Which analgesic to choose for dental pain

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs to relieve all types of pain, including toothache. This type of medication works by blocking the production of prostaglandins, chemical mediators of the inflammatory process.

There are many different anti-inflammatory drugs on the market. The choice of the most suitable medication for the individual patient should be the prerogative of a specialist because, like any drug, they can have side effects, some of which may be serious.

Therefore, in the case of toothache, it is advisable to contact your dentist, who, taking into account the patient’s general state of health, will be able to recommend the most suitable medication.

Anti-inflammatory drugs commonly used for the treatment of toothache include those based on ibuprofen, ketoprofen, and naproxen.

Paracetamol, although primarily an antipyretic, can also help manage toothache. Paracetamol is a painkiller that does not damage the stomach and is, therefore, more suitable for individuals with stomach problems, pregnant or breastfeeding women, and children.

Who can take anti-inflammatories

In most cases, taking non-steroidal anti-inflammatory drugs is safe. However, some patients must seek medical advice first, as side effects may be more likely to occur.

Those who should seek medical advice before taking anti-inflammatory drugs include:

• Individuals who have previously experienced allergic reactions to an NSAID
• Women who are pregnant or trying to become pregnant
• Lactating women
• People over 65 and under 16 years of age
• Asthmatics
• Individuals with a history of stomach ulcers
• People with heart, liver, kidney, circulatory, or intestinal problems
• Those who are already taking other medications

Possible side effects

Like any medication, anti-inflammatory drugs can have side effects. Unwanted side effects are more likely to occur when the medicine is taken over a long period and in high doses, especially among the elderly or those in poor health.

The most common side effects of anti-inflammatories include:

• stomach pain
• stomach ulcers
• headaches
• drowsiness
• allergic reactions
• digestive difficulties

Natural anti-inflammatory analgesics

Individuals who do not want or cannot take anti-inflammatory drugs can explore the many natural alternatives available on the market. While natural remedies cannot guarantee relief from a toothache, those interested can certainly give them a try.

Among the natural remedies with anti-inflammatory properties, the best known and most widely used are:

• Cloves, which can be used in the form of essential oil to rub onto the sore area with a cotton bud
• Myrrh, for gargling
• Powdered ginger, to make a paste to rub on teeth
• Peppermint, for a mouthwash
• Boiled lettuce leaf to place on the sore area

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What are canker sores?

Canker sores are small superficial ulcers located on the soft tissues of the oral mucosa, such as cheeks, lips and tongue, or at the base of the gums. These bubbles in the mouth have a rounded shape with a circumference of less than 1 centimeter, which generally does not exceed 3 or 4 millimeters. They have a yellowish color surrounded at the centre by an intense red halo.

Aphthous stomatitis tends to disappear within 3 or 7 days.

Causes

What causes canker sores is not fully known. Several triggering factors have been identified such as fever, nutritional deficiencies, immune disorders, lack of iron or vitamins, local trauma, stress, fatigue, hormonal changes, allergies and intolerance to certain foods, genetic predispositions.

Symptoms

Canker sores are excruciating, and even feeding is difficult. In its initial phase, the bubble in the mouth presents itself with a burning sensation. After a few days, it forms a small ulcer which causes severe pain when touched. On the back of the tongue, the mouth floor, or at muscle insertions, it can also lead to altered tongue motility and difficulty in swallowing.

If the lateral-cervical lymph nodes swell, there is no need to worry; lymph node involvement is usually due to bacterial over-infection and concomitant inflammation.

Canker sores and other diseases

Canker sores can be a wake-up call to the presence of specific systemic pathologies such as:

• Celiac disease
• Chron’s disease and other chronic inflammatory diseases of the gastrointestinal tract
• Behcet’s disease, a vascular condition that usually accompanies canker sores and eye lesions.

Bubble/ mouth ulcers treatment

You can apply gels or ointments directly on the bubbles and the area affected by the disease. It would reduce pain and healing time. When you have a tooth abscess you have to fight the infection with an antibiotic. In this case the situation is different. 

There is no cure to prevent mouth ulcers but only topical therapies. 

How to cure mouth ulcers naturally

You can use several natural remedies to relieve discomfort and facilitate the healing of mouth ulcers. Among the most popular:

• lactic ferments, useful if canker sores depend on the intestinal imbalance
• aloe vera, for its calming and regenerating properties
• propolis, for its anti-inflammatory and anaesthetic properties
• ice, because the cold dampens the pain and inflammation
• liquorice for anti-inflammatory properties
• green, anti-inflammatory and purifying clay

Is canker sore contagious?

Canker sores ulcerations are often associated with blisters caused by herpes. One of the main concerns of people suffering from a canker sore is whether it is contagious. Unlike herpes, canker sores are not infectious. There is no risk, therefore if you have accidentally drunk from your friend’s glass.

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It is a psychological disorder related to the anxiety of coming into contact with everything related to the world of dentistry. You can have a fear of entering the dentist’s office, fear of drilling noise, fear of the smell of disinfectant typical of dental rooms, fear of getting touched in your mouth. Those phobias involve the five senses: the most common dental phobia includes them all and is the fear of dental implants.

Psychology of fear

All feelings of anxiety, extreme apprehension and fears related to the dentist are psychological phenomena arising from what the patient knows or believes he knows about dentists in general.

Very often, you are afraid of the idea that the dentist may hurt you even without having had painful experiences about it. To a large extent, the fear of the dentist is a cultural phenomenon related to the collective imagination. Often, a series of conditionings that we suffer from since childhood cause us to reject the idea of booking an appointment at the dental office. Even in the cartoons that we see as children, the dentist’s office is shown as if it were a torture chamber. It’s normal for children to grow up thinking it actually is a bad place.

The fear of pain

From a rational point of view, fear of pain is not pain, but fear. The logic of this expression is that when there is fear, there is no pain, so what has feared in itself is not the pain, but the fear itself. At this point, we must ask ourselves how to overcome it.

Fear of the dentist, how to deal with it

There are many remedies to overcome the fear of the dentist. The first step is to become aware that this is an irrational fear, most often linked to conditioning.

Here are several remedies that many dentists suggest to fight this problem:

Bach Flowers: Rescue Remedy

Among the homoeopathic remedies, the most suitable to face the fear of the dentist is the Rescue Remedy, a preparation in drops beneficial to counteract states of anxiety, panic attacks and all concerns of irrational order, such as fear of flying, examination or interview anxiety, etc.
As an alternative to Bach flowers, valerian or linden are lighter remedies. They always have to be taken in drops, a little before the visit to the dentist, because they need more time to take effect.

Conscious sedation

Very often, patients would like to undergo general anaesthesia to solve their fear. Many dentists (including our practice) allow patients to choose conscious sedation. In the presence of an anaesthetist the inhalation of nitrous oxide or – more effectively – the intravenous administration of benzodiazepines can completely dumb you. Actually, the patient is awake, can follow and cooperate, but is sedated and therefore cannot feel any pain.

Sedative hypnosis

Hypnosis is taking hold as an alternative to total anaesthesia or conscious sedation. The pre-intervention hypnotic techniques are based on listening to the hypnotist’s voice and have already proven to be effective in many cases. The practice of sedative hypnosis is indicated for patients who cannot be anaesthetised by medication. Some patients can’t undergo to anaesthetic for reasons related to their medical history, fear of puncture or intolerance to the type of drugs.

How to fight the fear of the dentist back

All the remedies in the world can only help, but the most significant work is the one on yourself. Every day we are faced with people who are more or less afraid of being in a dental office. The manuals teach us a lot, but only time and continuous contact with patients allows us to stay close to them and accompany them to the end of their worries.

That’s the real place to get a smile back!

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One of the most commonly prescribed antibiotics is the amoxicillin, suitable for adults, children and breastfeeding women. Amoxicillin can be taken by mouth either on an empty stomach or after eating.

Nausea, vomit and diarrhoea are among the most common side effects found in treatment with amoxicillin. It may cause skin reactions not necessarily related to penicillin allergy.

The second most used antibiotic in case of a dental abscess is a combinate antibiotic. It combines the action of amoxicillin and clavulanate. The union of the two substances is particularly useful for those bacterial resistances more challenging to combat. The dentist prescribes combinate antibiotic when amoxicillin is not sufficient.

Antibiotic without prescription

Patients, especially in a situation of acute pain, rely on do-it-yourself solutions. Often people take medicines arbitrarily, without being visited and without a prescription just because they found a suggestion on the internet. 

DIY in dentistry can be harmful. The inappropriate antibiotic may not have the desired effects, and the pain could persist. Moreover, an incorrect dosage can make the medicine useless or worse make it harmful, producing sometimes dangerous side effects. Not to mention that every time we take an antibiotic, antibiotic resistance occurs. So over time, it may become ineffective. The antibiogram is the result of susceptibility tests in which the microorganism is essayed for its susceptibility to several antibiotics.

Are you wondering how many days you should take antibiotics? Keep in mind that once you start taking them, it is never advisable to stop ahead of time. There are at least two good reasons. First, you risk not to eradicate all bacteria. Second, f you quit treatment too early the surviving bacteria could generate defences against the antibiotics themselves (antibiotic resistance).

When to prescribe antibiotics in dentistry?

Dentists prescribe antibiotics also for precautionary purposes, as pre or post-operative prophylaxis. A particular case of antibiotic prophylaxis in dentistry concerns cardiac patients, those with congenital heart defects and those with an artificial valve. In these cases, the dentist prescribes antibiotic therapy to prevent bacterial endocarditis which can occur following a simple tartar ablation.

The selection of the antibiotic mainly depends on the type of bacterium that caused the infection. It also depends on infection severity, on the presence of pathologies or allergies and any pregnancy.

Antibiotic or anti-inflammatory?

One of the most common emergencies in case of a dental abscess is the cheek swelling. This type of swelling can occur both in case of caries (endodontic abscess) as for periodontal problems (periodontal abscess) or during the eruption of wisdom teeth (pericoronitis in case of dysodontiasis)

It may not make sense to take antibiotics for wisdom teeth eruption unless an infection develops at the same time. A common anti-inflammatory will suffice to reduce swelling and keep pain under control. In any case, before taking drugs, it is always better to consult your dentist who will evaluate the actual presence or absence of an infection and the possible need for an extraction.

Are natural antibiotics effective?

If a bacterial infection of the oral cavity needs to be cured, a natural remedy may not be as effective as a drug. There is no scientific evidence to support the use of homoeopathic remedies to treat infections. However, there are natural treatments that can play an important role in counteracting the development of oral cavity infections.

We suggest the use of 

• ice to reduce inflammations and swelling 

• clove infusion to relieve pain (rinsing the mouth)

• ventilated green clay, with bactericidal and purifying properties

• essential oils, aloe vera gel, propolis and echinacea that fortify the body by acting naturally on the immune system.

Bibliography

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.

Cope AL, Francis N, Wood F, Chestnutt IG.

Cochrane Database Syst Rev. 2018 Sep 27;9:CD010136. doi: 10.1002/14651858.CD010136.pub3. Review.

PMID: 30259968

Antibiotics in Endodontics: a review.

Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH.

Int Endod J. 2017 Dec;50(12):1169-1184. doi: 10.1111/iej.12741. Epub 2017 Jan 16. Review.

PMID: 28005295

European Society of Endodontology position statement: the use of antibiotics in endodontics.

 Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH.

Int Endod J. 2018 Jan;51(1):20-25. doi: 10.1111/iej.12781. Epub 2017 Jun 14. Review.

PMID: 28436043

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Periodontitis

As the most recurring and feared pathology, the periodontitis is an inflammation of the periodontium, that is the whole tooth sustain structure, which, if not promptly treated leads to dental mobility and then to the loss of the dental elements involved by this pathology.

Behind this pathology, there is always the accumulation of bacterial plaque, which is in relation to the high or low individual sensibility to the periodontal disease. Plaque and tartar tend to accumulate by the gingival crevice especially because of an incorrect or low frequency teeth brushing with a possible consequence to expand to the gingival margin. Bacteria, here, can go undisturbed, creating the so-called gingival pocket and damaging the periodontium. This is the reason why it is necessary to keep an accurate home daily care within periodical dental hygiene session by professional dental office specialized in periodontology. This is remarkable because the standard dental hygiene usually keeps on the supragingival level without removing the subgingival tartar and plaque, which are the true responsible for periodontitis.

A clue to recognize a well done dental hygiene is the level of pain felt. The higher the pain is the better the hygiene have been done.

Unfortunately, there is no evident clue that helps us identifying the periodontitis; actually, the very first sign of a periodontal disease for a patient is often the dental mobility, which represents one of the last stages of the disease. The main reason why this pathology is often unnoticed is that the loss of bone, which is its peculiarity, does not necessary mean a gingival recession that is a gingival estrangement from the tooth. It is actually very common that the gingiva keeps being in its place although a moderate loss of bone. In this case, the gingival bleeding, due to the inflammation, represents a clear evidence of the disease, speaking of which the gingivae must never bleed.

Although the pathology is in place, there is still the chance to save the patient’s teeth and avoid the dental extraction and dental implantology.

It is important to know that the periodontist’s first step is oriented to the teeth preservation: instead of choosing surgery, it contemplates different dental hygiene sessions to remove the subgingival and the supragingival tartar.  Our procedure, for example, contemplates the usage of sonic and ultra-sonic tools with whom the tartar croncretion from the tooth deep in the periodontal pocket helping to clean the radicular surface and allowing the periodontal tissues healing.

If periodontal pockets keep lasting, surgery is recommended.

Tooth Migration

The dental element migration occurs when a great quantity of bone has been lost due to the periodontitis and a high level of inflammation. The central incisors are generally those who move creating a space between the teeth. This migration can be partially reversible as the space between the teeth, which, can be partially or totally closed removing the subgingival tartar, that is removing the teeth inflammation. When a teeth migration is observed, it is important to contact your periodontist promptly because dental migration anticipates the dental elements loss if not intervening immediately.

Trauma

A trauma can also be the cause of dental mobility. It’s not so unusual for the tooth sustain structures to be damaged in order to cause dental mobility by a hit, a fall or any other accident. In any of these cases, never underestimate the damage and always let it check to your dentist who will surely value the situation finding out the best treatment for your problem.

Occlusal trauma

Occlusal trauma, known as the presence of excessive forces pushing on the teeth until damaging the periodontium, is another cause of dental mobility. Actually, these forces have such power to cause the dental mobility and then the loss of the tooth involved. As for the case of a tooth pre-contact or for the lack of molars there can occur an occlusal trauma leading to one or more teeth mobility. If promptly diagnosed, the occlusal trauma is completely reversible thanks to the simply removal of the pre-contact.

PREVENTION

As they say : “prevent is better than cure”, sponsored by a well know toothpaste brand, tells us a great truth connected to the dental mobility. No one should ever reach that moment where one or more teeth start to move, just because this could only mean that the teeth were already on their way for loss. Prevention is avoiding gingivae to recede without seeking for help so often and, most of all, it is avoiding that tartar accumulation during a long period of time could damage irremediably the gingivae.

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These bacteria feed on carbohydrates releasing acid which corrodes the dental enamel which becomes porous and leads the untreated caries to deepen first towards the dentine and then to the dental pulp.

Therefore, tooth decay isn’t more than the tooth acid corrosion due to the result of the streptococcus mutans secretion which can be found in the form of the plaque and the tartar adhering to the tooth (these bacteria eats the sugars secreting then acids).

In its first stage the cavity is asymptomatic and it shows as a small darker spot at the enamel layer.

If it is located on the occlusal surface of the tooth it can be clinically highlighted by an explorer meanwhile if it is located between two teeth it can be highlighted by an intrabuccal x-ray where there can be found a dark spot if the caries has already at least destroyed a quarter of the dental mass.

The more this caries advances to the pulp a stronger pain arises to the teeth. It is recognizable by a dark “hole” within soggy material. It is important to remind that the caries has a pyramidal shape and what we see it’s only the tip which means that that small dark spot on the tooth can hide a very wide caries.

When the caries reaches the pulp causing pain the tooth must be devitalized.

How much does it cost to treat tooth decay?

The dental caries treatment fee is variable and the evolution stage of the disease affects the final amount. The devitalization, for example, is a much more expensive procedure than the filling. The number of the teeth involved in the carious process can also contribute to increase the fee, it can actually occur that some patients can show more than one carious dental element even at different stages of evolution.

Just for a general idea of the amount of the cost, in our dental office the fee for a basic filling is from about 80 € up to 250 € depending on the complexity of the cases. The complexity of the filling depends on how many parts of the tooth are involved in the carious process. There can be diagnosed I class simple cavities where only the occlusal surface is involved, II class cavities where the interdental surface is also involved, the mesiocclusion distal cavities (MOD) where at least three parts of the tooth are involved, V class cavities which involve the dental neck (in these cases it is much more complex to add the rubber dam) and the III and IV class cavities which involve the incisors and the canines for what concerns the aesthetical zone.

How much does it cost to treat cavities?

Average cost in Italian dental practices.

How to treat caries

As already said, treating caries can vary according to the pathology stage. For the easiest cases the dentist proceeds with a filling after cleaning the tooth removing the infected dentine, which means that the cavity caused by this procedure is filled by some composite material. If the caries has extended to the pulp it is necessary to devitalize the tooth and in some cases to protect it with a dental crown.

In both case a rubber dam must be used, that is a rubber sheet that isolates the tooth avoiding contamination caused by salivary liquids and especially the patient’s breath.

Can cavities be prevented?

Caries can be prevented by using fluorine within a procedure since the childhood or even before. Taking fluorine in pregnancy and giving it to the child until age seven, can determine such a mineralization able to preserve the teeth from the bacteria causing caries.

Once chosen this option It is important to avoid home remedies preferring to seek help from the dentist as an overdose of fluorine can provoke spots on the teeth then hard to remove.

Who hasn’t taken fluorine is condemned to tooth decay?

Absolutely not. Caries can be prevented also with a correct domestic oral hygiene, with the professional oral cleanliness and with healthy nutrition. The rules are always the same, washing teeth regularly and carefully after every meal, using the interdental floss and the water flosser, always remember to check up your dental health and to periodically undergo to professional oral cleanliness sessions.

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Tooth decay is one of the most widespread pathologies in the dental field. It consists of a destructive process of tooth’s hard tissues due to the action of different kinds of bacteria present in the mouth and found in plaque and tartar, the ideal environment to reproduce. Generally, the most affected teeth are the molars, the premolars and the upper incisors, while the areas most affected by decay are the interdental spaces, where the removing food is more difficult. Dental floss has often not been used for years and this increases the reluctance to turn to a dentist, with the consequences that we all know.

In its initial phase tooth decay is asymptomatic and is manifested as a change of colour in the enamel that shows darker spots. As it progresses and reaches the pulp of the tooth, it causes severe pain in the teeth, which visually presents as a kind of dark “hole” containing softened material. A strong dental sensitivity can be developed. If you have not had the courage to make an appointment with the dentist until this point, it is time to stop feeling ashamed and pick your phone up right now.

It is important to remember that dental pain is not caused exclusively by decay in the advanced phase, then by cavities, but also by gingivitis, abscesses and pulpitis, which is why it is always advisable to overcome the embarrassment and find the courage to consult a dentist to solve this problem permanently.

Carious process

The carious process begins with the weakening of the enamel by the acids produced by the bacteria, which pierced this barrier, come first to the dentin and then to the pulp rich in vessels and nerve endings.

If for reasons of embarrassment or lack of courage you do not seek a cure at this stage several complications more serious of the classic toothache may occur. Bacteria attacking the pulp can impair tooth’s health causing apical periodontitis, abscesses, granulomas or cysts.

Generally the evolution process of decay is quiete slow and can last over six months.

What causes decay

The causes of decay are still little known. As already mentioned, you know that the bacteria that inhabit our mouth in some cases can become dangerous and start to puncture your teeth with the carious process. The most feared among the bacteria is surely the lactobacillus that nourishing glucose produces as a waste product the lactate, a substance with a high acidity content, which can dissolve and pierce the dental enamel.

These microorganisms become very dangerous when:

• They accumulate excessively on the teeth beacouse of poor oral hygiene, in presence of plaque and tartar
• They have a lot of available nutriment due to a diet rich in simple sugars and carbohydrates
• The amount of saliva decreases. Not everyone knows that saliva is able to exert a protective, antimicrobial and immune function against cariogenic agents thanks to some substances dissolved in it.
• You ignore periodical check-up

Bacteria are not the only responsible for decay. There are several factors and bad habits that contribute to the onset of this pathology.

Foods: good and bad

Foods that favour decay

Everyone knows the relationship between diet and the onset of decay. But if it is true that there are some foods that can affect this process it is equally true that these foods pose a danger the longer they remain in the mouth. To avoid getting cavities from tooth decay, simply remember to brush your teeth thoroughly after each meal, especially before bedtime.

Among insidious foods for healthy teeth there are those containing simple sugars, such as sucrose and glucose, which can be replaced by fructose which has a lower cariogenic power. Also in this category are complex carbohydrates, such as those present in pretzels, crisps and sticky foods such as candies and also jam and some types of dried fruit, such as raisins.

Also beware of fruits such as citrus, strawberries and pineapple as they are quite sour.

There are other types of foods that help to protect the health of the oral cavity such as:

– substances contained in red wine, proanthocyanidins, capable of preventing decay and periodontal diseases;

– mushrooms, for the positive effects of the quinine acid;

– milk and yogurt, for calcium;

-raw vegetables and fruit such as apples,that for their crispy texture help teeth’ self-cleaning;

-propolis, for its antibacterial effects;

-dark chocolate with 80% of cacao which contains natural antibacterials;

-cranberries, because of the presence of procyanidins;

-the wasabi, containing isothiocyanates, which prevent bacteria from adhering to teeth;

-water and tea, for the presence of fluorine.

Bad habits

Some habits promote oral bacteria proliferation. Poor oral hygiene is the most important predisposing condition, but smoking is a risk factor as well. Some types of tobacco, in fact, contain sugars that increase the probability of developing decay, in addiction, smoking can also be responsible for diseases such as pyorrhoea and gingival recession, which leave the dental collars uncovered, conditions that facilitate the attack of the pathogens agents to the dental pulp and the onset of classic cavities in the teeth. These are the conditions which we must not be embarrassed by, but find the courage to put confidence in the work of the dentist, who in any case is not there to judge us, but to do his work, that is to save our teeth.

Decayed milk teeth

Like those of adults, even the deciduous teeth of children can be attacked by decay. This pathology primarily affects four superior incisors and milk molars.

In children the cariogenic process is faster, because milk teeth are smaller in size and have less mineralized enamel.

Among the causes of decay of the milk teeth there are poor oral hygiene and lack of fluoride. Children are not always able to clean the oral cavity properly, so we recommand to use a toothbrush with parental guidance since the eruption of the first tooth and to supplement the diet of smaller children with fluorine (except in areas where the running water is already rich in fluorine).

What should I do if the milk tooth is already decayed?

Erroneously, it is a common thought that the decayed milk tooth should not be treated because it is destined to fall out. In reality decay of the deciduous teeth must be treated, not only because it can be very painful, but potentially damaging for the development of the permanent teeth and the mandible. So it’s important that parents do not neglect this kind of decay.

If the decay is already in an advanced stage and it is not possible to treat the cavity, extraction will be necessary.

Diagnosis of decay

As we said the decay in its initial stage is asymptomatic and difficult to see. To prevent its degeneration, it’s opportune to periodically undergo visits to the dentist so that an early diagnose may be made.

Diagnosis of decay is divided into: diagnosis in presence, activity and risk.

Diagnosis in presence

This is based on the direct observation of the accessible surfaces to evaluate the coloration of the enamel and the presence of any open cavities. At this stage, the dentist can perform several instrumental tests, such as the use of sharp probes, transillumination, electrical conductance, laser fluorescence and digital or traditional radiographs.

Activity diagnosis

The evaluation of carious lesion activity is based on careful observation of the colour and texture of the tooth tissues.

Risk diagnosis

The main risk factors such as susceptibility, the presence of producing bacteria and the type of diet are evaluated. This type of diagnosis afford to implement preventive measures for patients who have high chances of developing a carious process.

Types of decay

Not everyone knows that there are different types of decay with different evolution periods.

• Chronic decay: it has a slow development, about two years, and does not present a strong dental sensitivity;
• Acute decay: Evolves in about six months;
• Secondary decay (or relapsing): the decay has not been treated adequately so that it reoccurs where there is already a filling;
• Interdental decay: it develops on the surface between the teeth.

How to treat decay

The best cure is definitely prevention. With proper dental hygiene, periodic professional cleaning and healthy nutrition, it is possible to decrease the probability of decay. If one of these aspects has not been observed, you should not feel embarrassed when booking a visit to the dentist. This is very important, because embarrassment and inaction produce worse results.

When it is too late and the process has already started, the only thing to do is to contact a dentist. The main treatment for decay is a filling, that seal all the fissures and canaliculus caused by the bacteria. If the carious process has already passed through the enamel and dentin and is attacking the pulp, then it is necessary to devitalize the tooth. The branch of dentistry that treats these disorders is called endodontia.

Curing decay without filling

Some websites talk about alternative techniques to cure decay without using a drill which would be ideal for all patients suffering from particular sensitivity and fear of the dentist. In most cases, these techniques are not supported by reliable scientific publications, so we mention them just as information.

Prep Start

This technique is based on a device that emits aluminium dioxide, a mineral that with its micronized particles uses the kinetic energy to shave the decayed dental tissue. It requires a specific ability to skilfully manage the jet, which is calibrated to remove only the decayed tissue, sparing the healthy dental tissue.

EAER

Nigel Pitts and his colleagues of the London Dental Institute at the King’s College of London have developed a new decay removal system based on a technique called Electrically Accelerated and Enhanced Remineralisation (EAER). This technique allows the acceleration of the natural movement of calcium and phosphate in the damaged tooth, thus stimulating the repair.

Laser

Often we hear about the use of lasers for treating decay, but less frequently mentioned are the disadvantages that this type of treatment involves. For example, during its operation the tip of the handpiece can reach high temperatures that can overheat the pulp of the tooth causing his necrosis. Moreover it produces loud noise that often frightens patients, making treatment longer and more difficult.

Toothpastes to regenerate the enamel

Another often debated aspect among patients concerns the existence of toothpastes able to counteract the carious process. A question that frequently arises is “are there toothpastes that can regenerate the enamel by closing the holes caused by decay?” We must say that the process of erosion of the enamel is actually irreversible, in fact our organism fails to regenerate it autonomously. However we read about toothpastes containing calcium silicate and sodium phosphate, also quite expensive, that promise an enamel regeneration of 82% and even the filling of any microscopic holes caused by carbonated drinks or sweetened foods. We must to be very clear on this point, saying that there are no toothpastes able to cure decay already present, while they can just help to fortify the dental enamel, so that in most cases it is useless to rely on any particular toothpaste. It is advisable to find the courage to treat decay in the most appropriate way: turning to the dentist.

Prevent decay by taking fluoride

The intake of fluoride from pregnancy and continuing in a child up until seven years, can result in a mineralization that makes the teeth resistant to the acids responsible for decay produced by streptococcus mutans. However, it is important to measure fluoride intake, since an excessive dose may produce stains on the teeth at a deep level, which are not easy to remove, called fluorosis. We must pay attention to fluoride intake by food or water which make the ideal dosage of fluorine more difficult to calculate.

Can you treat decay by yourself?

DIY treatment for decay is quite impossible because softened tissues do not have regenerative abilities, so the only way to stop the evolution of the process is to turn courageously to the dentist who will proceed to the treatment for the elimination of the problem. It may seem absurd that we reaffirm the fail of self-management in dental care, but we hear always more frequently of sale of “DIY dentist kits” that promise excellent results with considerable savings. This “alternative methods” spread thanks to people’s scary and embarassment of facing the idea of showing to dentist their “bad”situation. We suggest to always turn to a specialist. I mean, in layman’s words, you can’t cure the cavities in your teeth by yourself, because self treating of a cavity is impossible. However, as already said, the only way to self treat decay is to prevent it.

Caring for decay with diet and supplements

According to some alternative theories, it would be possible treating decay autonomously by diet. Dr. Price studied teeth of people who had never eaten western food and who did not know oral hygiene practices. He found that although they had never brushed their teeth and that food residues were stuck in the mouth undisturbed for weeks, these indigenous people had a healthy dentition without a trace of decay. Although modern scientific literature disavows this theory, some affirm that enamel erosion process as result of decay may be inverted, remineralizating the tooth with a proper diet, avoiding legumes and sugar-rich foods, thus blocking the supply to the bacteria responsible for decay. Instead, dr. Prince suggests to increase the intake of vitamin A, C and D, which are found in many foods, and minerals, such as magnesium. We should always remember that such decisions should be taken under medical advice and not just from information found on internet sites, so you should contact a nutritionist if you do not dare to make an appointment with the dentist.

Untreated decay, what are the complications?

If ignored, decay can cause pulpits, abscesses, gingivitis, granulomas until the total tooth’s destruction. In these cases also filling the tooth is useless and the only procedure is the removal of the infected pulp.

How much does it cost to treat decay?

The price of treatment depends on the state of the decay. For example, if the problem can be solved with a simple filling, it will cost less than if it is necessary to devitalize the tooth, a much more expensive process. In our studio the cost of a filling goes from 80 euros up to 250 euros for the most complex cases.

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The radicular caries are the oral diseases most frequently diagnosed in elderly patients. It can occur when the gums recede, exposing the root surface to pathogenic agents attacks, dental hypersensitivity, dry mouth or xerostomia often due to the intake of certain types of drugs, yellow teeth, caused by the dentine natural color variation or by the use of pigmenting substances.

Another frequent problem in the elderly population is the periodontitis, which can be managed and monitored even in old age, if diagnosed in its early stages preserving the patients’ natural teeth.

If the dental elements have already failed or the evolution of the disease cannot be contained, elderly patients can also replace them with removable prostheses or dental implants.

Let’s see which solution is indicated in the following cases.

Denture or implant?

Patients who have lost their natural teeth may decide to replace them with removable or fixed prostheses. The aim is to rehabilitate the correct masticatory and phonetic functions as well as to restore the beauty of the smile.

Removable prostheses, which are used to replace the whole dental arch, are made up of resin teeth laid on a resin support. The denture is not anchored to any tooth but adhered to the gums with a suction mechanism.

A removable partial prosthesis can be used in case of replacement of one or more teeth. It is anchored by some clamps to the residual natural teeth or implants.

The advantages of choosing a denture are definitely related to the low costs and short realization times. On the other hand, in addition to minor inconveniences such as injuries due to movement or to the difficulty of eating easily, the denture requires a relining procedure approximately once a year; it is the replacement of the pink part of the prosthesis laid on the mucous membranes due to bone resorption.

Denatl implants are a much more stable and comfortable solution for patients. With implantology, the teeth are replaced with artificial titanium roots anchored to the bone. This type of surgery can be also performed with low bone quantity conditions, using implants made of titanium zirconium alloys, which are thinner and shorter.

For the most severe cases, it is necessary to intervene with bone regeneration procedures.

If there are no contraindications, the dental implant is an ideal solution even for elderly patients, who will no longer have to worry about all those aspects related to the removable prosthesis and will be able to live normally their daily life.

Possible contraindications to dental implants in elderly people.

It is a common idea that the more aged is the patient the less dental implant surgery is recommended; the age is not actually a factor that affects the possibility to put an implant. This type of therapeutic procedure can be undertaken by young people as well as by elderly patients.

A possible drawback to dental implantology can be due to other kinds of conditions such as the presence of other diseases that require the use of some types of drugs.

One of these is osteoporosis treated with bisphosphonates. Who takes this type of molecules for a long time and wants to put a dental implant could face osteonecrosis, necrosis of the jawbones, which can hardly be kept under control leading to very serious consequences. This condition does not concern only elderly patients, but all those who need to take these types of drugs, especially through injections.

However, preventive protocol procedures can be implemented to avoid any complications.

In any case, the dentist will check the patient’s general state of health before recommending the implant or the removable prosthesis.

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Our advice is very clear: when it is possible, it is better to save the tooth.
The technology for dentures and dental crowns has reached excellent levels, both regarding dental aesthetics and functionality. Anyway, a prosthesis or an implant still cannot fully replace a natural tooth as the latter is organically connected to the mandibular bones to which its function is related. The “Dental system” is a complex organic mechanism of absolute precision. For this reason our practice is constantly striving to raise its qualitative standards towards conservative dentistry. In order to save our patients’ teeth in most of cases, avoiding the use dental implants as much as possible.

Saving a tooth, in addition, costs much less than its replacement with a dental implant. Suffice it to remember that saving the teeth from periodontitis has a cost 10 times lower than the average required for replacement with implants and crowns.

Conservative dentistry

In the following cases the question more frequently asked is whether or not to choose the conservative way.

Periodontitis

When the inflammation of the gingiva (gingivitis) caused by accumulation of tartar degenerates in periodontitis – most frequently due to a genetic predisposition – it would very often be sufficient to have some sessions of in depth curettages with a good periodontist. A professional and thorough cleaning of the teeth could, in many cases, save the teeth avoiding extraction and avoiding the need for a dental implant.

Caries

The tissues inside a tooth can die as a result of caries or a trauma. In these cases we proceed with root canal therapy. Sometimes the endodontic treatment fails to remove all the necrotic tissue and the infection can persist continuing to feed granulomas that manifest themselves as cysts. In the worst cases, those in which it is more difficult to intervene, it is often preferable to move in a conservative way doing an apicoectomy, as described in the blog Zerodonto.

Evolution in Dentistry

Dentistry evolves in two directions: on the one hand, the most advanced prosthetic materials and the most advanced techniques are studied to ensure an ever greater precision in the practice of guided implantology through the use of computers and microscopes. On the other hand the techniques of intervention aimed at preserving the natural teeth for longer and in a healthier state.

To read all the studies on conservative dentistry produced by the most renown specialists in Italy and abroad, we refer to the scientific blog Zerodonto.

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In the past it was thought that late eruption of wisdom teeth could preclude the alignment of other teeth, or even cause a misalignment. Today it has been shown that the wisdom tooth alone is unable to cause the misalignment of the anterior teeth. This occurs regardless of the presence of the wisdom teeth.  Masticatory forces cause misalignments.

Crooked teeth, although being more difficult to reach with the toothbrush, can easily be attacked by the bacteria that cause decay and cavities. However it must also be said that if a wisdom tooth is crooked and inclined towards the previous one, it almost always risk to cause a decay in that tooth. This kind o caries are often difficult to treat. In these cases it is recommended to extract the wisdom tooth as a preventive measure.

It is proven that the wisdom tooth is unnecessary for chewing so when it represents a problem the first thought is to extract it. In fact, the chewing process involves all the teeth up to the seventh one. The self–cleansing action that normally occurs on the teeth during chewing does not involve the wisdom teeth. This makes them more susceptible to decay.

As oral hygiene is difficult at the level of the wisdom tooth, infections and gum inflammation may occur. Fever and sore throat are also possible (lower third molar dysodontiasis).

When a wisdom tooth hurts, the pain is due to a decay that reached the pulp chamber (the nerve) or to the inflammation of the gum around the tooth. In the latter case the symptoms are generally gum swelling and pain. But also earache, difficulty in swallowing and the inability to open the mouth very wide. In case of necrotic tissues, bad breath could be caused by abscesses or sores.

At what age do wisdom tooth-related problems show?

The first problems related to the wisdom tooth are due to its eruption which usually begins in adolescence, around 17 years old. Cases requiring extraction have a wider age variable from around 35 years, up to 50 and in some cases even 60 years.

Wisdom tooth and pain, what to do?

We usually recommend patients at the initial stage of the wisdom tooth eruption, who experience moderate pain, avoiding hard, cold and hot food. When the pain increases you can take an analgesic, but don’t exceed the recommended dose – remember, analgesics only have effect on the symptoms.

Some suggest keeping the gums clean by rubbing them with a cotton wool wad soaked with hydrogen peroxide, or doing the same thing with a syringe without needle. Usually, however, in absence of specific problems, the pain disappears in a few days. When pain is not caused by the natural and physiological development of the wisdom tooth, it could depends on infections or on orthodontic-related problem. In this cases the only remedy is to schedule a visit to the dentist who will evaluate the situation and decide what to do.

When should the wisdom tooth be removed?

Sometimes it is necessary to remove it because it can obstruct the mouth completely. Apart from the burning sensation caused by infections it can even damage the surrounding teeth or tissues. It could even cause holes or serious injuries to gums or cheeks. When such a risky situation occurs, you need to extract it.

Wisdom tooth removal – how is it usually performed?

Wisdom tooth extraction is usually carried out as for that of any other permanent tooth. Dental forceps are used to tilt the tooth in its alveolus. The applied force loosens the gum intake and allows the extraction. The problem with this canonical technique is that its application often causes a fracture of the tooth. This entail the an operating session that can last up to two hours. This would be the time necessary to remove all the fragments of the broken tooth from the alveolus. Is not infrequent, after the problematic extraction of a wisdom tooth, the occurrence of alveolitis, i.e. the inflammation of the alveolar bone, the bone cavity in which the roots of the teeth are housed.

Wisdom tooth extraction in a few minutes

A fracture occurs when the the forceps move the tooth towards a “lateral” direction. There is, however, a technique – we use in our study – which allows you to extract the wisdom teeth without forceps, using elevators.

Using the elevator instead of the forceps, allows you to push the tooth directly from the bottom to the top, with no lateral movements. The patient will be extremely satisfied with the quick wisdom tooth removal. A painless extraction. Above all, there are no major complications because using levers will avoid breaks, so there will be no residual fragments.

This technique is less traumatic, painless, quick and safe. Therefore we recommend it to all our patients and in general to everyone requiring the extraction of a tooth.

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