When everything is perfect, your teeth are covered by a
protective layer. The roots are covered by bone and gums, and the tooth above
the gum line is covered by enamel.
But when the protective covering is breached – e.g. by tooth
decay, acid erosion, toothbrush abrasion or by the gums receding – the underlying
layers are exposed. And that hurts.
In the centre of each tooth is the pulp, which contains the
nerves and blood vessels. Between this and the outer protective covering is the
dentine. Dentine is made up of thousands of tiny tubes (tubules) radiating out
from the pulp. These tubules are not sealed at either end. They contain fluid
which moves when exposed to heat, cold or sugar. This movement stimulates the
nerves in the pulp, causing pain.
If you have sensitive teeth, you need to take the following
steps:
1.Find out what is causing the problem – tooth decay,
a cracked tooth, gum recession, erosion or whatever. All of these require
treatment or the problem will get worse – so don’t be tempted just to ease the
sensitivity. You need to tell your dentist that you have a sensitive tooth or
teeth so that the cause can be accurately diagnosed and appropriately treated.
2.When a stable situation has been achieved with
no active destruction taking place, you may be left with some residual
sensitivity from uncovered dentine tubules. This is where sensitive toothpastes
come in. The older types of sensitive toothpastes contain chemicals such as potassium
citrate to soothe the nerves in the pulp. You need to use these regularly for a
few weeks to get a result.
The newer sensitive toothpastes, like Colgate
Sensitive Pro Relief, achieve a more immediate effect by sealing the end of the
dentine tubules. The benefit will increase with continued use.
Of course you don’t have to have
your teeth checked before you start using a sensitive toothpaste but the worry is
that, if you’re not having any discomfort, you might not bother to see the
dentist and an developing problem will get worse – eventually to the point
where the tooth is no longer saveable.
It’s a good rule always to treat
pain as a warning signal. Of course you want to get rid of it but you also need
to find out WHY it is there.
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Beware of
‘Before and After’ Photographs – there’s a reason they’re called ‘Mug’
shots
All
dentists, including me, use ‘before and after’ photographs to show
patients what can be achieved with various forms of treatment. That’s
perfectly valid and photos are very useful in this respect – but they
only tell part of the story.
Photos
shows you what the situation looked like before anything was done and
they show you how it looked immediately after treatment. They don’t tell
you if that patient suffered pain or any sort of disability because of
the treatment. They give you no indication what that smile is going to
look like a year later – or even the next day.
Before and
after pictures do serve a useful function. They show you what can be
achieved and they show you what sort of a job the dentist made of it in
purely cosmetic terms. They do not show whether the work was clinically
sound, or if it was the right thing to have done for that patient.
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Make sure you have something to eat before your dental appointment.
Some people still get confused about this and starve themselves before treatment - but you should only do this if you're having a GENERAL ANAESTHETIC (being put to sleep) or SEDATION.
In these situations, it's necessary to have an empty stomach (no food or drink for 3 hours before the procedure) in case you vomit under the anaesthetic.
In all other situations, you will feel stronger and more able to cope with whatever we throw at you if you have eaten normally.
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Tooth Care for the Older Person
In the not too distant past, most people were destined to lose their teeth well before retirement age. Now, thankfully, that is no longer the case. With proper care, and barring accidents, there is no reason why you shouldn’t keep your teeth for life.
Tooth and gum problems are much the same throughout adult life and require the same preventative measures and the same response in terms of treatment at whatever age they occur. So we won’t discuss those here. They will be covered in separate articles.
So what specific difficulties are you likely to encounter with respect to your oral health as you get older?
Essentially, these are problems that affect other parts of the body and limit an individual’s ability to look after his or her teeth and gums:
If you have trouble moving your hands or arms, it can make it difficult to clean your teeth properly but there is (almost) always a way. Ask your hygienist to devise a method of cleaning that will match your capabilities and meet your needs. This is her field of expertise and she will be able to help.
An electric toothbrush is often the answer for people with reduced dexterity. The handles are fatter and easier to grip than those of manual brushes and, once you’ve placed the head of the brush in the correct position, it does all the work for you.
If your eyesight is deteriorating, a good light and a magnifying mirror can make all the difference. Again, it’s wise to get professional advice specific to your individual needs.
Certain medical conditions, medications or radiotherapy can cause reduced production of saliva. Saliva helps protect teeth from decay and it increases the adhesion and comfort of dentures. Artificial saliva is available over the counter from most pharmacies but your dentist will be able to advise you as to what is most appropriate for you.
If you are housebound, you should contact your local Primary Care Trust (PCT) for a list of dentists who are equipped to provide home visits. If you require treatment that cannot be carried out in your home, they will be able to make arrangements accordingly.
I suppose this all boils down to the fact that, however difficult things may seem, there are things that can be done to make life easier. So please ask for help if you need it. That, after all, is what we’re here for.
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Your Teeth and Headaches
It is well known that pain from toothache and gum problems can spread to various parts of your head but are you aware that head and face pain can also arise from perfectly healthy teeth?
There are two main causes:
Occlusion - the way the teeth meet when they close together.
Parafunction - destructive habits such as grinding or clenching your teeth (grinding the teeth during sleep is also known as ‘Bruxism')
This isn't a small problem; in the UK, 1 in 4 people is affected to some degree.
Occlusion:
If your teeth don't fit together properly, it can cause problems with your teeth, you gums, your jaw joints (TMJs - Tempero-Mandibular Joints) the muscles that open and close your mouth, and the muscles that move your jaw from side to side.
Teeth
As with most things in the body, this is a two-way thing. If your teeth are out of line or broken down or missing or painful, it causes you to bite differently in order to avoid pain or to be able to chew. Similarly, if you bite abnormally, it puts strains on your teeth that they aren't equipped to deal with. This can make your teeth feel bruised and tender, it can make them loose and it can break fillings and shatter veneers.
Gums
The abnormal strains mentioned above will have a more dramatic effect on teeth that are already mobile, making them looser and speeding up gum recession.
TMJ
If your jaw joints click when you open your mouth, if they are tender or painful, or if you have difficulty opening or closing, it's likely that this is caused by either occlusal problems or parafunction - or both.
Muscles
If your jaw is not in the correct position, it forces the muscles that move your jaw to work abnormally. This can cause them to go into spasm (similar to cramp in your leg), leading to headaches, facial pain and stiff neck and shoulders.
Parafunction:
Grinding and clenching of the teeth is usually stress-related and often occurs during sleep. This causes pain, which is an extra source of stress, so you clench or grind more... and so on.
If you clench or grind your teeth when you're awake - perhaps when things go wrong at work or if you've been kept waiting at the dentist (which would never happen here, obviously), simply being aware of the problem generally solves it - because you can make the decision to stop. It's not so simple if it happens when you're asleep, though.
Clenching and grinding your teeth causes the same problems as those mentioned above for occlusion. If you have an unbalanced occlusion AND parafunction, the problems multiply because not only are you overloading the teeth and their supporting structures but you are doing it in directions they were not designed to withstand even at normal levels.
So what can you do about it?
Your dentist will be able to treat the treat the problem in most cases. If not, he or she will refer you to a specialist.
The dentist will ask questions such as : Are you particularly stressed at the moment? Do your jaw joints ever click or grate? Do you wake up with a headache or a sore face? Has a sleeping partner mentioned that you grind your teeth at night? Are you aware of clenching your teeth when you're concentrating on a difficult task?
Then the dentist will examine you, checking your bite, feeling how your jaw joints move, testing for tender muscles, looking for worn or damaged teeth and so on.
As with most problems in life, the best solution is to treat the essential cause. If this is an incorrect bite, it needs to be remedied and there are various ways of doing that - for example, by reducing high spots or replacing missing teeth. Some people get instant relief from these measures. For others, it can be a lengthy business.
When someone is clenching or grinding, it's less straightforward because stress is usually the cause and that is not always easy to eliminate. In the past, psychoactive drugs were sometimes used but that is rare these days because they bring their own set of problems.
If we can't eliminate the cause of parafunctional activity, we have to minimize its effect of the on the teeth and their supporting structures while trying to break the self-reinforcing habit cycle.
This is usually achieved by means of a bite guard, made to fit over either your upper or lower teeth. The bite guard is made of plastic and can be either soft or hard, depending on individual need. With a bite guard in place, it's impossible to clench or grind your teeth. This prevents the chewing muscles going into spasm and causing pain, either directly or by pulling the jaw joints into an abnormal position in their sockets. Some people may need to wear a bite guard permanently for sleeping but in many cases, all that's required is a couple of weeks to break the habit cycle. Then you can leave the bite guard out - but keep it safe in case you need it again. Unfortunately, this problem does tend to recur from time to time.
Bite guards are available over the counter but it is far better to have one specially made for you. A ‘one size fits all' guard can put more pressure on certain vulnerable areas and actually make the problem worse.
Discomfort can also be reduced by the application of heat (hot water bottle), anti-inflammatory analgesics such as Ibuprofen and, sometimes, physiotherapy.
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This one probably seems a bit simplistic but it is important.
In the last week, two patients have responded with shock when I told them their gums were in a bit of a state: ‘But I’ve been coming to see you and the hygienist every six months! What’s going on?’ (In other words, ‘Why haven’t you been looking after me properly?’)
Well, what’s been going on is the stretch of 180-odd days between those regular appointments. No-one should underestimate their own role in maintaining their oral health. The dentist can fix you up, the hygienist will get everything clean and show you how to keep it that way but, unless you actually DO what we advise you ON A DAILY BASIS, we are all wasting our time and you are wasting your money – and neither of us wants that.
(Obviously the ‘you’ mentioned here doesn’t apply to you personally. In fact, it applies to very few of the people who come to The Dentist in Town – so, well done. But if it prods just one person into being a little more pro-active about their health, then it has achieved something)
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Don't forget that your mouth does not exist in isolation. Problems in other parts of your body - and any drugs you might be taking for them - can have a big effect on the way we need to treat your teeth and gums. For example, some local anaesthetic agents can react unfavourably with some blood pressure tablets. But this is the tip of a very large iceberg, so please do not try to decide what is and is not relevant to tell us. If we are to avoid complications, we need to know about ANY other treatment you might be having.
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A patient recently told me that she found it hard to remain motivated to look after her teeth because they were ‘so horrible’. This shook me because I had been treating her for years and she had never expressed any dissatisfaction with her appearance. I had taken this to mean that she was happy with the way things were. She, on the other hand, presumed that, if anything were possible, I would have suggested it. While I was congratulating myself for not trying to sell her something I thought she didn’t want, she was suffering needlessly.
So this week’s tip is: Don’t resign yourself to having ‘horrible’ teeth. And if you want to know something, please ask (because, you know, I’m a man and we can be a bit insensitive sometimes) There is always something that can be done to improve an unsatisfactory smile and new procedures and materials are coming along all the time. The solutions to many problems that couldn’t be fixed satisfactorily 3 or 4 years ago are now routine. Some of the solutions may appeal to you and, for various reasons, some may not. Some are expensive but many aren’t and some things, such as teeth whitening, are MUCH cheaper than they used to be. It costs nothing to find out what your options are – and if we can’t help you, we will happily refer you to someone who can.
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In the real world, you are not going to stop eating everything that is bad for your teeth. Just remember the basic rule that the longer a harmful substance is in your mouth, the more damage it will cause. So, sweet things that stick to the teeth (gummy sweets, toffee) or that dissolve slowly in the mouth (mints, seaside rock) are far more harmful than, say, chocolate or crisps (at least, as far as your teeth are concerned).
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I've just realized that all the tips so far begin with "Don't". So, to be a little more positive (but no less bossy) let's start with a "Do"
Do remember to clean between your teeth. Unless you have gaps (at least 2-3 mm) between EVERY tooth, a toothbrush will not get in there adequately. You need to use an interdental cleaner. It could be dental floss (with or without a threader) tooth picks or interdental brushes. Our hygienists will work with you to find the cleaning method that works best for you and that you are most comfortable with.
By the way, if you use dental floss wrapped around your fingers, wrap it around your SECOND fingers NOT your index fingers. By wrapping the floss around your second fingers, you leave your index fingers and thumbs free to manipulate it in all areas of your mouth. If you’re not sure how to do this effectively, ask us and we’ll be happy to show you. ******
•1. Don't take newspaper reports of celebrity make-overs at face value. I used to work at a practice where we treated a lot of celebs and there was ALWAYS a deal on the price in return for publicity. If you read that some TV star splashed out £30,000 on a new smile, you can be certain that he or she paid no more than a fifth of that - maximum. The quoted figure is the most that the dentist thought they might be able to charge for follow-up business on the strength of the celebrity name - and then the paper probably doubled it to add to the impact of the article. Remember, celebrities have agents and agents don't get employed for being all soft and generous.So, if you fancy having something done, find out what it would really cost. You might be pleasantly surprised.
D
Don't underestimate the value of seeing the hygienist. Think of your teeth as buildings. The most beautiful and perfect structure will collapse if built on dodgy foundations. Your gums are the foundations and unless you keep them healthy your teeth will not last - no matter how much you spend on making them look beautiful with veneers, crowns, bridges or implants.
The hygienist will get your teeth immaculately clean and show you how to keep them like that. In the process, she will identify any problem areas and work out with you the best way for you to deal with those problems on a daily basis.
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Don’t ignore symptoms. This is one that most of us, including me, are guilty of at some time. If you have any lumps, discharge, discolouration, pain or sensitivity, get it checked out. It may be nothing but, if you don’t know for sure, you need to find out – and no-one is going to think you’re making a fuss if it turns out there isn’t a problem. I would rather have a hundred people being over cautious than have one person suffering in silence while things deteriorate.
H Here's a common scenario: a tooth becomes painful for a few days, then the pain eases off. It could be that the problem has gone away. Perhaps, say, a piece of apple peel got wedged beneath the gum and began to decompose there. The gum becomes inflamed but eventually the fragment of peel comes out or breaks down sufficiently for the body’s defences to mop up the debris and instigate repair. BUT it’s more likely that the pain was caused by the live part of a tooth (the pulp) swelling as it died. When the pulp is dead, the pain stops – until the dead tissue leaks out of the end of the root and the body defends itself by forming an abscess!
S So if your body is telling you something is wrong – please listen to it! Come along and see us. If it turns out not to be anything important, just think how relieved you will be. And if it is something requiring treatment, think how much worse it could have been if left to develop.
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D Don't eat or drink anything other than water after you've brushed your teeth at night. Saliva is your natural defence against plaque acid and bacteria. When you are asleep you produce much less saliva (hence ‘morning breath' - I really don't envy Prince Charming; no matter how beautiful Sleeping Beauty was, the woman had been asleep for a hundred years!) Less saliva = greater susceptibility to decay, so don't give those plaque bacteria a late-night snack.
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Don’t brush your teeth within 30 minutes of consuming any acidic food or drink such as fruit, fizzy pop or fruit juice. The acid softens the surface layer of enamel and makes it easily brushed away before it has a chance to remineralize from your saliva.
To minimize the acid damage, you should rinse your mouth out with water immediately afterwards – but don’t brush yet. Alternatively (or in addition) you can chew sugar-free gum to stimulate saliva production and dilute the acid.
It has been suggested that chewing antacids, such as Rennies or Gaviscon, would help, but I have been unable to find any evidence of research proving that this is effective throughout the mouth – and there are potential problems with long-term antacid use. If you would like to know more about his, go to:http://hubpages.com/hub/Tooth-Erosion---Do-Not-Use-Antacids
