Urgent Dental Problems

Urgent Dental Problems

Certain dental problems require early treatment to relieve discomfort and minimize damage to the structures of the mouth. These problems include some toothaches; fractured, loosened, and knocked-out teeth; jaw fractures; and certain complications that develop after dental treatment. None of these problems is life threatening.

A toothache may result from a cavity, an abscess, inflammation of the gum around the root of a tooth (pericoronitis), or sinus inflammation (sinusitis).

If several upper teeth hurt when a person is chewing or is bending down (for instance, to tie a shoe), the cause is probably sinusitis - especially if the toothache develops while the person has a cold. Sinusitis can be diagnosed by a dentist or a doctor. Treatment is usually an antibiotic for the infection and a decongestant to help the infected sinuses drain. Inhaling steam for a day or two may also help.

Fractured, Loosened, and Knocked-Out Teeth
A person who has brief, sharp pain both while chewing and while eating something cold may have an incomplete (greenstick) fracture of a tooth. As long as the fracture is incomplete and part of the tooth has not split off, the dentist can correct the problem with a filling (restoration).

The upper front teeth, particularly protruding teeth (buck teeth), are prone to injury and fracture. If after an injury a tooth is not sensitive to air, most likely only the hard outer surface (enamel) has been harmed. Even if the enamel has sustained a small chip, immediate treatment isn’t required.

Fractures of the intermediate layer of the tooth (dentin) are usually painful when exposed to air and food, so people with such fractures seek dental help quickly. If the fracture affects the inner-most part of the tooth (pulp), a red spot and often some blood will appear in the fracture. Root canal treatment may be needed to remove the remaining pulp before it dies and causes severe pain. If the patient is under age 12, root canal treatment may be postponed until the roots of the affected teeth are fully formed.

If an injury loosens a tooth in the socket or if the surrounding gum tissue bleeds a great deal, a person should see a dentist. Damaged baby (deciduous) teeth in the front of the mouth usually are not a problem. If the damage is severe, the teeth can be removed without harming the permanent teeth or losing space for those that are yet to come. When the damaged deciduous teeth are in the back of the mouth, the dentist inserts a space-maintainer appliance, so that the permanent teeth will not be crowded out.

A knocked-out (avulsed) permanent tooth requires immediate treatment. The tooth should be wiped off with a clean tissue and placed back in its socket. If that is not possible, the tooth should be placed in a glass of milk (the milk provides a good medium for sustaining the tooth). In either case, the patient and the tooth should be taken immediately to the nearest dentist. If a tooth is reimplanted within 30 minutes, the likelihood of long-term success is good. The longer the tooth is out of the socket, the worse the chances for long-term success. The dentist usually splints the tooth to the surrounding teeth for seven to 10 days. Most reimplanted teeth eventually need root canal treatment. If the bone around the tooth also has been fractured, the tooth may have to be splinted for six to 10 weeks.

Jaw Fracture
A fractured jaw causes pain and usually changes the way the teeth fit together. Often, the mouth can not be opened wide or it shifts to one side when opening or closing. Most jaw fractures occur in the lower jaw (mandible). Fractures of the upper jaw (maxilla) may cause double vision (because the muscles of the eye attach nearby), numbness in the skin below the eye (because of injuries to nerves), or an irregularity in the cheekbone that can be felt when running a finger along it.

Any injury forceful enough to fracture the jaw may also injure the spine in the neck, so before a fractured jaw is treated, neck X-rays are often taken to rule out spinal damage. A blow powerful enough to fracture the jaw may also cause a concussion or bleeding within the skull. If a person suspects a jaw fracture, the jaw should be held in place with the teeth together and immobile. The jaw may be held with a hand or preferably with a bandage wrapped under the jaw and over the top of the head several times. The person wrapping the bandage must be careful not to cut off breathing. Medical help should be sought as soon as possible because fractures can cause internal bleeding and an airway obstruction.

At the hospital, the upper and lower jaws may be wired together; they remain wired for six weeks to allow the bone to heal. During this time, the person is able only to drink liquids through a straw. Many jaw fractures can be repaired surgically with a plate (a piece of metal that is screwed into the bone on each side of the fracture); the jaws are immobilised for only a few days, after which soft foods can be eaten for several weeks.

In children, some jaw fractures are not immobilised. Instead, initial treatment allows restricted motion, and normal activity resumes in a few weeks. Antibiotics are usually given to a person with a compound fracture - one that extends through a tooth or its socket and opens to a contaminated area, such as the mouth.

Problems after Dental Treatment
Swelling is usual after certain dental procedures, particularly tooth extractions and periodontal surgery. Holding an ice pack - or better yet, a plastic bag of frozen peas or corn, which adapts to facial contours - to the cheek can prevent much of the swelling. When the person is awake during the first 18 hours, ice should be held on the cheek for 25-minute periods and then re-moved for five-minute periods. If swelling persists or increases after three days or if pain is severe, an infection may have set in, and the patient should contact the dentist.

A dry socket (exposure of the bone in the socket causing delayed healing) may develop after a lower back tooth has been removed. Typically, discomfort improves for two or three days after the extraction and then suddenly worsens, usually accompanied by an earache. Although the condition goes away by itself after one to several weeks, a dentist can place an anesthetic dressing in the socket to eliminate the pain. The dentist replaces the dressing every day or two for about a week.

Bleeding after oral surgery is typical. Usually, it can be stopped by keeping steady pressure on the surgical site for the first hour, normally by having the person bite down on a piece of gauze. Bleeding in the mouth can be deceptive because a small amount of blood may mix with saliva and appear worse than it is. If bleeding continues, the area can be wiped clean, and another piece of gauze or a moistened tea bag can be held against the area with steady pressure. If bleeding continues for more than a few hours, the dentist should be notified. People who regularly take an anticoagulant or aspirin (even if they only take one aspirin every few days) should mention it to the dentist a week before surgery because these drugs increase the tendency to bleed. The dentist and the person’s doctor may adjust the drug dos-age or temporarily stop the drug.n

Submitted By
Dr. Kamaluddin Ahmed, BDS

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