Tooth Disorders
Introduction
Tooth disorders include cavities (caused by tooth decay), pulpitis, periapical abscess, impacted teeth, and malocclusion. Fractured, loosened, and knocked-out teeth are considered urgent dental problems, as are some toothaches (see Urgent Dental Problems: Toothaches). Tooth decay, which often leads to toothache and tooth loss, is largely preventable with good oral hygiene to remove plaque and prevent tartar buildup.
Plaque is a filmlike substance composed of a mixture of bacteria, saliva, and dead cells that is continually being deposited on teeth, day and night. It occurs in everyone. Because plaque can encourage growth of the kind of bacteria that leads to tooth decay, it needs to be removed by daily brushing and flossing.
Tartar (calculus) is hardened (calcified) plaque that forms a white covering at the base of the teeth, particularly the tongue side of the front lower teeth and the cheek side of the upper molars (the teeth at the back of the mouth). Because tartar is formed from plaque, daily brushing to remove plaque can significantly reduce the buildup of tartar. However, once tartar has formed, it can only be adequately removed by a dentist or dental hygienist.
Although a healthy mouth can be maintained with meticulous brushing and flossing, limiting sugar intake and using fluoridated water also help reduce the risk of tooth decay.
Symptoms of Tooth Disorders
Pain affecting an individual tooth (toothache) is probably the most recognized symptom of a tooth problem. A tooth may be painful all the time or only under certain circumstances, such as when chewing or when tapped by a dental instrument. Pain in a tooth suggests tooth decay or gum disease. However, pain may also result when roots are exposed, when a person chews too forcefully or grinds his teeth (bruxism), or when a tooth is fractured. Sinus congestion can cause similar symptoms of pain in the area of the upper teeth.
Worn-down or loose teeth can be a symptom of bruxism, a disorder characterized by frequent clenching or grinding of the teeth. Bruxism occurs mostly during sleep, so that the person is unaware of it, but it may also occur during the day. People who have bruxism must concentrate on not clenching or grinding their teeth during the day. Attrition refers to the worn surfaces of the teeth where grinding of food occurs. Attrition may make chewing less effective.
Abnormally shaped teeth can be a symptom of genetic diseases, hormonal disorders, or infections acquired before birth. Teeth can be misshapen due to fractures or chipping from trauma to the mouth.
Abnormal tooth color is not the same as the darkening or yellowing of teeth that occurs as a person grows older or exposes his teeth to staining substances, such as coffee, tea, and cigarette smoke. Graying of a tooth may be a symptom of a previous infection within the tooth that has seriously damaged the pulp, which is the living center of the tooth. The same may occur when a permanent tooth replaces an infected baby tooth. Permanent discoloration of the teeth may be a result of having taken tetracycline while pregnant. Excess fluoride ingestion during childhood can cause mottling of the enamel.
Abnormal tooth enamel (enamel is the hard outer surface of teeth) may be due to a diet containing insufficient vitamin D. Abnormal enamel may also be the result of a childhood infection (such as measles or chickenpox) occurring when the permanent teeth were forming. Abnormal enamel may also be due to repeated vomiting, as occurs in bulimia nervosa, because the stomach acid dissolves the surface of the teeth. Swimmers who spend a lot of time in chlorinated pools can lose tooth enamel, as can people who work with acids or chlorines. Damaged tooth enamel can allow bacteria to more easily invade the tooth and form a cavity.
Cavities
Cavities (dental caries) are decayed areas in the teeth, the result of a process that gradually dissolves a tooth's hard outer surface (enamel) and progresses toward the interior.
Along with the common cold and gum disease, cavities are among the most common human afflictions. If cavities are not properly treated by a dentist, they continue to enlarge. Ultimately, an untreated cavity can lead to tooth loss.
For tooth decay to develop, a tooth must be susceptible, acid-producing bacteria must be present, and food must be available for the bacteria to thrive. A susceptible tooth is one that has relatively little protective fluoride incorporated into the enamel or that has pronounced pits, grooves, or fissures that retain plaque. Poor oral hygiene that allows plaque and tartar to accumulate can accelerate this process. Although the mouth contains large numbers of bacteria, only certain types generate acid, which causes decay. The most common decay-causing bacterium is Streptococcus mutans.
Some people have especially active decay-causing bacteria in their mouth. A parent may pass these bacteria to a child through kissing or sharing eating utensils. The bacteria flourish in the child's mouth after the first teeth come in and can then cause cavities. So a tendency toward tooth decay that runs in families does not necessarily reflect poor oral hygiene or bad eating habits.
Progression of Tooth Decay: Decay in the enamel progresses slowly. After penetrating into the second layer of the tooth—the somewhat softer, less resistant dentin—decay spreads more rapidly and moves toward the pulp, the innermost part of the tooth, which contains the nerves and blood supply. Although a cavity may take 2 or 3 years to penetrate the enamel, it can travel from the dentin to the pulp—a much greater distance—in as little as a year. Thus, root decay that starts in the dentin can destroy a lot of tooth structure in a short time.
Impacted Teeth
Impacted teeth are teeth that become stuck beneath the gum and are thus unable to emerge (erupt) properly.
Impaction is usually caused by the overcrowding of teeth, thus leaving insufficient room for a new tooth to emerge. Impaction can occur when a baby tooth is lost before the new tooth is ready to emerge, which allows the remaining teeth to drift into the space reserved for the new tooth. However, most teeth that become impacted are wisdom teeth because they are the last permanent teeth to come in and the jaw lacks enough room to accommodate them.
Impacted teeth are likely to become infected, thus they are usually removed. Often the removal can be done in the dentist's office with the person remaining awake, with use of a local anesthetic or with sedation to calm the person. Sometimes the surgery is performed in a hospital with the person asleep, with use of a general anesthetic.
Malocclusion
Malocclusion is an abnormal alignment of the upper and lower jaws that prevents the teeth from meeting properly.
Occlusion refers to the alignment of the teeth and the way in which the upper and lower teeth fit together. Ideally, the upper teeth fit slightly over the lower teeth. Proper alignment of teeth prevents undue force from being placed on just a few teeth and keeps the lips, cheeks, and tongue away from the biting surfaces. If the teeth are maloccluded (out of alignment), undue strain is placed on some of the teeth, which may fracture portions of the crown or loosen the teeth.
Periapical Abscess
A periapical abscess is a collection of pus, usually from an infection that has spread from a tooth to the surrounding tissues.
Pulpitis
Pulpitis is painful inflammation of the tooth pulp, the innermost part of the tooth that contains the nerves and blood supply.
Information Obtained From National Institute Of Health