Tooth Trouble

Dr Rajkrishnan | 01-July-2014

Detailed News

Dental diseases are one of the most common non-communicable diseases. Though they are rarely life-threatening, they do impact the quality of life. Dental problems can cause severe pain, loss of man days and morbidity. Thus they are an important health concern and it is vital that people seek awareness about the issue. Here are signs and symptoms that may present itself to a patient that can alert him/her of the possibility of an underlying dental/systemic problem which can motivate them to seek professional help sooner than later

Dental Specialist,
Dr.Rajkrishnan’s Dental Clinic,
North Fort Gate, Tripunithura

Some common diseases

Gum disease/periodontitis: Periodontal disease is an infection of the tissues that hold your teeth in place (gums and underlying bone).  Its typically caused by poor brushing and flossing habits that allow plaque- a sticky film of bacteria- to build up on the teeth and harden. In advanced stages, periodontal disease can lead to sore, bleeding gums, painful chewing problems, and eventual tooth loss.  

Gingivitis (gum inflammation) usually precedes periodontitis (gum infection). However, not all gingivitis progresses to periodontitis. In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

When gingivitis is not treated, it can advance to periodontitis where gums pull away from the teeth and form spaces between (called pockets) that become infected.

What causes gum disease?

The main cause of periodontal (gum) disease is plaque, but other factors affect the health of your gums are:

  • Smoking: Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.
  • Hormonal changes in girls/women: Hormonal changes during pregnancy, puberty, menopause, and monthly menstruation make gums more sensitive, which makes it easier for gingivitis to develop.
  • Illnesses: It may affect gum condition, including diseases like cancer or AIDS, which affect immunity of the body. People with diabetes are at higher risk of developing infections, including gum disease.
  • Medications: There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Some drugs like anti-hypertensive and anti-convulsant can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.
  • Genetic susceptibility: Some people are more prone to severe gum disease than others. 

Signs and symptoms of gum disease

  • Bad breath that wont go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums or longer appearing teeth


The main goal of treatment is to control infection. The type of treatment will vary from deep cleanings to surgical treatments, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest change in any medication and change certain behaviour such as quitting smoking, as a way to improve treatment outcome.

Tooth Decay

Tooth decay  is the damage that occurs when the bacteria in your mouth feed on the sugar from food you eat and make acids that eat away at a tooth. It can lead to a hole in the tooth, called a cavity. If not treated, tooth decay can cause pain, infection, and eventual tooth loss.

Things that make you more likely to have tooth decay

  • Not brushing and flossing your teeth regularly and not seeing a dentist for checkups and cleanings.
  • Eating foods that are high in sugar and other carbohydrates, which feed the bacteria in your mouth.
  • Not getting enough fluoride. Fluoride helps prevent tooth decay by making teeth more resistant to acids produced by plaque. Fluoride is added to most public water supplies.
  • Not having enough saliva. Saliva washes away food and harmful sugars, so it helps protect your teeth from decay. A dry mouth may be caused by a condition such as xerostomia or Sjögrens syndrome, by taking certain medicines, or by breathing through your mouth. Older adults are more likely to have a dry mouth.
  • Having diabetes.
  • Smoking, using spit (smokeless) tobacco, or breathing secondhand smoke.

Children, whose teeth are still growing, are more likely than adults to have tooth decay. This is because the minerals in new teeth are not very strong and are easier for acids to eat away. Even babies can be at the risk of tooth decay. Babies who are put to bed with a bottle can get Nursing bottle caries” —tooth decay caused by the sugar in milk or juice.

What are the symptoms?

Tooth decay usually doesnt cause symptoms until you have a cavity/infected tooth. When this happens, you may have:

  • Toothache (most common symptom)
  • Swelling in your gums near a sore tooth. This can be a sign of severe tooth decay or an abscessed tooth.
  • Bad breath or a bad taste in your mouth
  • White, gray, brown or black spots on your teeth

If you have toothache, see a dentist. Sometimes, the pain will go away for a while, but the tooth decay will keep growing. If you dont get treatment, your cavities could get worse and your tooth could die.

How is it treated?

The best treatment for tooth decay depends on how severe it is. If tooth decay is caught early, before a cavity forms, you may be able to stop it by brushing with fluoride toothpaste or getting fluoride treatments. Thats one good reason to see your dentist on a regular basis.

If the decay has eaten through the enamel, you may need one or more of these treatments:

A filling if a cavity has formed

A root canal treatment if the pulp of your tooth is infected. A root canal treatment removes the diseased pulp of a tooth.

Removal (extraction) if the root of the tooth is severely damaged. The dentist may replace the tooth with a bridge or an implant.

oral cancers

Most commonly affecting the mouth, lips, tongue, or throat, this disease ranks among the top three types of cancers in India.

Signs and Symptoms

Oral cancer can be difficult to identify for a lay person. Regular dental visits are important factor in the early detection and treatment of cancer. Nevertheless, people should be aware of the following signs and symptoms and should visit a doctor or dentist immediately if they notice.

  • White or red patches in the mouth or on the lips or tongue
  • Changes in the texture or colour of tissues in the mouth (deep, hard cracks in mouth tissue that are often pale, but may also be dark or discoloured. Lumps may form on the tongue, lip, throat, or other areas of the mouth and they may be painless at first)
  • Numbness, sore patches, or abnormal bleeding in the mouth, especially sores that dont heal
  • Difficulty swallowing
  • Changes in taste or tongue sensation
  • Sharp teeth causing traumatic irritation to oral structures like tongue/cheek

The risk factors for mouth cancer

  • Smoking
  • Chewing tobacco
  • Taking snuff (snorting tobacco)
  • Both heavy and regular alcohol
  • Heavy smoking combined with heavy drinking 
  • Too much sun exposure on the lips, as well as sunlamps or sun beds.
  • GERD (gastro-esophageal reflux disease)- people with this digestive condition where acid from the stomach leaks back up through the esophagus have a higher risk of oral cancer.
  • HPV (human papillomavirus) infection.
  • Prior radiation treatment (radiotherapy) in the head and/or neck area
  • Regularly chewing betel nuts
  • Exposure to certain chemicals - especially asbestos, sulphuric acid and formaldehyde.

Many people will not receive any oral healthcare except that received from a physician, and new research suggests that tooth and periodontal diseases may have important systemic consequences. Therefore, physicians have an important role in the management of these conditions by identifying dental and oral disease, encouraging proper dental hygiene, counseling on the effects of tobacco and alcohol, and initiating referrals to dental professionals as needed.

In conclusion, it is very important to go for regular dental visits in order to keep your teeth and gums in good shape and disease free. A biannual check-up is the best thing you can do for your oral health. There is a strong relationship between your oral health and your overall health. So taking good care of your mouth is a big part of taking care of your whole body.

TMJ Disorders

Temporomandibular joint and muscle disorders, commonly called TMJ, are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement.

What are the signs and symptoms?

  • Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom.
  • Radiating pain in the face, jaw or neck
  • Jaw muscle stiffness
  • Limited movement or locking of the jaw
  • Painful clicking, popping or grating in the jaw joint when opening or closing the mouth
  • A change in the way the upper and lower teeth occlude/ join together when biting.


Since more studies are needed on the safety and effectiveness of most treatments for jaw joint and muscle disorders, experts strongly recommend using the most conservative, reversible treatments possible.

These are the steps you can take that may be helpful in easing symptoms

  • Eating soft food
  • Applying ice packs
  • Avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing)
  • Practise gentle jaw stretching and relaxing exercises that may help increase jaw movement. Your healthcare provider or a physical therapist can recommend exercises appropriate for your particular condition.

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