What Are Sensitive Teeth?

Teeth are sensitive if they often hurt when they are exposed to cold or to air. You may also feel discomfort or a sudden flash of pain when eating sweet, acidic, or hot foods. The pain you feel may be due to receding gums, worn tooth enamel, or worn root surfaces. Healthy teeth are protected by strong enamel and good gums.

How Teeth Become Sensitive

When enamel erodes or gums recede, dentin can be exposed. Dentin is the layer of the tooth that is normally covered by the enamel and gums. The most common cause of sensitive teeth is exposed dentin. Dentin is connected to the nerve that triggers pain in sensitive teeth.

If You Have Sensitive Teeth

See your dentist if you have sensitive, painful teeth. Your dentist will examine your teeth, determine the cause of your tooth sensitivity, and recommend a proper treatment plan.

Diabetes and Periodontal Disease: An Increased Risk

When you have diabetes, you are at greater risk for periodontal disease (infection of the gums and tissues supporting the teeth). Any periodontal disease you may develop can be more severe and harder to control. Preventing or controlling periodontal disease requires ongoing care.

Removing plaque and tartar from teeth daily helps keep the gums healthy.

What Causes Gum Infections?

Bacteria in your mouth form a sticky, whitish film (plaque) on teeth. If plaque is not removed daily, it can harden into a rough yellow or brown deposit (tartar). Tartar is harder to remove from your teeth than plaque. Bacteria from plaque and tartar can cause swollen, infected, and receding gums. More severe gum and bone disease may then occur.

Bacteria from plaque and tartar can cause periodontal disease.

Prevention

Follow the guidelines below to help prevent periodontal disease.

• Use good oral hygiene. Brush your teeth after each meal and floss daily. Don't forget to also brush your tongue. Your dentist may suggest special aids to help keep your teeth clean.

• See your dentist regularly. Your dentist may want to see you every 3-4 months for exams and cleanings. How often you visit your dentist will depend on how severe your periodontal disease is. It may also depend on your plaque and tartar buildup, and how well you care for your teeth and gums. Tell your dentist if you have any problems controlling your blood sugar.

• Control your blood sugar. Keeping your blood sugar at a healthy level will help control your diabetes. Doing so will also help your body fight infections and may lessen the severity of your periodontal disease. Take your diabetes medication as instructed.

Stages of Periodontal Disease

Periodontal disease is an infection of the gums and tissues supporting the teeth. If not treated, it often gets worse. Bone damage and tooth loss can occur. Regular self-care and dental visits can help prevent or control periodontal disease.

Gingivitis

This is the mildest form of periodontal disease. The gum becomes irritated and swollen (inflamed). The space between the gum and tooth gets deeper, forming a pocket. Gums may become red and may bleed. Or, there may be no symptoms. Left untreated, it can progress to periodontitis.

Periodontitis

Infection and inflammation spread to the bone supporting the teeth. Gums may recede (shrink back) from the teeth. Pockets between the teeth can get deeper and harder to clean. Redness, swelling, and bleeding may develop or get worse. Infection begins to destroy the bone. As bone is destroyed, teeth may start to feel loose.

Advanced Periodontitis

As periodontitis advances, pockets deepen even more and can fill with pus. Around the roots of the teeth, the gums may start to swell. Bone loss continues. The teeth may feel sensitive to heat or cold and may hurt when brushed. Teeth loosen more. In some cases, teeth may need to be removed to keep the disease from spreading.

What Are Oral Lesions? (Precancerous and Cancerous)

Precancerous oral lesions are abnormal cell growths in or around the mouth. They may become cancer. Cancerous oral lesions are life-threatening cell changes in the mouth. These lesions need to be detected early to give you a better chance for a cure.

Signs and Symptoms

The signs and symptoms of precancerous and cancerous oral lesions may include:

• A sore in the mouth that doesn`t heal within 3 weeks

• White or red lesions or ulcers on the tongue, gums, or lining of the mouth that don`t go away

• Tenderness or pain in the mouth that persists

Your Evaluation

See your dental professional about any sore or pain in the mouth that doesn`t go away in 3 weeks. He or she will ask questions about your medical and dental history. Your entire mouth, including your lips and teeth, will be checked. A biopsy or other tests may also be done.

• A biopsy is the best way to find out if a lesion is precancerous or cancerous. During a biopsy, the area around the lesion will be numbed. A part of the lesion will then be removed and sent to a lab to be examined under a microscope.

• Other tests may be helpful in making the diagnosis. They include:

  • Staining. The area in your mouth around the lesion may be stained with a special dye. The dye binds to cancerous cells, staining only these cells. After a few hours, the color from the dye will disappear.

  • Cytology. Your dental professional may scrape the surface of the lesion to obtain cells. The cells are then sent to a lab, where they are examined for cancer.

Treatment

Your treatment will depend on the nature of the oral lesion. Your dental or medical professional can tell you about types of treatment, which may include:

• Surgery

• Radiation therapy

• Combination therapy (Both surgery and radiation therapy may be used to treat advanced cases of oral cancer.)

• Chemotherapy

Prevention

The best way to catch any problems early is to have regular oral checkups. To help reduce your risk for oral cancer, follow the tips below.

• Get oral checkups. Visit your dentist at least 2 times a year.

• Don`t use tobacco. Tobacco use increases the risk for oral cancer. It`s never too late to stop using tobacco.

• Limit alcohol. If you drink a lot of alcohol, you may be at a higher risk for oral cancer.

• Eat a healthy diet. A diet rich in fruits and vegetables may lower your risk for oral cancer.

• Use good oral hygiene. Brush and floss your teeth each day. If you wear dentures, keep them clean.

Understanding Bruxism (Teeth Grinding)

Although teeth grinding (bruxism) may happen at any time, people often grind their teeth in their sleep. You may not even know you're doing it. The causes are not clear. Stress is one possible cause, but often the reason for the habit is not known.

Damage Caused by Teeth Grinding

Teeth grinding may cause:

• Chipped enamel and cracked teeth

• Flattened, grooved, worn-down teeth

• Loosened teeth

• Periodontal (gum) problems

If it goes untreated, bruxism may lead to jaw muscle and joint problems and even loss of your teeth.

Evaluating the Problem

Your dentist will examine your entire mouth and ask several questions. This evaluation helps confirm that you do grind your teeth. It may also help identify a possible cause of your teeth-grinding habit.

The Symptoms of Grinding

Symptoms like these may be a signal that you grind your teeth:

• A sore, tired jaw

• Sensitive teeth

• Loose teeth

• Dull headaches, earaches, or neck aches

• Clicking sounds when you open your mouth

Dental Trauma

Injury to the teeth or mouth can happen due to an accident or sports injury. Dental trauma may not always seem serious. But even minor injuries can cause infection or other problems. The key to saving your smile is getting help right away.

When to Go to the Emergency Room (ER)

Speed is crucial when it comes to most tooth trauma. The faster you're treated, the better the chances your tooth or teeth can be saved. Go to your dentist or the ER at once if:

• You break one or more teeth.

• You have one or more teeth knocked out (put the tooth in a glass of cold milk and bring it with you).

• A cut on your lip or tongue won't stop bleeding.

What to Expect in the ER

Your injury will be examined. If you've lost a tooth, a dentist may be able to replant it. For the best results, this is done within an hour after your injury. In some cases, a broken tooth can also be repaired. Cuts and abrasions may be treated with cold packs and dressings.

Follow-up

Once you're home, call your dentist right away if you:

• Develop a fever over101F .

• Have drainage from around a repaired tooth.

• Have pain that worsens after 24 hours.

Oral Thrush

Oral thrush is a yeast infection that affects the mouth. It causes creamy white patches to form on the tongue or inner cheeks. These patches can be painful and may bleed. Babies with thrush are often fussy and may have trouble feeding. Thrush is seldom serious in healthy children and adults.

Risk Factors

Thrush is common in infants and toddlers. Babies sometimes pass the infection to their mothers. You are also likely to develop thrush if you:

• Take antibiotics, steroid medications, or birth control pills.

• Have diabetes or HIV (the virus that causes AIDS).

• Are pregnant.

• Use oral steroid inhalers.

When to Go to the Emergency Room (ER)

In most cases, thrush isn't a medical emergency. Call your pediatrician if your baby develops symptoms of thrush. Teens and adults should see their healthcare provider. If symptoms are severe, seek emergency care if you can't reach your doctor.

What to Expect in the ER

The affected mouth and throat will be examined. A tongue blade may be used to scrape the mouth and take a sample to check for the yeast that causes thrush. Healthy infants with mild thrush may not need any treatment. More severe cases are likely to be treated with a liquid antifungal medication. Older children and adults may receive the same medication in tablet or lozenge form.

Understanding Temporomandibular Disorders (TMD)

Do you have pain in your face, jaw, or teeth? Do you have trouble chewing? Does your jaw make clicking or popping noises? These symptoms can be caused by temporomandibular disorders (TMD). This term describes a group of problems related to the temporomandibular joint (TMJ) and nearby muscles. Your symptoms may be painful and frustrating. But don't worry. Your healthcare team can help you treat TMD and prevent future problems.

What's Wrong?

TMD causes many kinds of symptoms. That's part of the reason it can be hard to diagnose. You may have headaches, tooth pain, or muscle aches. Your pain may be constant. Or it may come and go without any apparent reason. TMD-related problems include:

• Tight muscles

• Joint inflammation

• Joint damage

• Teeth grinding or clenching

What Can You Do?

If you are having TMD symptoms, don't wait. Call your dentist or primary care doctor right away. You don't have to live with pain or discomfort. TMD can be treated. In fact, a key part of treatment is learning to manage your condition at home.

Which Treatment Is Right for You?

Treatment helps rest the muscles and joint. It also helps relieve symptoms and restore function. Depending on the type of problem you have, your treatment plan may include:

• Temporary diet changes.

• New habits for managing stress and maintaining the health of your jaw.

• Medication to reduce pain and inflammation.

• Therapy to reduce pressure on the joint and restore function.

• Dental treatment to reduce pressure on the joint.

How Can You Avoid Future Problems?

Treatment can help relieve your current condition. But TMD symptoms may return over time. You can avoid future problems by maintaining the health of your jaw:

• Avoid foods and habits that make your symptoms worse.

• Lower the stress level in your life.

• Follow your treatment plan.

• Pay attention to your body and get help if symptoms recur.

Understanding Tooth Decay

Plaque is a sticky coating of bacteria and other substances that forms on your teeth and gums. It can cause two serious problems:tooth decay and gum disease. These problems damage the teeth and gums, and may even lead to tooth loss. When the mouth is well cared for, tooth decay and gum disease can be reversed in their early stages. Better yet, you can prevent these problems from starting by brushing and flossing daily.

Once tooth decay eats through the enamel, it spreads quickly through the softer dentin.

After tooth decay is removed, the hole is filled with a hard material.

How Tooth Decay Develops

Tooth decay happens when acid eats away at a tooth.Cavities (also called caries) are holes that form in the teeth. They are most common in places that are hard to reach with a toothbrush. This includes the grooves at the tops of the teeth, and on the sides where the teeth touch. In late stages, tooth decay can be painful. It can also lead to tooth loss.

Treating Tooth Decay

Tooth decaycan be treated to keep it from moving fartherinto the tooth. This is often done by filling cavities. First, any tooth decay is removed. This protects the tooth from further damage. Then, the cavity is filled with a hard material. This filling protects the damaged tooth and restores the tooth surface. If the tooth is severely damaged by decay, other treatments are available.

Follow-up Visits

Visit your dental team at least every6 months for a checkup and cleaning. If you're being treated for tooth decay or gum disease, you may need more frequent visits. These visits will likely decrease as your mouth care effortsstart to pay off. Keep flossing and brushing, and follow any special instructions your dentist or dental hygienist gives you. And enjoy flashing your healthy smile!

Understanding Impacted Wisdom Teeth

Wisdom teeth that cannot fully break through the gum (erupt) are called impacted.These teeth can grow in almost any direction, including:

• Straight upward (vertical position), but without room to erupt into a healthy position.

• Angled away from the other teeth (distoangular position).

• Parallel to the gumline (horizontal position).

• Angled in toward the other teeth (mesioangular position).

Straight upward

Parallel to the gumline

Problems Caused by Impacted Teeth

Impacted wisdom teeth can cause acute (sudden) problems, chronic (ongoing)problems, or no problems at all. Removing the teeth before symptoms develop can prevent or reduce future complications. Dental x-rays can help your dentist find existing problems. X-rays may also help show whether your wisdom teeth are likely to cause problems in the future. But it's not always clear whether your wisdom teeth will give you trouble. Potential problems include:

• Acute pericoronitis (gum infection). As the tooth breaks through the gum, the gum can become infected, causing pain, swelling, and sometimes bleeding.

• Chronic periodontal (gum) disease. Problems flossing at the back of the mouth can lead to gum disease. Or it may result if bacteria and food debris collect under the gum tissue covering an impacted tooth. Gum disease can lead to loss of the adjacent molar.

• Tooth decay. Wisdom teeth can be hard to clean because they're at the back of the mouth. This can lead to decay of both the wisdom tooth and the tooth next to it.

• Crowding. An impacted tooth can push on nearby teeth, forcing them out of alignment. This can interfere with your bite. Crowding can also damage individual teeth.

• Poorposition. A tooth that grows pointing in toward the tongue or out toward the cheek can irritate nearby tissue. It may interfere with your bite. Problems can also occur if there is no corresponding tooth in the opposite jaw for the tooth to bite on.

• Cysts and tumors. A tooth that's embedded in the bone is encased in a sac. This sac can fill with fluid, forming a cyst. A cyst can expand and destroy surrounding bone. In rare cases, a tumor forms in this area.

Understanding Orthognathic Anatomy and Problems

A jaw that's too small, too large, or crooked can cause problems with chewing, speaking, breathing, and even sleeping. The shape of your jaws also affects the way your face looks. This sheet helps you understand how the teeth and jaws work. It also describes common jaw problems that may need treatment.

How Bones and Teeth Shape the Face

Bones are the framework for the face. The size and position of facial bones determine how well the teeth fit together. Together, the positions of the jaws and teeth affect chewing, speaking, and the working of the jaw joint. The jaws also hold and support soft tissues, such as the muscles, lips, and tongue. And of course the jaws and teeth are factors in the face's shape and appearance.

How the Jaws Work

The lower jaw holds the tongue, which moves freely as you speak and eat. The upper jaw shapes the floor of the nasal cavity, allowing normal airflow. Normally, muscles are evenly developed on both sides of the face.

Common Problems

Some common jaw alignment problems are described below. It's also common to have a combination of these problems.

• Lower jaw too far back:When the lower jaw is too far back (retrognathia), biting can be difficult. The chin appears weak or receding.

• Lower jaw too far forward:A lower jaw that is too far forward (prognathia) causes the chin to protrude. Lower teeth may jut outward to overlap the upper teeth.

• Open bite (teeth don't meet):An open bite is often due to a long upper jaw. This can cause a "gummy smile." Or the problem may be that the rear of the lower jaw is too short. An open bite can make it impossible to close the lips.

• Asymmetry (jaws are uneven):Uneven jaws are larger or smaller on one side than on the other. Or one side may be too far forward or back. The face may look off-center or crooked.

When Jaws Are Not Aligned

Poorly aligned jaws can result in a variety of problems, including:

• Chewing problems:You may find it difficult to bite into a sandwich or an apple, or difficult to keep food inyour mouth as you chew. The TMJs may be stiff or painful.

• Speech problems:It may be difficult to make certain sounds or to speak clearly.

• Breathing problems:If the airway is narrow or blocked, breathing may be noisy or difficult. You may have sleep apnea (breathing that stops during sleep).

• Problems with appearance:You may be unhappy with the way you look. This can make you self-conscious and may affect your confidence.

Periodontal Disease: If You Need Surgery

If you have periodontal disease, you may need surgery to save one or more teeth. Surgery can helpreduce the size of pockets that form between tooth and gum. It can also help regenerate bone and other tissue, or adjust the gumline. In addition, surgery can be used to reach tartar that can't be removed with other techniques.

Your Surgical Experience

Periodontal surgery takes place in the dentist's office. You will go home soon after it is completed. To control pain you'll be given local anesthesia.You may also have a sedative (medication to help you relax). Be sure to arrange in advance for a ride home.

After Surgery

Your instructions right after surgery may include:

• Resting for a day or two

• Taking medication to control pain or prevent infection

• Using ice or medication to control swelling

• Not smoking

• Special instructions for cleaning teeth

• Caring for the surgical area or dressing

You'll have a follow-up visit in1-3 weeks to check how you're healing. This is when stitchesand any dressing (protective covering) are removed.

Risks and Complications

These vary depending on the surgery. In general, risks and complications of periodontal surgery may include any of the following:

• Pain or discomfort

• Increased tooth mobility or sensitivity(often temporary)

• Swelling and bruising of the cheek

• Numbness or tingling, due to temporary or permanent damage to nearby nerves

• Exposure of more crown or root

Periodontal Disease: Nonsurgical Treatments

Scaling at and just below the gumline reaches tartar deposits that can't be removed in an ordinary dental cleaning.

Scaling and Root Planing

This treatment is performedby a dentist or a dental hygienist. Sometimes a special ultrasonic device is used to remove heavy deposits. Then plaque and tartar are removed (scaling), and the root surfaces are smoothed (root planing). This helps keep the area free of bacteria. It may also help ligaments that have broken down to reattach to the teeth. This reduces the depth of pockets that have formed in the gums around the teeth.

Antibiotics

Infection can be treated withantibiotics, which decrease bacteria. Pills may be prescribed. Or the antibiotic may be placed directly into the infected pocket.

Root planing smoothes rough spots on the roots where bacteria collect.

Bite Correction

Bite problems such as an uneven bite can worsen bone loss. Grinding or clenching the teeth may contribute to the problem. A splint or other ways of adjusting the bite canreduce pressure and help control the damage.

Periodontal Disease: Pocket Reduction Surgery

Periodontal disease can cause pockets to form between tooth and gum. These pockets can gather plaque and require treatment. If nonsurgical treatments can't reduce pocket depth, surgery may be needed. Surgery on gum and bone can reduce pocket depth and save a tooth or teeth. It also allows the dentist to remove tartar deep below the gumline. In some cases, pocket reduction surgery is combined with regenerative procedures (techniques that stimulate growth of new bone).

Before surgery

After the gum heals

Reshaping Gum and Bone

Pocket reduction begins with flap surgery.The gum is separated from the tooth and later reattached in a new position. In most cases, osseous surgery is also performed. This involves reshaping and smoothing the bone. After treatment is complete, the gumline will most likely be lower, leaving more of the tooth exposed. If the root is exposed, ongoing treatment with fluoride or another material may be needed to reduce sensitivity.

• Before surgery. A deep pocket allows plaque and tartar to collect far below the gumline. Inflammation and infection have destroyed some supporting bone.

• Opening the gum.The gum is first lifted and rolled back, creating a "gum flap." Tartar is then removed from the root. The surgeon also removes diseased gum tissue.

• Shaping the bone.If needed, the bone is smoothed and reshaped. This reduces pits and rough areas where bacteria grow.

• Helping tissues heal. A substance may be applied to the root to help the ligaments and gum reattach. Instruments may be used to cauterize (seal off) the area and reduce bleeding.

• Closing up.The gum flap is sewn shut in a position that reduces pocket depth. A dressing may be used to protect the area. This dressing is a bit like clay or putty. If used, it remains in place until removed by your dentist at a follow-up visit.

• After the gum heals. Once the gum is healed, the stitches dissolve or are removed. Your dentist also removes the dressing. The pocket is shallower. With a lower gumline, it is likely that more of the tooth will be visible.

Periodontal Disease: Soft Tissue Graft

When you look in the mirror, doesyour gumline look uneven?Or do you see too little gum? These are common effects of periodontal disease. A type of gum surgery called gingival surgery can lower or even out the gumline. And if more of the tooth needs to be exposed, gingival surgery can fix that, too. One type of gingival surgery is called a soft tissue graft.

Before surgery

After surgery

How a Soft Tissue Graft Works

When the gum isn't supported by bone, the gum can start to pull away. A graft can be used to fill in an area where the gum hasreceded. The graft tissue may be taken from the roof of the mouth or from a tissue bank.

• Before surgery. A gumline that has receded can expose the root. This can lead to tooth sensitivity and cavities in the root. The uneven gumline may also be visible when you smile.

• After surgery.Graft tissue covers part or all of the exposed root. This protects the root and prevents the gum from receding further. It can also improve your appearance.

Periodontal Disease: Bone Replacement Graft

Teeth are held in place by surrounding gums, bone, and other tissues. But periodontal disease can cause the bone to break down. Certain techniques called regenerative procedures can be used to stimulate growth of new bone. This growth increases the height of the bone around the tooth, giving the tooth more support. Getting back even half the lost bone height extends the life of the tooth. One type of regenerative procedure is called a bone replacement graft.

Placing the graft

After the area heals

How a Bone Replacement Graft Works

A graft helps your body replace lost bone. The graft consists of your ownbone, synthetic material, or bone from a tissue bank. A gel containing growth factors may also be used to stimulate tissues to grow. This is how a graft is done:

• Placing the graft. First, a gum flap is created. Growth factors may then be applied to the root. Graft material is packed into the area where bone was lost. This material provides a platform for new bone to grow.

• Closing up. The gum is closed and sewn together. The growth factors stimulate tissue to grow.

• After the area heals.Stitches dissolve or are removed. Though the gum has healed, it takes a year or more for new bone growth to fill the space.

Periodontal Disease: Crown Lengthening

When you look in the mirror, doesyour gumline look uneven?Or do you see too little gum? These are common effects of periodontal disease. A type of gum surgery called gingival surgery can lower or even out the gumline. And if more of the tooth needs to be exposed, gingival surgery can fix that, too. One type of gingival surgery is called crown lengthening.

Functional crown lengthening: Gum and bone are removed. The remaining portion of the tooth can now support a replacement crown.

Cosmetic crown lengthening: Removing gum can create a more attractive smile.

How Crown Lengthening Works

Surgery to expose more of the crown (the part of the tooth you can see) includes:

• Functional lengthening. In some cases, a restoration (artificial crown) is needed. Gum and bone are removed to expose enough tooth to anchor the new crown. This also helps prevent future damage to gum and bone near the restoration.

• Cosmetic lengthening. This is done to remove an overgrowth of gum tissue that causes a "gummy" smile. It can improve appearance and may make teeth easier to keep clean.

Periodontal Disease: Guided Tissue Regeneration (GTR)

Teeth are held in place by surrounding gums, bone, and other tissues. But periodontal disease can cause the bone to break down. Certain techniques called regenerative procedures can be used to stimulate growth of new bone. This growth increases the height of the bone around the tooth, giving the tooth more support. Getting back even half the lost bone height extends the life of the tooth. One type of regenerative procedure is called guided tissue regeneration (GTR).

Surgery on gum and bone

How GTR Works

A special membrane is placed between gum and bone. This prevents gum tissue, which grows quickly, from filling the space where bone was lost. That way, new bone has time to grow where it's needed. This is how GTR is done:

• Surgery on gum and bone. The gum is opened. Then a membrane is placed over the damaged bone.

• Separating tissues.Once in place between bone and gum, the membrane allows space for bone to heal.

• After healing.The stitches and membrane dissolve or are removed. In about a year, bone forms to support the tooth.

After healing