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Pain

Don’t Wait Until Your Tooth Hurts to Go to the Dentist

Dental Pain

Oct 21, 2011

Dental Pain Toothache — ©Fotovika/Shutterstock.com

This morning I saw a patient who had been in extreme pain for the last couple of weeks. What started as a small cavity grew into a large cavity that eventually made its way to the tooth’s pulp. We were able to take her out of pain by starting a root canal today.

If we end up fixing her tooth, rather than extracting it, it will cost her around $1200. Even then, with the condition of the tooth, it may only last her 5-10 more years.

A bridge to replace that tooth would cost her $1350. An implant to replace that tooth would cost her $2100. And those are dental school prices. It would probably be about twice that in a private practice. You can find the average dental fees in your area here.

Had she come in a couple of years ago, we could have easily removed the decayed portion of the tooth and put in a filling. With the prices at my dental school, that would have cost her only $84 and would have most likely lasted her at least 20 years (she has several amalgam fillings that are still going strong after more than 15 years.)

Find out how long a silver filling lasts.

The Moral of the Story

What I’m trying to get across is that if your dentist recommends getting a filling in a tooth, get it (As long as you trust your dentist!)

If you put it off simply because the tooth doesn’t bother you, there’s a good chance both you and your wallet will be experiencing some pain in the future.

Problems that a High Filling Can Cause

Fillings and Inlays

Sep 12, 2011

High Dental Filling Problems — ©Adam Gregor/Shutterstock.com

Many people wonder what they should do when they come home from the dentist after getting a filling and notice that their bite isn’t quite right. If you end up having problems with a filling, it’s always best to check back with your dentist to see if you have a high filling.

If your filling is high, the dentist can simply smooth it down. Smoothing down a filling is usually a quick procedure and doesn’t require any injections.

Here are seven problems that a high filling can cause.

Problems That a High Filling Can Cause

Keep in mind that some people with a high filling may experience many of these problems while others might not go through any of these difficulties.

1 – Biting Pain

The ligament may become inflamed around the tooth, causing the tooth to hurt when you bite down on it. This may affect the tooth with the high filling, but it can also affect other teeth if the high filling has thrown off your bite.

2 – Aching and Sensitivity

The tooth may develop pulpitis. It could become sensitive to hot and cold or it may simply ache.

Find out more about pulpitis here.

3 – Excessive Tooth Wear

The tooth can wear down rapidly. Also, other teeth may wear down if the high filling causes you to shift your bite slightly.

Learn about the four ways that your teeth get worn down.

4 – Loose Teeth

The tooth can become loose. If the high filling causes your jaw to shift, other teeth can become loose if they are subjected to high forces that didn’t exist before the high filling.

5 – Muscle Pain

The muscles in your jaw can ache because your bite has changed and the muscles are forced to adapt after so many years of moving your jaw in it’s natural bite. This can make it difficult to open your mouth and/or chew your food.

6 – TMJ Problems

Problems with your temporomandibular joint (TMJ) can occur due to the abnormal movement that now takes place due to the high filling.

7 – Headaches and Stress

The muscle pain coupled with the TMJ pain can bring on headaches and increased stress in your life.

Don’t Ignore a High Filling

If you think that you have a high filling and you are in pain, it’s a good idea to get it checked out before a small problem turns into a bigger one.

If you have any questions, comments, or personal experiences, please share them below!

How to Reduce Swelling After Wisdom Teeth Extraction

Oral Health & Hygiene

Aug 8, 2011

How to Reduce Swelling After Wisdom Teeth Removal — ©Robert Kneschke/Shutterstock.com

Nobody wants to look like a chipmunk after getting their wisdom teeth out, but when their cheeks get swollen, most people do end up looking like a chipmunk!

While some swelling is normal after this procedure, the good news is that you have some control over your swelling. Here are a few simple things that you can do to reduce your swelling after wisdom teeth extraction.

How to Reduce Swelling After Wisdom Teeth Extraction

1 – Apply Cold & Heat at the Right Time

Many oral surgeons send their patients home with ice packs after getting their wisdom teeth extracted. There is some controversy over whether or not using ice immediately following wisdom teeth extraction can actually reduce swelling. Although it may not be proven, it probably wouldn’t hurt to try this method. Applying heat to your cheeks has been shown to reduce swelling after wisdom teeth extraction, but you have to do it at the right time.

Here’s a time line of when you should apply cold and heat to your cheeks to reduce swelling:

0-24 hours after wisdom teeth extraction: Apply ice for 20 minutes on, then 20 minutes off.

24-48 hours after wisdom teeth extraction: Don’t apply ice or heat.

48 hours after wisdom teeth extraction: Apply heat.

Keep in mind that you shouldn’t apply ice directly to your skin. It’s a good idea to have a cloth between the ice and your skin to avoid causing damage to your skin. If you don’t have ice packs, you can use a bag of ice cubes or frozen vegetables. Along the same lines, you don’t want to use water that is too hot for too long – you don’t want to burn your skin! Heating pads and hot water pads are good suggestions.

2 – Keep Your Head Held High

Reduce Swelling After Wisdom Teeth Extraction by Keeping Your Head Up — You Can Reduce Swelling After Wisdom Teeth Extraction by Keeping Your Head Elevated

Keep your head held high – literally! By keeping your head elevated above the rest of your body, gravity will be your friend and cause excess fluid to flow down from your cheeks and back into your bloodstream. This is the reason why your cheeks are more swollen after a good night’s sleep. By laying down, you don’t have gravity helping you keep your swelling to a minimum.

To use this principle to your advantage, it would be a good idea to keep your head propped up with pillows rather than laying down so that your head is at the same level as the rest of your body.

3 – Use Corticostroids

Certain studies (such as this one) show that steroids can reduce cheek swelling after your wisdom teeth get extracted.

The textbook Contemporary Oral and Maxillofacial Surgery recommends the steroid dexamethasone to control “postsurgical edema” (which means swelling after surgery) and said the following regarding using steroids to reduce swelling after wisdom teeth extraction:

Dexamethasone is a long-acting steroid and its efficacy in controlling third molar postsurgical edema is documented. This drug can then be continued in an oral dose of 0.75 to 1.25 mg twice a day for 2 to 3 days to continue edema control.

There are, of course, several drawbacks to using steroids. You may want to ask your oral surgeon if dexamethasone is a good choice for you to reduce swelling after you get your wisdom teeth extracted. He or she will be able to help you weigh the pros and cons.

Why Do Your Cheeks Get Swollen After Wisdom Teeth Extraction?

This article wouldn’t be complete without mentioning the reason for your swollen cheeks. Swelling after wisdom teeth extraction is simply a natural, healthy response that helps your body heal. Many times, the oral surgeon has to cut through your gums and drill through bone to remove your wisdom teeth. You would probably expect to have swelling after any invasive surgery to remove an appendage of your body, and getting your wisdom teeth out is no exception.

To learn more and to find out how long you can expect to have swollen cheeks after wisdom teeth removal, read the article Why You Get Swollen Cheeks After Wisdom Teeth Removal.

Do you have any questions, comments, or concerns about your swollen cheeks and wisdom teeth extraction? Go ahead and write them in the comments section below. Thanks for reading!

Why Dental Anesthetic Makes Your Heart Beat Faster

Mar 2, 2011

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Dental Anesthetic Makes Your Heart Beat Faster — ©Nejron Photo/Shutterstock.com

You may have noticed that when you get a dental injection, sometimes your heart feels like it’s going to beat right out of your chest. You’ve probably just assumed that your heart is beating so hard because you’re nervous.

That’s partly true, but there’s another reason — the dental anesthetic actually contains something that makes your heart beat faster!

Why Your Heart Beats Faster When You Get a Dental Injection

As I mentioned above, nervousness may play a role in making your heart beat faster when you get a dental injection. When we get nervous, our heart beats faster because our body sends out a substance called adrenaline that increases our blood pressure and causes our heart to race.

Most of the local anesthetics used in dentistry in the United States contain epinephrine (also known as adrenaline.) Not only is your body causing your heart to speed up by releasing adrenaline, your dentist is giving you adrenaline in the local anesthetic!

Don’t worry, dentists don’t want you to have a double-dose of adrenaline to make you nervous. Local anesthetics contain epinephrine for another reason: The epinephrine constricts your blood vessels.

With your blood vessels constricted, the local anesthetic stays near your tooth for a long time. That way, it gives your dentist a lot of time to work on your tooth without you feeling it. Another reason that dentists want your blood vessels constricted is so that only a small amount of local anesthetic gets absorbed into your body.

Conclusion

You may have felt your heart pounding more during some dental injections more than others. If the dentist happens to inject the local anesthetic into a small blood vessel, it can quickly travel to your heart and cause it to beat very hard and fast. This generally subsides after 10 seconds or so and is not dangerous to you. Most of the time, the local anesthetic is not injected directly into a vessel and stays right near the nerve without affecting the heart.

Have you ever felt your heart race when getting a dental local anesthetic injection? I’d love to hear your comments and questions in the comments section below. Thanks for reading!

Update 2/25/13 – I wrote a new post about why dental anesthetic makes your heart beat faster, with more science to back it up after some comments below made me question whether or not this can really happen. You can read it here: Can Dental Anesthetic Really Make Your Heart Beat Faster?

Why Teeth Hurt

Sensitive Teeth

Oct 27, 2010

Why Teeth Hurt — ©Vladimir Gjorgiev/Shutterstock.com

There are several easy answers to the question, “Why do teeth hurt?” For example, teeth hurt because you don’t take care of them. But, that’s not what I want to talk about in this article. I want to talk about why it is that teeth hurt so much. They’re so small, yet if you’ve ever had a toothache that kept you up at night, you know that teeth can hurt almost as much as any other feeling of pain you’ve ever felt.

Teeth Hurt Because They Are So Hard

Teeth hurt because they are so hard. When the tissue inside of the tooth (the pulp) gets hurt, it has no room to expand. Here’s an example. Let’s say someone punches you in the shoulder. Your shoulder might get warm and swollen. Your shoulder has room to get bigger.

Now let’s say that someone punches your tooth and chips the bottom of it. The force of the blow will likely irritate the pulp of your tooth and cause it to get warm and swollen. Here’s the problem, when the pulp gets swollen, it wants to get bigger, but there’s nowhere to go! The pulp is encased in a hard shell known as the dentin and enamel of your tooth. Pressure builds up inside of your tooth. Suddenly, the tooth that was hurting due to the initial trauma is now also hurting because of the pressure.

Not sure what the difference between pulp, dentin, and enamel is? Read my article about the anatomy of a tooth.

Here is what happens in technical terms when the pulp becomes inflamed. It’s a quote taken from the book, Cohen’s Pathways of the Pulp by Hargreaves:

Inflammation in the pulp takes place in a low-compliance environment composed of rigid dentinal walls. Compliance is defined as the relationship between volume (V) and interstitial pressure (P) changes: C = Δ V/ Δ P. Consequently, in the low-compliant pulp, an increase in blood or interstitial volume will lead to a relatively large increase in the hydrostatic pressure in the pulp. The acute vascular reactions to an inflammatory stimulus are vasodilatation and increased vascular permeability, both of which will increase pulp interstitial fluid pressure and may tend to compress blood vessels and counteract a beneficial blood flow increase.

Other Parts of Our Body Experience Similar Pain Levels

The dental pulp isn’t the only tissue that experiences high levels of pain when it is inflamed. Most places in the body that are enclosed in a rigid structure experience lots of pain.

This is why headaches can be so painful, the skull is rigid and there’s no room for the swelling to go.

Another example is when you smash your fingernail and you get lots of inflammation underneath the fingernail. Some people have even gone so far as to burn or poke holes through their fingernails to relieve the pressure that builds up.

Conclusion

Teeth hurt because when the pulp gets even slightly injured, it wants to expand and there’s no room for it to expand.

Do you have any questions related to tooth pain? Leave them below in the comments section. Thanks for reading!

A Popping Click When You Open Your Jaw Is Pretty Common

Jun 16, 2010

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Popping and Clicking in Jaw is Normal — ©Absolutimages/Shutterstock.com

If you experience a popping sound, a grating sound, or a click when you open your mouth, you’re not alone.

Many people have slight problems with their jaw joint, which is formally known as the temporomandibular joint, or TMJ for short. Whenever we want to open our mouth, our jaw glides down and forward to allow our mouth to open.

The rounded end of the jaw bone that glides down is called the condyle. Between the condyle and our skull, there is a small, soft, lubricated disk that allows our jaw to open smoothly. This is called the articular disk.

Sometimes, that disk may not be big enough, or it may not be the right shape to allow the jaw bone to smoothly glide forward and down when you open your mouth. When this happens, it is a condition known as crepitus.

Crepitus is a word that is used to describe the grating, crackling, and/or popping sounds that are heard around people’s joints.

Unfortunately, not everyone has jaw joints. When I open my mouth, my jaw slides down and out nicely on the right side, but on my left side, there is a loud popping noise. Luckily this only happens when I open my mouth really wide, so it doesn’t affect me when I chew gum or eat (unless it’s a really big hamburger!)

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