Tooth Sensitivity ....commonest dental problem

Dentinal hypersensitivity, or tooth sensitivity, is a common dental problem. It is experienced as a painful sensation in the teeth, often occurring after eating or drinking something hot, cold, sweet or acidic. Most sufferers are between 20 and 50 years old. Tooth sensitivity can start to happen when the softer, inner part of the tooth called ‘dentine’ becomes exposed. Dentine lies under the enamel and the gums. 

Thousands of microscopic channels run through the dentine towards the centre of the tooth that link to the nerves on the inside of the tooth. When dentine is exposed, these nerves are easily stimulated by external triggers (such as a cold drink), resulting in the characteristic short, sharp sensation of tooth sensitivity.

Common causes of tooth sensitivity include:

Aggressive brushing  

Toothbrush and/or toothpaste damage may be the most frequent cause of sensitive teeth. By brushing too hard and/or using abrasive toothpaste, you may be removing tooth structure at the necks of your teeth resulting in pain, especially to cold drinks, food, and air, but also to physical pressure, hot, sweet and sour.

Lack of a Twice-Daily Routine

Taking a laid-back approach to brushing, flossing and rinsing can let tarter build up along the gum line leading to advanced gum disease there by exposing root surface and a potential cause of tooth sensitivity.   

Cracked tooth

A crack or chip in your tooth may expose the underlying dentin or may fill with bacteria from plaque, causing the nerve to inflame.

Teeth grinding

over time, grinding or clenching your teeth can erode enamel and expose dentin.

Gum disease 

You may have noticed that your gums are starting to pull away from your teeth. This means your gums are receding, exposing sensitive nerve branches living in the tooth’s root. Inflamed or sore gums may cause sensitivity due to the loss of supporting ligaments, which exposes the root surface leading directly to the tooth. Harsh brushing can be culprits.

 Or if you have advanced gingivitis, that is periodontal disease, the gums are moving away from the tooth, exposing the roots.

Tooth decay

Gum disease or other local factors can cause lodgment of food thus resulting in decay which is also a potential cause of tooth sensitivity. Since you see no decay on top of the tooth, you might not be aware a cavity exists, but it can create tiny holes near the gum in front or the back of the tooth.

Tooth whitening 

Using products with peroxide or baking soda can seriously aggravate exposed roots or dentin.

Acidic Diet

If you frequently eat sharp-tasting and/or sour food and drinks, this could be stripping away tooth enamel. Check your regular diet for highly acidic foods like citrus fruits, tomatoes, yogurt, sour cream, aged cheeses and acidic drinks such as orange juice, sports drinks, wine and carbonated drinks including soda, and aim to limit your intake.

5. Sugary Diet

Loading up on sugary treats such as cookies and cake can prompt bacteria to grow, leading to eroding gums that expose sensitive areas of the teeth.

OR

It is possible to experience tooth sensitivity after routine dental procedures such as the placement of a filling or crown, tooth restoration, or even teeth cleaning. Such sensitivity is temporary

Measures in handling sensitivity

Toothpastes for sensitive teeth

Desensitizing agents (there’s loads of different ones on the market now) work by blocking off the dentinal tubules, so that the nerves don’t get stimulated.

They work a lot better by gently massaging the paste or gel into the sore spot with a finger. Do not rinse it off with water or mouthwash. It may take several weeks before the desired effect is achieved.

High-fluoride mouthwashes

You may want to try a non-alcohol mouthwash with a high fluoride content instead. Some of them are specifically designed to reduce sensitivity. They should be used twice a day after brushing – one of those times should be just before you go to bed, so the mouthwash doesn’t get rinsed away when you drink or eat something.

Swish the mouthwash back and forth between the teeth for at least 30 seconds, and do not rinse with water afterwards.

Recaldent

Now there are also available tooth remineralizing agent which have also proved to be beneficial (these are quite expensive though).

Professional Intervention

What can dentists do about sensitive teeth?

Only a dentist can confirm you have dentinal hypersensitivity. If you are experiencing any dental problems, always consult your dentist for advice. If you have dentinal hypersensitivity, you can help to minimize further exposure of the dentine, care for your sensitive teeth and relieve the  symptoms by making some simple changes to your daily oral care routine and dietary habits.

• Depending on the cause of the sensitivity, your dentist may be able to paint special fluoride gels, rinses or varnishes onto the affected teeth
• If this doesn’t help and you can’t put up with the sensitivity, your dentist can seal or put bonding around the neck of the tooth, to cover exposed dentine. You should try the other options first though.
• If you grind your teeth, ask your dentist about the possibility of having a mouthguard made to wear at night.
• If there is a hidden caries probably it needs to filled.

 

Rules for Sensitive Teeth

Continue to follow a good brushing and flossing routine to maintain the good health of your teeth. Use a soft bristle brush and brush gently. Try desensitizing toothpaste. There are several different brands for sensitive teeth. With regular use, you should notice a difference in the degree of sensitivity.

Finicky about fluoride in dentistry....facts to explore

Dental decay is, by far, the most common and costly oral health problem in all age groups. It is one of the principal causes of tooth loss from early childhood through middle age. Decay continues to be problematic for middle-aged and older adults, particularly root decay because of receding gums. Older adults may experience similar or higher levels of dental decay than do children. In addition to its effects in the mouth, dental decay can affect general well-being by interfering with an individual’s ability to eat certain foods and by impacting an individual’s emotional and social well-being by causing pain and discomfort. Dental decay, particularly in the front teeth, can detract from appearance, thus affecting self-esteem and employability. In addition to impacting emotional and social wellbeing, the consequences of dental disease are reflected in the cost of its treatment.

Again, the goal must be prevention rather than repair. Fluoridation is presently the most cost-effective method for the prevention of dental decay for residents of a community

What’s fluoride ????? and it’s spotlight effect in dentistry

There are several examples of how everyday products are fortified to enhance the health— iodine is added to salt, folic acid is added to breads and cereals, and Vitamin D is added to milk.

Fluoride is not a medication, but rather a nutrient found naturally in some areas but deficient in others and when present at the right level, Fluoride is often called Nature’s Cavity Fighter and for good reason. Having 0.7 to 1.2 parts of fluoride for every million parts of water has been shown to have the best effect. Fluoride in drinking water has two beneficial effects: preventing tooth decay and contributing to healthy bones.

Fluoride a natural guardian

It is important to note that dental decay is caused by dental plaque, a thin, sticky, colorless deposit of bacteria that constantly forms on teeth. When sugar and other carbohydrates are eaten, the bacteria in plaque produce acids that attack the tooth enamel. After repeated attacks, the enamel breaks down, and a cavity (hole) is formed. There are a number of factors that increase an individual’s risk for dental decay:

§  Snacking habits

§  Poor oral hygiene

§  No (or little) access to a dentist

§  Sticky/sugary/carbohydrate diet

§  Increased consumption of fruit juices/ soft beverages

§  Bridges, crowns, braces, and other restoration procedures

§  Irregular/ misaligned teeth

§  A history of tooth decay (cavities).

How fluoride plays its role?

It potentiates its effect in broadly 2 ways

·         Systemic/ through our body

·         Topical/ applied directly to tooth

When Is Fluoride Intake Most Critical?

It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. This is the time frame during which the primary and permanent teeth come in. However, adults benefit from fluoride, too.

Systemic fluorides are those ingested into the body. During tooth formation, ingested fluorides become incorporated into tooth structures. Fluorides ingested regularly during the time when teeth are developing (pre-eruptively) are deposited throughout the entire tooth surface and provide longer-lasting protection than those applied topically. Systemic fluorides can also give topical protection because ingested fluoride is present in saliva, which continually bathes the teeth providing a reservoir of fluoride that can be incorporated into the tooth surface to prevent decay.

Children who have fluoride when their teeth are developing tend to have shallower grooves in their teeth, so plaque (thin, sticky film of bacteria) can be more easily removed.

Topical fluorides strengthen teeth already present in the mouth (posteruptively). In this method of delivery, fluoride is incorporated into the surface of teeth making them more decay-resistant. Topically applied fluoride provides local protection on the tooth surface. Topical fluorides include toothpastes, mouthrinses and professionally applied fluoride foams, gels and varnishes. As mentioned previously, systemic fluorides also provide topical protection.

Fluoride is said to protect the teeth in two ways:

§  Protection from demineralization - when bacteria in the mouth combine with sugars they produce acid. This acid can erode tooth enamel and damage our teeth. Fluoride can protect teeth from demineralization by making teeth resistant to acid attack.

Fluoride disrupts the process of tooth decay by:

§  Providing an environment where better quality enamel is formed, which is much more resistant to acid attack

§  Reducing the bacteria's (bacteria in plaque) ability to produce acid, a major cause of tooth decay.

§  Remineralization - if there is already some damage to teeth caused by acid, fluoride accumulates in the demineralized areas and begins strengthening the enamel, a process called remineralization.

Relation between Dental issues and General health………..Fact/Myth????

Yes, teeth infection can really turn out to be serious issues. It’s hard to imagine how a toothache could turn deadly—but it can. Even mild or moderate dental discomfort quickly turns into a serious condition, known as an abscess - a pus-filled infection inside the tooth or between a tooth and the gum. 

No one has a precise explanation for the trend, but some experts speculate that the high cost, pain phobia, lack of awareness of dental treatment prevent many people from seeking routine dental care and perhaps delaying treatment when a dental problem occurs/arises.

Dr. Erin Sutton, a Fort Walton Beach dentist, pointed out the infection could either move to bone marrow or the bloodstream, causing sepsis and affecting major organs.

“Toothache leads to multi-organ dysfunction” Ms Mala, 26 yrs, lands in ICU, unable to drink, eat or speak. Never had she, imagined that lack of oral hygiene could prove so disastrous. What started as a simple toothache landed with multi-organ dysfunction. Mala survived three mild cardiac attacks and was on ventilator for two months before recovery.

When a toothache and swelling in her right jaw bothered, she, like any other youngster, thought pain killers would be the cure. However, those didn't help her in fact, the ache led to dental cellulitis and the swelling made its way to her throat, blocking the passage. An examination revealed the infection had spread to her vital organs and she was diagnosed with multiple organ dysfunction syndrome. There was a shower of bacteria on her lungs and fluids in the lungs started accumulating around her heart. Besides, there was a clot in a vein that connects the heart, head and the neck region. Oral hygiene was compromised, leading to the spreading of anaerobic bacteria,"

“Ms Mala had a lot of cavities and didn’t bother to take care of them. It hit her only when she lost speech, couldn’t lie down and wasn’t even able to swallow water. It’s a rebirth for him.”

(http://www.thequint.com/health-fitness/2016/07/19/bengaluru-womans-ignored-dental-problem-toothache-led-to-multi-organ-dysfunction)

Root canal treatment??....Can that be avoided….A simplified approach.

Teeth are the hardest part of our body. Significantly, teeth plays a role in chewing (old concept), while the newer concept says that they helps to sense, feel the food which is missing in artificial teeth and essence of teeth is in defining the individual’s personality. Presently, cosmetic and esthetic factor is one of the most prime factors in defining the health of oral cavity.

Building blocks for teeth are calcium and phosphorous, which are prone to dissolve under acid, formed during the fermentation of stuck up food. Tooth has layered pattern, ‘enamel’ on the top followed by ‘dentin’ and the deepest part being the ‘pulp’. Pulp is a type of tissue with rich supply of blood and nerves. Function of pulp is creating hard tissue of tooth during development, however once tooth is fully matured it can survive without pulp as then tooth continues to be nourished by the surrounding tissues.

Natural tooth when exposed to prolonged acid attack from dietary sources and stuck up food, there is dissolution of tooth and cavities are formed. It’s recommended to get those cavities filled up as early as possible to avoid large destruction of tooth.

Stage I- In case of gross destruction of tooth the pulp gets infected with bacteria and all different types of microbes and the oral food taken has the potential role in increasing inflammation.

Symptom –pain /sensitivity but not continuous

Stage II- Inflamed pulp with due course of time gets dead and necrotized and pus/abscess is formed.

Symptom – severe uncontrollable pain with sleepless nights, swelling, if still unattended, fever too.

So from here doctor is left with 2 options

1. Tooth extraction – tooth is lost and requires artificial replacement

2. Root canal treatment/therapy – natural tooth is preserved in an uninfected state- Best option to select from patient’s aspect.

Saving the natural tooth with root canal treatment has many advantages:

·         Efficient chewing

·         Normal biting force and sensation

·         Natural appearance

·         Protects other teeth from excessive wear or strain 

Prevention

Initially in a usual course, when tooth erupts, its free from defects like cavity, but it requires time to mature so that it can be resistant to acid attack from different dietary sources. Few easiest ways to get rid of all this mess

Diet modification – prevent frequent exposure to sweet food and beverages, have your favorite sweets in a single go to your heart’s content.

Fluoride application—the easiest way to prevent and stop the caries process

Dental sealants – blocks some of the deep pits and grooves in tooth this no chances of food stuck up.

Professional cleaning/scaling

Tooth brushing and oral health

It is widely accepted that toothbrushing plays an important role in the prevention of tooth decay, a significant goal to ensure the overall quality of health for all. Toothbrushing is considered fundamental self-care behavior for maintenance of oral health. Even though we’ve been brushing and flossing our teeth for years and years, many of us are surprised to learn that we’re not doing it properly.   When you brush your teeth, you help remove food and plaque — a sticky white film that forms on your teeth and contains bacteria. Brushing before bedtime is especially important, in order to prevent plaque and food particles remaining in contact with the teeth throughout the night.

More brushing makes teeth healthier.

Areas where cervical abrasion is appreciated

Excessive brushing causes tooth wear due to the abrasive in toothpaste, specially at the neck of tooth, there by inviting dental issues. Between twice a day brushing, rinse is the safe alternative; adding sugar free chewing gum also enhances the saliva secretion after meals thus helps in attaining the pH of oral cavity towards neutrality in less span of time, but not a substitute.

Should brushing and flossing should be avoided in bleeding gums?

 

    

No, rather bleeding is an indicative and protective sign thus appraising that disease has moved to advanced stage where professional help is required. Professional treatment rendered is "SCALING" (deep cleaning in gums), followed by polishing (makes tooth surface smooth shiny, by removing stains and scratch line, thus reduces the area for bacterial attachment) and fluoride treatment (makes tooth more resistant to decay and kills the remaining microbes) as and where required.