. First permanent molars should be given equally extra good care, as they are the key to good occlusion.

Toothbrushing and flossing help to keep the teeth and gums from developing plaque and prevent plaque buildup and hardened plaque or tartar. Toothbrushing also helps to massage the gums to maintain its health and integrity.

CARING FOR THE CHILD’S TEETH

Do you know that nine out of ten children have tooth decay?

This is especially true for children from 2 to 6 years old who have improper dietary and dental habits.

We could lessen this ratio by caring for our children’s teeth and by teaching them the proper means to keep their teeth healthy and strong.

PLAQUES, DENTAL CARIES, AND PERIODONTITIS

The daily diet plus the mineral constituents of the saliva lead to the formation of dental plaque, which consists, for the most part, of bacteria with a scattering of leukocytes, macrophages, and epithelial cells contained within an amorphous ground substance matrix. The plaque is soft at first and may be brushed away with soft toothbrush. About 2-14 days after the formation of soft plaque, the precipitation of calcium salts begin to harden the plaque until it becomes hard dental calculus.

Numerous factors contribute to the amount and quality of plaque that patient generates; diet, pH of saliva, age, sex, and oral hygiene are but a few of the variables that are thought to influence plaque formation.

Current dental research indicates that plaque, sugar, and streptococci must all be present and in sufficient quantities before dental caries can be initiated.

If plaque accumulates near the gingival attachment, especially in the 3-mm normal gingival pocket, it becomes a source of chronic irritation. This eventually leads to chronic inflammation of the gum tissues with resultant downward migration of the gum attachment. This in turn lead to a progressive loss of bone, deeper gum pockets, accumulation of more bacteria including anaerobic strains in deeper pocket, mobile teeth, and bleeding gums. The common term for these signs is “pyorrhea”. It may occur in only one area of the mouth or throughout the dentition; it may occur early in childhood or after approximately 40 years of slow buildup.

Periodontal pain due to chronic or acute periodontal disease is generally characterized as an ache or pressure-related ache in contrast to the “heart-throbbing” quality of a dental pulp pain or classic toothache. If allowed to encroach on the dental pulp, decay leads to pulpal necrosis with resultant death to the neurovascular component of the tooth. Necrosis of the dental pulp usually begins at the apex of the root where the foramen is small and therefore the blood supply most vulnerable. At this time, the pain is usually of the “heart-throbbing” nature characteristic of a vascular component which is exactly the effect of necrosis is having on the vascular component of the tooth. If allowed to progress further, the necrosis results in an abscess at the apex of the root.

Accumulation of purulent exudates at the root of the tooth continues until relieved by root canal therapy or tooth extraction or until erosion of nearby bone opens a fistula, usually on the outside of the dental arch because buccal bone is thinner than lingual bone.

Sometimes the first sign of an abscess with resultant cellulites can be a large swelling or fistula on the face near the apex of any of the teeth. This is not uncommon since frequently the apex of certain teeth are below the attachment (or above on the maxilla) of the buccinator, mentalis, myelohyoid, or other muscles, and the easiest avenue for the fistula is through subcutaneous tissue directly onto the face rather than through muscle attachments back into the oral cavity.

TOOTHACHE

Common causes of toothache:

1. The pulp or nerve center in the tooth is inflamed.

2. Fractured (broken) tooth.

3. Dental abscess (collection of pus in the gums over the effected tooth).

To prevent accidental fracture of the teeth, do not bite hard nuts, bones, or crab shells, and ice.

TOOTH DECAY

Tooth decay is usually found on tooth surfaces where food stagnates and which are hidden from the mechanical action of the tongue and the flushing action of the saliva. These are also areas which the toothbrush cannot reach. The pits and fissures of biting surfaces of the back teeth, the cheek surfaces of the last molars, and the areas between teeth are most prone to decay. A decaying spot on a tooth could possibly be there for as early as 6 months or 1 to 2 years before being detect clinically.

Symptoms of tooth decay:

1. Tooth sensitivity to hot and cold stimuli

2. Tooth cavity ( hole)

3. Change in tooth color such as darkening of enamel

4. White spot between teeth

5. Pain or toothache which is a late symptom

Tooth decay begins when bacterial plaque, which clings to the teeth, ferments sugars to produce acids. Acid erodes into the enamel (outer layer of the tooth), allowing minerals to pass out of enamel into the saliva, and results in softening of the surface enamel.

Bacterial plaque + sugar ---------> acid --------------> erode enamel

Prevention:

Brush teeth after meal.

Floss between teeth once a day.

Avoid sweet sticky foods

Have regular dental checkups every 6 months.

A diet low in refined sugar helps prevent tooth decay. So cut down on cookies, sweets, chocolates, sweet drinks, and pastries. Sticky sweet foods like cookies that lodge in the teeth are worse than sweet drinks that do not stay long on the teeth. If you must take these foods, brush your teeth right away or at least rinse vigorously afterwards.

ROLE OF FLOURIDE

Flouride acts in three ways to protect the teeth against decay.

1. Flouride in the drinking water is absorbed readily by developing and newly-erupted teeth from the birth of the child up to 12 years of age. It gets incorporated into the teeth during tooth formation, resulting in harder and more decay-resistant teeth.

2. Flouride also works on the bacterial plaque. If high concentrations are applied to the teeth by a dentist, the growth of bacteria on tooth surfaces can be reduced and organisms killed. Lower concentrations, as in toothpaste, have an anti-enzymatic effect that results I reduced production of acid, therefore, decreasing the incidence of tooth decay.

3. Flouride in the saliva and from other sources like drinking fluoridated water and using toothpaste with fluoride allows fluoride in uptake by the enamel and therefore inhibits erosion of enamel.

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