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Tooth Pain

 

This can be directly linked to a tooth or the gum and jaw linked to it. Sometimes people cannot define exactly where the pain is as it can radiate. 

To help us diagnose the issue as efficiently as possible the following may help your dentist ascertain the exact nature of the problem. 

1) Can you identify exactly where the pain is and is it spreading?

2) Have you had this pain before?

3) Does anything trigger the pain?

4) Does eating hot or cold foods and drinks help or worsen the issue?

5) Does the pain last for a few seconds or does it linger?

6) Is the pain worse during the day or does it keep you up at night?

7) Do you have a swelling in your gum?

8) Is the tooth fractured or wobbly to your knowledge?

9) Is your pain related to recent or previous dental treatment (past 12 months)?

10) If related to recent treatment, is it something your dentist is monitoring or does it need reviewed immediately?

 

We normally suggest to take your usual painkillers and analgesics i.e. paracetamol 500mg or Calpol for children.

Please do not exceed the recommended dose. If your usual analgesics are not helping we suggest you see your local pharmacist for advice.

Adults can use warm salty mouthwash or Corsodyl daily or Curasept rinses to help. 

We advise you try and maintain your regular teeth brushing and flossing routines.  

Sometimes pain relieving mouth gels are available at pharmacies and supermarkets can help. 

If the area is sore when you are eating, try to eat on the other side and try a soft diet. 

Try and contact your dentist as soon as possible to get some advice or book in an emergency consultation.

If you have seen another dentist who has taken x-rays of your tooth please forward this on to your new dentist to help them.

Broken or Traumatised Tooth

 
When accidentally fracturing ones tooth, this can be a very stressful event. If it is your front tooth you may end up avoiding all social interactions. If it is your posterior tooth you may avoid eating on that side for fear of further fracture. No matter the issue, rest assured we can help you... whether it is just a quick temporary fix until a more permanent solution or a full repair on the same day where possible. 
It is important to differentiate the types of fracture or trauma to ones teeth in order of severity to decide the most appropriate course of treatment:
Simple enamel tooth fracture:
 
This can be just a small chip from a tooth or lost filling that does not really cause pain but can be sharp, irritating or look unsightly. Normally this can happen on trauma, eating, teeth grinding or you just don't even remember. 
Solution: Your dentist will diagnose and discuss the most suitable options which could be i) repairing by bonding white composite resin to make it look good as new ii) smoothing the sharp edge iii) if the chip is indicative of a deeper issue such as your bite or grinding your dentist will discuss alternative solutions such as a night guard, crowns, veneers or orthodontics etc. Your dentist should also always discuss with you what the consequences of doing nothing would be. This could range from the chip or fracture getting worse leading to more invasive treatment being eventually needed.
 
Our advice is always, no matter how small the issue make sure you visit your dentist to review it before it gets any worse. 
 
Large enamel-dentine tooth fracture:
 
This is where a larger portion of the tooth is lost that also involves the hard outer shell (enamel) and inner softer inner core (dentine). This can normally lead to sensitivity and pain due to the exposed dentine. It is very important that you do not leave this dentine exposed as it can lead to bacteria spreading into the nerve of the tooth. If the nerve ends up being affected it could mean the tooth ends up needing root canal treatment or if the fracture is very severe the tooth may be lost. 
Solution: Will be the same options as a simple enamel fracture but with the possibility of root canal treatment should the nerve be affected and can be saved. Once again our advice is the same... consult your dentist as soon as possible, discuss all the options and pick the best suited treatment for you. 
"I've traumatised my tooth and now it is wobbly or I've knocked them out":
 
Please contact your dentist straight away if you can. Most clinics will provide an out of hours emergency mobile number or guide you to the NHS 111 emergency dentist service. If your emergency has occurred during normal working hours please explain the emergency to your clinic and they should normally be able to see you. If you have a retainer, whitening trays, mouthguard, teeth model, moulds or splints please bring that with you also. 
At TAHA Dental Excellence we aim to 3D Scan every new patient so that if anything ever happens to your teeth we can 3D print models using our own printers from your original scan to recreate your damaged teeth exactly as before. We invest in the latest most advanced technology not because it is the newest trend or fashionable but because it makes a positive difference to our patients' lives.  
If you have knocked out the tooth or fragment - try not to handle it too much. We normally advise to place it in blood, milk or saliva. If dirty do not scrub or contaminate it (hold it by the crown and not the root). If nothing is available just wrap it up gently in sterile gauze or wipes and place it in a secure container. 
Once at the dentist they will hopefully be able to reattach the fragment and build up the tooth again. If wobbly or knocked out they may reposition the teeth under local anaesthesia and temporarily splint the teeth with a wire or retainer for around 10-14 days to make sure everything heals in the correct position. There is always a risk of infection (your dentist may prescribe antibiotics), which may result in your teeth needing root canal therapy and a crown or orthodontics. Failing this, if the tooth is not saveable see our section on missing teeth to see what we can do to help.
 
It is normal to develop swelling and bruising after trauma, this normally peaks around 48-72 hours and can take up to 14 days to resolve. We recommend use of analgesics, ice packs, soft diet, warm salty mouth rinses and maintaining your teeth cleaning routine as best as possible. 
Our main advice on such a scenario is that time is of the essence. 
 
"My child just knocked out or lost their baby (deciduous) tooth" :
If the knocked out or wobbly tooth is a baby tooth, it is unlikely your dentist will re-implant this back in (we normally do this with adult teeth). In such situations we just monitor and observe the site and warn parents that there is a risk that the adult tooth developing up in the gum may become discoloured, mis-shaped or un-erupt.
 
There is also a possibility that you may need to see an orthodontist for an opinion to correct the teeth into the best positions. Give your child the appropriate analgesia, soft diet and rest assure that children heal very fast. We always advise that if there are other injuries or loss of consciousness that your child is checked over by a medical professional first before seeing the dentist. Make sure no fragments are trapped in the gums or lips also. 
 
For more information please visit:
1) Dental Trauma UK
2) The Dental Trauma Guide 
3) American Dental Trauma Advice
4) Baby Teeth Trauma 
5) Dental Trauma Guidelines 
 
 

Lost or Damaged Filling

Sometimes no matter how good your dentist is or how well you try to look after your teeth some dental work just doesn't stay in place. Dentistry is not an easy job and sometimes we just try our best for the given situation. Nonetheless we always say in general anything artificial in your mouth can normally be easily replaced whether with just a new restoration or a new type of crown. 
We personally believe nothing is as good as your own original healthy tooth but sometimes they get decay, fracture or wear down and eventually require some dentistry. Dentistry can fail sometimes especially if it has developed decay below it, worn down, the bonding agent has lost its strength or it has been designed as a temporary restoration. You can visit your local pharmacy, Boots or Amazon and buy a temporary filling or cement kit if you cannot get to a dentist initially (make sure it is a safe for human use certified product). 
If you do lose or damage your filling try not to worry too much. Do not leave the problem for too long a time, this normally makes the situation worse. Book in a consultation as soon as you can and discuss all the advantages and disadvantages and costs of each option with your dentist.

Broken or Lost Crown 

 
It is rare for permanent new crowns to fracture but this can happen. If it is a temporary crown with temporary cement do not worry too much as normally your dentist can fix this easily. If the core of the tooth has fractured or decayed underneath your dentist will need to assess the damage and advise if the tooth is restorable or not. If so then they may need to make a new crown. If there is not much remaining tooth left then the tooth may need to be removed. 
If the glue has simply failed and the tooth and crown are still in good condition your dentist will need to clean the tooth up and the crown and recement the crown back in. Cementing crowns is not an easy procedure as your dentist needs to make sure there is enough cement but not an excess. The bite and fit will also need to be checked.
If a crown is consistently coming out or causing persistent gum swelling or bleeding - there may be a more pressing problem that needs to be addressed and it is possible a new core and crown will be needed.
If a tooth has had a root canal but no crown it can be more fragile as a result and be more prone to fracture. 
Sometimes in an emergency if your front crown has chipped your dentist may temporarily bond some white composite resin on the area. The reason why this is temporary is because porcelain is a 'glass-like' material and bonding to this is very difficult and tends to be quite weak. In such scenarios your dentist will normally advise you to come back for a new crown and a temporary crown placed on until the new one can be fitted. 

Loose Bridge or Implant

 
Anything that has been cemented can become loose over time. If everything underneath the bridge is still in good condition the bridge should be able to be recemented. If the bridge support is decayed, fractured or infected then this may need to be addressed first. Bridges can work very well over a long period of time but when they fail it could mean that you could also lose the supporting teeth as they are all connected. 
If you have a bridge you must remember to clean under it everyday either with an interdental brush or super floss. 
There are a few main reasons why your implant may become loose:
1) If it is a glued on implant crown. If just a simple debond, it can be recemented. In general with implant crowns we prefer not to cement where possible as it can make treating complications more difficult and cement can sometimes irritate the gum. 
2) If it is a screw retained implant. This is the most common issue with implant crowns and bridges. Essentially these restorations are screwed in and overtime the screw can become a little loose leading to movement. If this should happen make sure you know what brand of implant you had placed so that your dentist has the right screwdriver to tighten it. Unfortunately implants are not all the same and there are thousands of different types. We always provide our patients' with a guarantee card at the end of their treatment informing them of their brand, length and diameter of the implant they received. 
3) If the abutment connector is loose. A dental implant is normally made of 3 components: i) the titanium implant that goes into the bone ii) the abutment connector that connects the implant with the crown iii) the crown that goes on top (sometimes the abutment and crown are fused together). It is rare for an abutment to fracture and normally just need to be re-tightened if they become loose. 
4) The implant has lost bone support. If extensive bone loss and infection occurs around an implant (peri-implantitis), the implant can become loose. If the implant in the bone itself is loose the prognosis is normally poor and inevitably needs to be removed. Once the site has healed post removal, another implant in the area maybe a potential option. 
Some temporary cement from Boots, a local pharmacy or Amazon may be helpful in such situations until you can visit your dentist. Continue your normal cleaning routing with warm salt water mouthwashes to keep the site as healthy as possible. 
 

Stained Dark Teeth

Teeth discolouration can be due to external factors (extrinsic) and internal factors (intrinsic) 
1) External (extrinsic discolouration):
Certain foods can stain the outer part of your teeth such as: tea, coffee, red wine, curry, turmeric, soy, orange juice, sugary drinks. 
Smoking and the build up of tartar (calculus) can create dark staining on your teeth also. 
We always advise maintaining your regular brushing routine and especially interdental cleaning. Sometimes we advise if your toothbrush is not available to rinse with water to neutralise any acids.
 
Make sure you change the bristles of your toothbrush at least every 2-3 months. 
If staining is building up quickly on your teeth, ensure you book 3 monthly hygienist sessions in advance. 
Water flossers and electric toothbrushes can be helpful also. 
2) Internal (intrinsic discolouration):
As you get older your teeth may become yellower due the underlying dentine become more exposed and the enamel thinning.
Sometimes when your adult teeth come through you can see developmental white and brown patches on your teeth.
Teeth can look darker after root canal therapy, old large silver fillings and trauma to your teeth.
Certain developmental conditions can affect the appearance of your teeth such amelogenesis imperfecta and previous tetracycline therapy. 
We normally find internal staining of teeth require either micro-abrasion, teeth whitening or failing this veneers or crowns. No matter what the cause of discolouration we always find a solution that best suits our patient's needs. 
 

Crowded Teeth

Teeth can become crowded from a childhood age. Ideally we want spaces between our baby teeth as this normally means less crowding with the adult teeth when they come through. There are lots of factors that can lead to crowding such as genetics, losing teeth early on, thumb sucking habits, extra teeth, the teeth being too large for the jaw, trauma and natural movement of teeth over time.  
Crowded teeth can create the following issues:
1) Difficulty in cleaning
2) Develop gum disease 
3) Decay 
4) Uneven bite 
5) Speech and chewing issues 
6) Trauma to gums 
7) Teeth wearing down or fracturing 
8) Psychological effects of not wanting to smile
At our clinic we provide every major type of orthodontics from Invisalign™ clear invisible aligners, Incognito™ hidden lingual braces behind your teeth and white ceramic fixed braces and wires. All these systems are designed to be as inconspicuous as possible and have minimal impact on your eating, speaking and social interactions. We will go through the advantages, disadvantages and costs of each and allow you to make an informed decision as to what best suits your needs. 

Missing Teeth

 
Having missing teeth can be an issue on a number of levels.
 
1) Appearance. Over time if you loose your teeth, your face can look more sunken in and result in loss of lip support. If it is a front tooth, you may become increasingly self-conscious and also develop crowding or the inability to clean the area effectively.  
2) Bite. If you loose more teeth over time this can create more pressure on the remaining teeth especially during eating. This increased pressure could result in the remaining teeth being more prone to fracture and being lost prematurely. We normally suggest that missing teeth are replaced in some form in order to evenly distribute the pressures created in the mouth and allow for easier, more efficient chewing when eating.  
3) Speech. Gap and spaces can result in increased difficulty in pronouncing certain words which can have a large psychological impact on a persons mental health. 
 
There are many reasons why people may have missing teeth some of these include:
1) Tooth removed when younger for orthodontic reasons to create space. 
2) Infection or extensive decay developed. 
3) The tooth fractured or underwent trauma. 
4) Gum disease that led to bone loss which resulted in the tooth being lost.
5) The tooth never developed (congenitally absent). 
6) The tooth never erupted and is still in the bone.
 
No matter what your reason, there is a solution for everyone. If the gap created by the missing tooth is very small your dentist may recommend no treatment. Other options also include: 
- Dental implant: This is a small mini piece of medical grade titanium place in the bone (almost to replicate what a natural root would do). Attached to this is a dental crown that sits permanently fixed on top. The advantage of this is that it can feel and act almost like a real tooth without involving any other teeth in the mouth.  
- Dental bridge: This is very similar to a traditional dental crown except where there is a missing tooth there will be porcelain crown sitting on top of the gum and this will be attached to either or both of the neighbouring teeth beside it. 
- Denture: This can be a cost effective and efficient way to replace multiple teeth quickly. We can create very natural removal acrylic and chrome dentures that stay in place when eating and talking and look exactly like your own natural teeth.  
- Orthodontics: Where suitable, we can close mutilple gaps in the mouth via orthodontic measures. This can range from invisible aligners to fixed ceramic braces. 

Loose Teeth and Gaps

 
Overtime if the bone support for a tooth disappears one can find eating or putting pressure on the tooth very uncomfortable. Many patients that have bone loss related to gum disease that are not in pain with the loose tooth tend to want to keep them for as long as possible. If this is the case, then the tooth needs excellent regular cleaning to give it the best chance of survival. We normally recommend regular visits to our hygienist to make sure the awkward and deeper areas are cleaned thoroughly as well as a customised individual cleaning routine for each of your mobile teeth. Your dentist and hygienist will work as a team to evaluate the level of mobility and improvements over time to give you an accurate assessment of the prognosis. 
It is not uncommon for loose teeth to stabilise if cleaning improves and in some occasions your dentist may recommend a splint to stabilise and night guard for the teeth if appropriate. We always remind patients' that if a loose tooth does end up causing pain and infection it can be removed and replaced in many circumstances. If left, loose teeth can suffer more bone loss and be prone to infections. If in doubt always seek advice. 
Gaps can present in the mouth a number of ways. If it is small and does not bother you, chances are your dentist will not recommend anything. Sometimes gaps present in the mouth with food trapping in between which can lead to decay or gum inflammation. The other disadvantage, is that over time gaps can cause the neighbouring teeth to tilt in to the space and the opposing teeth to erupt higher (over-eruption). This can then lead to problems such as making cleaning trickier and also affecting your bite relationship. For these reasons many dentists recommend a retainer to stop teeth from moving or to fill in the space to prevent such issues. For large gaps, we tend to treat these like missing teeth spaces. It is important that your bite is analysed to see how filling in the gap will potentially affect this. Therefore your dentist may create study models of your teeth and develop a mock up of what they will potentially look like before proceeding with anything definitive. 
Many people close gaps in the front of their teeth (called a diastema) for cosmetic reasons. This can be done a number of ways:
1) Composite bonding (adding white filling material)
2) Orthodontics (i.e Invisalign) 
3) Veneers (thin sheets of porcelain that bond over the teeth)  
Your dentist will go through the benefits, disadvantages and costs of each option in order to recommend which option would be the most suitable for your needs. 

Bleeding Gums

 
One of the most common causes of bleeding gums is inflammation due to bacteria not being cleaned away effectively. Your dentist and hygienist will give you advice on how to best deal with this and create a custom cleaning plan for your teeth. We stress to lots of patients' that just brushing your teeth does not equal your teeth being clean. One of the most important parts of the routine should be DAILY flossing. When you do start flossing you may initially notice some bleeding but if you do this everyday in the evening for two weeks you should notice the bleeding reduce dramatically. We normally advise waxed Oral B satin floss, Tepe interdental brushes and fluoride mouthwash. Try and use an electric Oral B toothbrush with a small head to go into all the awkward spaces in your mouth. Also we advise patients to clean and exfoliate their tongues every morning to help prevent bad breath. 
 
Do not be tempted to use Corsodyl consistently without discussing this with your dentist first, as this can stain your teeth and could be masking a deeper problem that needs to be addressed. If you must you a mouthwash designed for gum disease please research Corsodyl Daily, Curasept and Peroxyl (seek the advice of a professional first). Hygiene sessions are important to remove any causes of bleeding gums such as tartar/calculus (calcified plaque) that can built up in and around the gum.  
Sometimes the cause of bleeding gums is due to previous dentistry such as old crowns and fillings placed that were far too deep in the gum and that can stop you from cleaning effectively or the material used constantly irritates the gums. In such situations your dentist may need to change the old dentistry to a newer more gum friendly restoration and possibly do some minor gum surgery to help correct the issue. 

Gum Recession

 
Many people do not realise that they have gum recession until it is pointed out to them. It is normally a slow silent process but is normally potentiated by:
1) hard bristle manual brushing
2) gum disease
3) poor cleaning of the area  
4) trauma 
5) previous dental treatment 
6) the natural ageing process 
7) smoking 
8) tooth grinding 
9) acid and soy diet related 
10) misaligned teeth 
As the gum recedes back it normally exposes the root dentine of the tooth or the enamel has been worn away. This leads to sensitivity to air or cold foods because the expose root triggers the nerve receptors. At TAHA Dental Excellence we have special software that can allow us to digitally measure your recession rate over a number years. 
Treatments include the following:
1) Soft bristle toothbrush changed every 3 months - slow circular rotation action for at least 2 minutes 2-3 times a day (do not brush the gum hard with a sawing action). We advise electric toothbrushes now as many of them will stop if you apply too much pressure. Many people are used to a manual non-electric brush and feel the electric does not clean as thoroughly. We advise that you discuss your technique with your hygienist or dentist and use disclosing tablets. 
2) Use of a sensitivity tooth paste such as Sensodyne pro-enamel or Colgate pro-relief. You can even leave a pea-sized amount over a particularly sensitive area before you go to sleep at night. 
3) Your dentist can apply a dentine de-sensitising varnish or layer a white bonded restoration to help cover the exposed root dentine. 
4) At TAHA Dental Excellence, Dr Thomas is trained and experienced in PINHOLE gum rejuvenation surgical procedure. This is where with no cutting or stitches of your gum is required (which is a far nicer experience as opposed to conventional gum grafting). Dr Thomas will reset the gum to its original correct position and protect as much of the exposed dentine as possible. 

Wisdom Teeth

 
Most wisdom teeth come through around 18-24 years of age. If there is enough space in your jaw they normally come through without incidence (just remember to brush and floss all the way to the back!). Many times there is a flap of gum (operculum) overlying the wisdom tooth that can be sore when eating or become infected due to bacteria building up underneath it. If you keep this area clean, you should be fine. Try to use warm salty mouthwashes and rub Corsodyl (Chlorhexidine 1%) anti-bacterial gel around the area 2-3 times a day and brush the teeth as best as you can. Sometimes if this little flap of gum becomes a constant issue your dentist may remove it using a soft tissue laser. 
Sometimes wisdom teeth erupt at a funny angle that can affect the molar teeth in front, these are called impacted third molars (commonly called wisdom teeth). When they come through at this angle they can be difficult to clean and develop decay or gum infections. This decay and bacteria can spread to the molar tooth in front. Your dentist will need to take an x-ray or scan of the area to assess the level of pathology in the area. 
If you have repeated infections that require antibiotics or the infected wisdom has extensive decay or other potentially progressive pathology your dentist may advise the tooth to be removed. This is a common procedure but carries a risk of temporary to permanent numbness to your chin, lip and tongue due to the proximity of the nerve that surrounds the roots of your lower wisdom teeth. 
 
The upper wisdom teeth in general are easier to remove as the bone is thinner than the lower jaw. The biggest risk is the possibility of a small bone fracture around the area but most sites heal without incident. Your dentist will normally be guided by the NICE guidelines regarding assessment of whether your tooth will need removal or not. 
 
If you are very nervous your dentist may be able to refer you to an oral surgery specialist who may be able to remove the tooth under sedation. We normally advise that you will need at least 1-2 days rest post surgery. 
Our general advice is tooth keep your wisdom teeth area as clean as possible and make sure you see your dentist and hygienist regularly to make sure they are healthy. 

If your dental concern is not addressed precisely here please do visit our dental treatments section or contact us for a consultation for a bespoke analysis of your dental needs.

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