Diseases and Conditions
Dental education library
Welcome to our dental education library. The information shared below is provided to you as an educational and informational source only and is not intended to replace a dental examination or consultation, or dental advice given to you by a physician or dental professional.
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.
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.
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.
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.
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
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.
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:
- Radiation therapy
- Combination therapy (Both surgery and radiation therapy may be used to treat advanced cases of oral cancer.)
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.
Your dentist may suggest one or more of these treatments:
- A mouth guard (plastic device that fits over your teeth) protects teeth from grinding damage. It’s worn at the times when you’re most likely to grind your teeth.
- Bite adjustment (correcting the way your top teeth fit against your bottom teeth) can reduce chances of grinding if your bite is uneven.
- Reducing stress may lessen grinding by relaxing your jaw muscles. Your dentist may suggest ways to reduce stress, like exercise.
- Medication may be given to help relieve sore muscles or reduce stress.
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
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.
Steps to Saving a Permanent Tooth
If a permanent tooth is knocked out:
- Handle the tooth by the top, not the roots.
- Keep the tooth in a glass of milk or saltwater (dissolve 1/4 teaspoon salt in 1 quart of water). This keeps the tooth from drying out.
- Get medical help right away.
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.
Once you’re home, call your dentist right away if you:
- Develop a fever over 101°F .
- Have drainage from around a repaired tooth.
- Have pain that worsens after 24 hours.
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.
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.
To help prevent thrush in adults:
- Add unsweetened yogurt to your diet when taking antibiotics.
- Treat vaginal yeast infections right away.
- See your dentist every 6 to 12 months. Brush and floss as often as your dentist suggests.
- Rinse your mouth and spit after using a steroid inhaler.
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.
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.
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 decay can be treated to keep it from moving farther into 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.
Visit your dental team at least every 6 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 efforts start 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).
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.
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 in your 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 help reduce 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.
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 in 1-3 weeks to check how you’re healing. This is when stitches and 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
When to Call Your Dentist
Call your dentist after surgery if any of the following occurs:
- You have excessive bleeding or swelling.
- The stitches come undone earlier than your surgeon has told you to expect.
- Part or all of the dressing comes off or is uncomfortable.
- You have persistent pain.
- You have a fever over 100.4ºF.
- You have questions about your condition or treatment.
Periodontal Disease: Nonsurgical Treatments
Some treatments for periodontal disease do not involve surgery. The goal of these treatments is to create conditions that enable tissues in the mouth to heal. This is done by reducing plaque, infection, and other causes of periodontal disease. About 4-8 weeks after starting a treatment, you’ll have an evaluation by your dental care provider. Depending on various factors, surgery may be the next step.
Scaling and Root Planing
This treatment is performed by 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.
Infection can be treated with antibiotics, which decrease bacteria. Pills may be prescribed. Or the antibiotic may be placed directly into the infected pocket.
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 can reduce pressure and help control the damage.
About Home Care
Home care is your best weapon against periodontal disease. Daily brushing and flossing can help improve your gum health. This can prevent tooth loss, and may also help you avoid surgery. It’s easy to make a habit of brushing and flossing-and it’s not too late to start! Ask your dentist to show you the right way to brush and floss.
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).
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, does your 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.
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 has receded. 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.
How a Bone Replacement Graft Works
A graft helps your body replace lost bone. The graft consists of your own bone, 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, does your 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.
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).
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.