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Maybe It Will Go Away

These are without doubt the most dangerous words in the English language. Don’t wait to see if it will go away… call us as soon as possible. We can help!

When something isn’t right… when there is an awareness of a dental problem the best plan is to get it checked out as soon as possible. These seemingly “little” problems can escalate rapidly into intensely painful problems and can progress to situations that can be difficult to get under control.

When can a dental problem be life threatening? If you have an infection around a tooth or gum especially in the lower jaw, the infection can spread downward into your neck and can cause enough swelling to cut off your airway. Don’t wait for that to happen! If you do feel that there is a possibility of swelling down into your neck do yourself a favor and go immediately to your nearest hospital emergency department where you can be helped.

Regular dental care will certainly minimize the chances you’ll have a dental emergency, but even with the best of care, problems do happen.

The inside of the mouth is a hostile environment. A lifetime of chewing food, presence of sugar, clenching, sugary drinks, grinding, sugar, stomach acid reflux, more sugar, medicines that dry up saliva production, mouth breathing, combine this with sometimes less than adequate home care and you have a very hostile environment for teeth. I hope you “get” the emphasis on sugar… it really is “poison” for teeth!

So, it is not out of the realm of possibility that a tooth will break. If a tooth breaks, it will likely be sensitive, but sometimes it is not. If it is not sensitive… it might be okay, right? … wrong, a fractured tooth is a problem. It cannot grow back, it cannot repair itself. A fractured tooth is now open for attack by all the bacteria in the mouth. Eventually the fractured tooth can decay leading to infection, gum disease, pain, abscess, tooth loss, difficulty chewing, tooth migration, a gap in your smile, and unwillingness to smile because of embarrassment.

We want to have a chance to repair that broken tooth as soon as possible. It is our goal to get you in for an evaluation and treatment as soon as possible. We can often get you in the same day that you have a problem to assess the nature of the problem and to begin treatment to ease your pain, reduce symptoms and to begin repair of the problem.

Symptoms not to ignore:

Cold sensitivity:

Teeth are supposed to be able to feel cold. It is not an emergency if you are outside in Maine on a cold day and your teeth are sensitive to the sub-zero air… However, if there is one tooth that is more sensitive to cold than others, it often means that there is something causing the pulp or nerve center of the tooth to be inflamed. Inflammation causes swelling and inside the confines of the place where your tooth pulp lives there is no room for swelling! Add to this if you place cold on the tooth (maybe ice cream or a cold drink) it will make the tooth shrink microscopically putting painful pressure on the inflamed nerve.

What to do? A number of things can cause a tooth to be inflamed: recent dental work, clenching/grinding teeth, gum recession and exposure of the root surface, a cavity, a failing filling or crown, biting on something hard, a crack or fracture in the tooth. These are some of many possibilities for reasons for a cold or temperature sensitive tooth. Sometimes it is not easy for the dentist to find the direct cause, but it is important to have the dentist check out the situation especially if the condition has lingered for more than two weeks. Many temporary inflamed pulps will resolve within a couple of weeks… If it lasts longer or becomes more sensitive… come and see us!

Heat sensitivity:

As with cold sensitivity (see cold sensitivity above) a tooth is supposed to be able to feel heat. And, with inflammatory changes in the pulp of the tooth, there may be hot and cold sensitivity in a pulp.

There may be a difference though that may be significant in the instance of heat sensitivity. If the pain is immediate and prolonged, it may mean that the tissue in the pulp of the tooth has advanced to such a state that the pulp tissue is dying. This is definitely a situation that you do not want to wait. Make an appointment to come in as soon as possible to have the tooth evaluated!

Sweet sensitivity:

Although the network of nerve tissues throughout the interior of a tooth is vast, it is very well contained and protected as long as there is no break in the surface of the tooth. Sweet sensitivity is a pain response to the presence of sugar and represents an exposure of the network of nerve endings to that sugar stimulus.

Most often sweet sensitivity is found where there is a cavity in a tooth or a leak or gap around a filling or crown. As tooth structure breaks down from bacterial and acid invasion, these nerve endings become exposed and certain chemicals can become a painful stimulus or “sweet sensitivity.”

Also, if the gum tissue has receded exposing large areas of root surfaces of teeth these areas can become sweet sensitive as well. Most of the time this exposure occurs over time and so these micro pores in the tooth surface become plugged with debris so the nerve endings are not exposed. But, tooth grinding, abrasion, and acidic food or drinks can open these pores and allow the tooth to become sensitive to many things including sweet.

No matter what… sweet sensitivity is not a normal symptom and it should be investigated as soon as possible… Sweet Sensitivity? Call for an appointment!

Pressure sensitivity:

During normal chewing, forces on teeth can be in the range of 20 – 80 psi. This is a considerable amount of force that is generated by our muscles and we are generally not even aware of the force unless there is a problem. Forces that are placed on our teeth at other times, say for instance while clenching our teeth or grinding (bruxing) during sleep can be far greater… in the range of 300 to 3000 psi.

The extreme forces that occur on teeth during sleep are the forces that contribute to wearing down of teeth and also leading to crack formation in teeth. The wear and tear of sleep bruxism can lead to a lot of damage and can ultimately be a source of pressure sensitivity.

Teeth that have been weakened by cavities, and subsequently fillings, do not withstand those extreme forces very well and can become cracked and therefore sensitive. If gum disease is present and there has been considerable bone loss around the roots of teeth, this can also contribute to pressure sensitivity.

There is yet another situation that may sometimes be a factor in pressure sensitivity. If a person applies heavy muscular pressure to the muscles that are used for chewing over long periods of time, as is the case when a person habitually clenches their teeth while sleeping, small “trigger points” can develop in muscles that when stimulated can refer pain to certain teeth.

Tooth sensitivity to pressure is not a normal symptom and it should be investigated as soon as possible to find out the cause. Call for an appointment!
Pain when chewing:

As is the case with pressure sensitivity, teeth should not hurt when chewing normal foods. Teeth are designed to withstand tremendous pressures and unless there is something wrong, they should not hurt.

Cracks can occur in teeth than when pressed on can cause pain. This happens along the crack as the pieces move against one another. Sometimes the first symptom is when you bite on something hard or something that you don’t expect… a bone fragment or even a raspberry seed.

Old silver fillings are not “bonded” to tooth, when they were put into the tooth the dentist would place small indents or undercuts in the wall of the tooth to hold the silver in. Over time these undercuts can allow weakening of the tooth leading to cracks. The bigger the filling, the more possibility of cracks occurring. At the first sign of chewing pressure sensitivity on one of these teeth with old silver fillings, it’s time to have it checked.

Muscles that are fatigued from heavy clenching all night can be very sore when it comes to time use them to chew with. Clenching at night is often related to obstructive sleep apnea or other breathing problems while asleep. Tightening the “clenching” muscles also tightens the pharyngeal muscles used in maintaining an open airway. If you are having this kind of problem it’s very important that you seek care. As dentists we are not allowed to diagnose sleep apnea, a potentially severe health problem, but we work together with physicians in the treatment of these disorders and are happy to point you in the right direction for diagnosis and treatment of sleep disordered breathing problems.

Bleeding gums:

Pink toothbrush bristles are not normal. Bleeding gums are not normal.

The most likely cause of bleeding gums when brushing or flossing is because of gum disease. The CDC acknowledges that probably more than 50% of all American adults have some form of gum disease. Gum disease can be seen as a mild case of “gingivitis” (inflamed gums) all the way to the extreme of severe periodontitis (severe gum disease with bone loss and tooth loss). Quite often there may be absolutely no pain involved in any of the spectrum of this disease. It is difficult to understand how a disease process such as this comes with little or no pain. It is only through vigilant pursuit of reducing gum disease that we will overcome the bleeding.

The physical sign that possibly differentiates the bleeding gum scene of gum disease from other possible health problems is that the bleeding occurs when brushing or flossing. In other words it’s in the physical activity of scrubbing the teeth that we see the bleeding occur.

It is important to note that bleeding in the mouth that occurs spontaneously, that is without the activity of cleaning teeth or eating, may have serious health consequences. Spontaneous bleeding may be due to the presence of oral cancers or to blood clotting disorders or even leukemia. So no matter what the cause of bleeding gums, it is vitally important to have it evaluated!

Swelling:

Swelling is a sign of infection. There are no situations where swelling is not a significant problem. All swelling must be taken seriously without delay. Significant swelling that affects the lower jaw or the neck can be life threatening. The accumulation of pus in the spaces around the neck can restrict breathing and cause suffocation. For obvious reasons, if selling should ever encroach on the airway, the local emergency department must be consulted immediately!

Any swelling must be diagnosed as soon as possible so that proper treatment can be begun in order to avert possible grave consequences.

Spontaneous Pain:

If one has risked to take the chance that “maybe it will go away”… the result may be that a minor problem will become a major problem.

Spontaneous pain, pain that comes along with no provocation, is usually a sign that one has waited too long and that a serious tooth infection is at hand. Wait no longer! Call for an evaluation appointment as soon as possible!

Fractured tooth:

When a piece of tooth comes off it is cause for immediate distress. No one expects this to happen. There may be immediate pain, or oddly, there may be no pain. Regardless, a fractured tooth needs to be evaluated as soon as possible. A fractured tooth is a problem. It cannot grow back; it cannot repair itself. A fractured tooth is now open for attack by all the bacteria in the mouth. Eventually the fractured tooth can decay leading to infection, gum disease, pain, abscess, tooth loss, difficulty chewing, tooth migration, a gap in your smile, and unwillingness to smile because of embarrassment.

What will become of a fractured tooth? First it depends on the severity of the fracture or crack. Where is the defect? Is it above the gum line or below? Is the pulp exposed (bleeding)? Is the root fractured or cracked? Is there a fractured piece still attached to the gum tissue? All these questions need to be answered as soon as possible. Call our office to schedule an appointment!

Tooth Knocked Out:

A variety of situations can ultimately result in a permanent tooth being knocked out or dislodged from its normal position. If the tooth that is lost is a deciduous or “baby” tooth, it is rarely necessary to try to replace it. If the permanent tooth is dislodged, but not knocked out completely, it may be possible to gently push it back into place. You may be able to just bite the tooth back into place, but it is essential to see the dentist as soon as possible to have it assessed and treated.

If an adult tooth is knocked completely out it is important to see a dentist as soon as possible, preferably within 30 minutes. Handle the tooth only by the crown. If dirty, rinse it gently with water. Do not scrub the tooth, or dry it or place it in a cIoth or tissue. If possible, gently place the tooth back in its socket as soon as possible. This will give the tooth the best chance to survive. If this is not possible then keep the tooth moist by placing it placing it in a “Save a Tooth” kit or in milk. It can also be kept moist by placing it back in the mouth next to the cheek until the dentist can treat it. In any case, it is extremely important to see a dentist preferably within 30 minutes.

Fractured jaw:

It goes without saying that a broken jaw needs immediate attention preferably in the emergency department of a local hospital. However we have seen one situation in which the patients jaw had been broken and had no other symptoms other than the fact that the teeth no longer fit together.

If you are aware that teeth are suddenly not fitting together properly it is good reason to be evaluated as soon as possible. It isn’t likely that the jaw is broken without some evidence of trauma, but muscle spasms or temporomandibular joint problems can also affect the way teeth fit together. Regardless, it is very important to call for an evaluation appointment!

Bad Breath / Bad Taste:

Halitosis, or bad breath, is not something that would normally be construed as an emergency situation. However, awareness of a bad breath or bad taste problem may be evidence of something awry in the mouth. Bad odors can be caused by a number of medical problems such as diabetes. Or, a bad taste may be associated with an infected tooth or drainage from a gum disease abscess. Come in to get it checked out!

Dry mouth:

Dry mouth is becoming more and more prevalent these days. There are many prescription drugs that contribute to decreasing the volume of saliva production. Although this may not be considered an emergency situation, it may lead to much more severe dental problems. Dry mouth can generally lead to more inflammatory gum problems, and can promote the formation of cavities, as there is significant neutralization of acidity in the mouth by the more basic saliva.

It is important to approach the affects of dry mouth with an effective strategy to prevent the problems that occur with this.

Lumps and Bumps:

We arduously look for abnormalities when we do periodic examinations (check-ups). It is normal for soft tissue, cheek or tongue, to raise a welt if you accidentally bite it. But, without other similar reasons lumps and bumps inside the mouth are abnormal.

Generally anything that persists longer than two weeks without returning to normal should be considered abnormal and should be evaluated.

As part of every check-up examination we do a thorough intraoral cancer-screening exam. This involves visually examining all the accessible tissues inside the mouth, the tongue, the lips and areas around the mouth. We also check for swellings, lumps, discolorations and changes in lymph nodes. Any positive findings are referred for further diagnosis and treatment.

It cannot be overstressed the importance to have any persistent abnormality evaluated as soon as possible. Oral cancers are comparatively rare, however they can be deadly. “Maybe It Will Go Away” is a very dangerous strategy!

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John T. Hauge, DMD, has been a practicing dentist for nearly 41 years, is a graduate of the University of Pennsylvania School of Dental Medicine and has been practicing in Maine for the last 17 years. Although he has ample experience in all areas of dentistry, Dr. Hauge has special interest and extra experience in treating patients with obstructive sleep apnea and TMJ pain problems.