Abscess

Overview

An abscess is a localized collection of pus. Dental abscesses can be related to an infection of the pulp (periapical abscess), infection of the gum and tissues surrounding the tooth ( periodontal abscess), or a combination of both. Dental abscesses, if left untreated, can spread to become facial infections.

Causes(Periapical)

A periapical abscess is caused by bacteria from plaque infecting the pulp of the tooth. 
Bacteria can penetrate the pulp through a cavity (decay) or tooth fracture or through the gums. 
Finally, the pulpal infection escalates, extending to the bone surrounding the root tip, thus leading to the formation of an abscess.

Symptoms(Periapical)

-Sensitivity of your teeth and surrounding area, especially when you bite or touch it

-Sleep disturbance stemming from acute pain

-Sensitivity to hot and cold foods and beverages.

-Fever

-Difficulty in opening your mouth (trismus)

Prevention(Periapical)

The best prevention method is to make regular check up visits with your dentist. This is because decay can be identified and treated before it results in the formation of a periapical abscess.

When to Seek Help(Periapical)

If experiencing intense toothache, see a dentist immediately. If you are experiencing issues in breathing or swallowing, immediately head towards the closest Accident & Emergency department, if you are unable to locate a dentist.

Treatment(Periapical)

Your dentist will perform dental procedures at once to minimize pain and stop the infection. 
The first thing to do is the drainage of pus through an incision into the abscess or removal of the infected tooth, or by drilling a hole into the pulp chamber. Usually, it is performed under local anaesthesia. However, hospitalization is required for more serious infections. A prescription of antibiotics and painkillers will be provided as well.

Once the acute infection has receded and if the tooth is salvageable, an Endodontist will propose the option of saving the tooth with root canal treatment.

Complications(Periapical)

-Infection may spread to your facial features

-An infection to the bone caused by bacteria from the abscess spread through your blood stream

-Cysts can form, surrounding the root tip of a pulpally infected tooth

Causes(Periodontal)

-Preceding gum disease (periodontitis)

-Bacterial infection from a deep periodontal pocket

-Food or debris lodged in the gum

Symptoms(Periodontal)

-Restricted gum swelling; tenderness and redness to touch

-Constant, resonating pain

-Tooth sensitivity to heat and chewing of food

-Tooth with elevated mobility

-Pus discharge (foul-smelling and foul-tasting fluid) if the abscess ruptures

-Fever

Prevention(Periodontal)

Practicing good oral hygiene and dental care will help to prevent periodontal disease from occuring and thus the resulting periodontal abscesses. Since periodontal disease is usually more difficult to identify, regular dental check-up is essential for early detection.

When to Seek Help(Periodontal)

If you experience a toothache or have noticed an abscess on your gum, visit your dentist. Even if the abscess drains and the pain decreases, a visit to the dentist for full treatment is critical.

Treatment(Periodontal)

Effective treatment of an abscess targets the shrinkage and riddance of infection source. As with the periapical absccess, the procedure includes draining the abscess, which generally eases pain and eliminates much of the infection. Antibiotics will be prescribed as well to aid in the healing process.

The periodontal abscess will not be treated unless the cause is eradicated. A variety of treatments from deep scaling to root planning and gum surgery to treat the gum disease will be utilized by a periodontist. If the pulp has been infected as well, then the tooth will also require root canal treatment.

Apthous Ulcer

Overview

Apthous ulcers are a variation of ulcers that develop inside the mouth, in the form of open sores. These sores cause distress as routine oral tasks such as eating or brushing become very uncomfortable. Depending on their size, apthous ulcers can be minor or major.

Symptoms

-Ulcers in the mouth, never on the lips

-Singular or multiple mouth ulcers, span between 2mm (minor apthous ulcer) to more than 10mm in diameter (major apthous ulcer)

-Minor apthous ulcers persist for 7 to 14 days before diminishing and regenerate without scarring

-Major apthous ulcers heal in 6 weeks, may result in scarring

Risk Factors

There are no specific risk factors involved. Lack of vitamin B12, folic acid and iron have been discovered in a small percentage of patients with apthous ulcers. The occurence of apthous ulcers are also associated with food allergies and reactivity.

When to Seek Help

-You develop high fever

-Your ulcer is unusually big and persistent

-You experience extreme pain when consuming food or beverage

Treatment

Minor apthous ulcers typically heal in 2 weeks, even without treatment. Generally, treatment is only given to ease pain and discomfort. Forms of treatment include:

-Usage of a gel or paste could aid in shielding the affected area from abrasion during function, such as eating

-Sometimes, steroid ointment or topical medication is prescribed by a dentist. If infected, antibiotics may be prescribed

Bad Breath

Overview

Bad breath, also known as Halitosis, refers to unpleasant odours present in exhaled breath. It is primarily caused by the millions of bacteria that live in the mouth. Most of the time, bad breath stems from within the mouth. Bad breath has a significant impact, whether personally and socially, on those who have it or think that they do. The severity of bad breath vary throughout the day and may be temporal or persistent.

Causes

-Untreated Dental Problems

-Dry Mouth

-Diseases

-Food Stagnation

Symptoms

Initially, a person might not be conscious of his own bad breath. This is because odour-detecting cells in the nose become accustomed to the constant flow of bad smells from the mouth. However, other people may notice as you yawn or open your mouth. Other indicative symptoms are dependent on the actual cause of the condition.

Prevention

-Abstain from specific food containing volatile oils

-Sufficient intake of water(8-12 glasses) daily

-Daily toothbrushing, flossing of teeth and cleaning of the tongue

-Daily cleaning of your denture and soaking it in a denture cleaner overnight

-Daily usage of antiseptic mouthrinses for better results

-Early detection of dental conditions such as gum diseases by visiting your dentist regularly

When to Seek Help

If you experience bad breath, swollen/bleeding gums or loose teeth or if you have teeth with decay, immediately contact your dentist. If you have been practising good oral hygience and proper dietary intake, contact your dentist should your bad breath continue.

Treatment

Treatment of Halitosis depends on its underlying cause. Halitosis can only be treated by receiving the proper dental care in accordance to the underlying cause.

Bleeding Gums

Overview

Bleeding gums is the primary cause of Gingivitis. It is the inflammation of the gum tissues, which is caused by plaque. Generally, most people are oblivious to their condition until it evolves to a later stage, also known as periodontitis.

Causes

Plaque is a biofilm of bacteria which sticks to tooth surfaces above and below the gum line, causing the teeth to have pale yellow discolouration.If unremoved, it hardens to form calculus, a hard deposit which makes it impossible to be eliminated by brushing or flossing. As a result, the condition produces toxins which inflame the gums and thus causing it to be red and swollen.

Symptoms

-Bleeding when brushing/flossing

-Sensitive and swollen gums

-Bad Breath

Risk Factors

-Diabetic condition is not regulated

-Smoking or use of tobacco

-Going through puberty, pregnancy or menopause

-Having a weakened immune system

-Under prescription of specific types of medicine or on chemotherapy

-Poor nutrition

-Habit of not taking out dentures when sleeping

Complications

If left untreated, this condition will advance to a later stage known as Periodontitis, which affects the tissue structure of the teeth.

Prevention

Plaque builds up within a day after removal through brushing or flossing. In order to not allow plaque to form, active dental care on a daily basis is essential. Making regular visits to your dentist helps to reveal the condition early before it transpires to a later stage. 

Treatment

Gingivitis is curable. Your gums will become healthy once again with proper dental treatment and home care. Some of the dental procedures include a scaling and polishing to get rid of plaque and tartar. 

It is important to find out what is aiding the plaque build up and correct the issue. Learning how to brush and floss in the correct manner is also important.

Caries

Overview

Caries is a loss of hard tissues of the teeth, such as enamel, dentin, cementum(demineralization and destruction) by organic acids produced by bacteria found in dental plaque. When you develop a cavity (caries), the dentist will remove the decayed tooth structure and place a filling to replace the lost tooth structure.

Causes

Your tooth is made up of calcium and phosphate ions. There is a potent exchange of these ions between your tooth and its surrounding. When any of the above factors are altered to complement the lost calcium and phosphate from your tooth, you will develop a cavity gradually. Caries can be caused by saliva, plaque, diet and other tooth factors. 

Symptoms

-Tooth sensitivity on eating cold or hot food

-Pitting or a hole developing in your tooth

-Food trap

-Pain on biting

-Toothache which may be spontaneous

-Swelling in the gum (see periapical abscess)

Risk Factors

Reduced salivary flow 
-  this occurs when you do not drink sufficient water, or are dehydrated by high temperatures
-  radiotherapy in the head and neck region can affect salivary glands and reduce the production of saliva

Poor oral hygiene 
- failure to brush properly results in accumulation of plaque. Bacteria is attributable to caries development and it flourishes in thick plaque

Diet Intake
- food types that are high in sugar eg; sweet drinks, ice cream, candy, which allows bacteria to feed on and multiply
- food types that are acidic eg; cola, juices, as they demineralise tooth structure upon contact
- food types that are sticky and starchy (biscuits, toffee) as they persist on surfaces of teeth longer and enable bacteria to feed on 

Habit of Snacking
- snacking leads to a drop in saliva pH which promotes demineralization. Snacking subjects your teeth to acid attack 

Tooth factors
- defects in teeth increases plaque retention and present exposed surfaces for decay to occur
- gingival recession exposes root surfaces which are not protected by enamel

Prevention

-Minimize refined sugar in your diet

-Abstain from snacking in between meals, substitute with fruits instead of biscuits

-Brush twice daily with a fluoride toothpaste, and floss nightly

-Visit your dentist every six months

Treatment

The treatment of caries is to restore the decay tooth. The type of restoration process depends on the extent of decay. If there is sufficient tooth structure remaining, fillings can be used to restore them. All filling materials have their advantages and disadvantages. You can decide on the filling material for your tooth, in consultation with your dentist.

Dental Aesthetics

Overview

Your teeth and your smile affect your appearance. For example, whiter teeth give a more appealing smile.  Poorly aligned teeth also affect your looks. There are several simple procedures which can help you attain a better smile such as teeth whitening and the use of veneers.

Teeth Whitening

Teeth Whitening is a dental procedure where the discolouration of tooth is restored to the natural tooth color, or even whiter than before. It gets rid of the staining agent through use of chemicals. The outcome of the treatment is generally dependent on the severity of the tooth discolouration. This procedure however, is ineffective when carried out on dental restorations such as fillings or metal or porcelain crowns.

Teeth can become stained and discoloured for various reasons, such as poor oral hygiene or coloured compounds in food and beverages. An in-clinic examination will be required to find out the source and severity of your  discolouration, so that the optimal whitening procedure can be recommended.

Veneers

Veneers are thin layers of tooth coloured material used to mask the frontal side of teeth to enhance the aesthetic appearance of teeth. They are fabricated using either thin plastic resin or porcelain.

They can be placed to realign crooked teeth, fill minor gaps between teeth, cover up internal stains as well as refurbish moderately broken down teeth.

Tooth preparation is usually restricted to the enamel structure. The veneer(s) can be bonded directly in a single session or in 2 sessions if cermic/porcelain is used. The advantage/disadvantages of the 2 materials can be discussed with your dentist.

Crown Lengthening

Sometimes, your teeth are mostly covered by your gum tissues, thus making your teeth appear short. A crown lengthening procedure can be carried out by displacing some of the gum tissue so as to give you a better, complete smile.

Orthodontics(Braces)

Due to a mouth injury, or abnormal growth of your teeth structure, your dentition may appear crooked as a whole. Not only does that affect the aesthetics of your dental features, it also affects the functionality of your teeth such as when biting on food. The latter can lead to being unable to chew properly, thus affecting digestion as well.

Orthodontic treatment aims to fix facial displacement so that your teeth comes together nicely with your face as a whole. As a result, the functionality, appearance and dental health of your teeth will be enhanced.

Cracked Tooth

Overview

A crack can take place in any part of your tooth. Cracks may vary in depth of penetration and length of crack.

Categories

Craze lines – superficial tiny cracks which occur within the enamel, which do not cause symptoms and need no treatment

Fracture of a cusp – when part of the chewing surface of a tooth is chipped off.

Cracked tooth – where a crack lengthens from the biting surfaces to differing depths down the tooth. The crack does not cause a separation into two pieces

Split tooth – the tooth is divided by the crack into two independent segments

Vertical root fracture – a crack which arises from the root and prolongs to differing lengths towards the crown

Causes

-Stress forces (chewing on tough food)

-Oral habits; Grinding of teeth

Treatment

Treatment of a cracked tooth is dependent on the extent, type and location of the crack. Badly cracked teeth may require extraction. Radiographs will be required to assess the tooth. If there is a filling, it will need to be removed for further assessment. 

To prevent additional crack in the treatment process, a metal band can be placed around the tooth to hold the cracked fragments together to prevent a further split. If the crack has penetrated into the pulp, root canal treatment will be carried out. A restoration process of the tooth will be performed with a full crown for optimal protection, but this does not ensure success in all cases.

Prevention

You can decrease the risk of developing a cracked tooth by avoiding very hard foods such as ice, crab shells and bones.

You should also avoid habits such as clenching or grinding your teeth. It will be helpful to wear a mouth guard when playing contact sports to prevent injuries to the mouth. A night guard will be useful if you tend to grind your teeth at night in your sleep.

Enquiries(Will my tooth completely heal?)

Unlike a broken bone, the fracture in a cracked tooth will not heal. Treatment will alleviate pain and minimize the likelihood of the crack worsening. Despite treatment, some cracks may continue to progress and result in loss of the tooth.

Crowns & Bridges

Overview

A crown is a cap planted over a tooth and held in place by dental adhesive or cement.

Material Composition

Crowns can be manufactured using a variety of materials. They can be formed of plastic, ceramic, zirconia or metal alloys. Sometimes, a combination ofmaterials is used to maximise on strength or aesthetic qualities.  It all depends on what is required in the specific case. 

Procedure

A comprehensive clinical examination together with radiographs is done by the dentist. The suitability for crowns is appraised and any preparatory work is performed. In addtion, your dentist will be able to recommend the material of choice, treatment sequence and any other concerns you may have.

At the crown appointment, the teeth to be crowned are prepared. This involves preparing teh tooth (generally under local anaesthesia); followed by an impression or mould of the prepared tooth. This trimming of the tooth is needed to generate space for the crown to be fitted. The mould is then delivered to a laboratory where skilled technicians will construct the crown. Meanwhile, a temporary crown is created and fitted onto the trimmed tooth.

At the fit appointment, the completed crown is tested on the tooth for fit, synchronizing with the bite and appearance. The crown is finally cemented onto the specific tooth with dental cement.

Durability & Care

Crowns are formed of inert materials which do not regress over time. However, the underlying tooth is still vulnerable to decay and gum disease.

Ceramic on the surface may chip or fracture. To prevent such occurence, you should avoid chewing on tough food altogether.

Daily brushing and flossing are attributable to maintaining good oral health as well as preserving the crown from problems. The most susceptible part of the crown is the margin or the junction between tooth and crown.

Regular check-ups will allow your dentist to uncover issues with your crown and propose an appropriate treatment.

Bridges

A bridge is a method of supplanting missing teeth using neighboring teeth as supporting complex.

Bridges are generally done by embellishing teeth on either side of a missing tooth like in crowns. The crowns formed are assembled together by adding a tooth in between. The ensuing structure is called a bridge.

Like crowns, they are also constructed in a laboratory using the identical materials and then fitted and cemented in the mouth.

Maintenace care for bridges is similar to that for crowns. The focus is on regular flossing, brushing as well as regular checkups.

Replacement

Bridges can be utilized to replace a small number of missing teeth if the neighbouring teeth are adequately strong. 

The number of missing teeth, condition of the neighbouring teeth, condition of the supporting gums and bone are all essential factors which need to be determined by your dentist prior to making a bridge. 

Your dentist will consult on substitute methods of replacing missing teeth after a clinical examination.

Dental Implants

Overview

Dental implant therapy has been implemented for several decades and has proven to be very effective and successful. Advancements in materials and surgical techniques have made dental implants the gold standard in the replacement of missing teeth.

A dental implant is a replacement of a missing tooth root. Each implant is delicately and specifically drilled into the intended location to act as a foundation for long-term support of replacement teeth.

Most dental implants these days are produced from titanium alloy. This material has been shown to be well-tolerated by bone. The terms ‘osseointegrated implants’ and ‘endosseous implants’ are widely used to describe dental implants that are so biocampatible that they fuse with the underlying bone to form an integrated unit.

Suitability

Implants can be implemented to replace a single or multiple missing teeth. Thus, most cases can possibly be treated with this modality. However, several factors need to be considered, such as a bone volume and quality, tooth and jaw relationships, oral habits and general medical health. Your dental surgeon will assess your suitability to receive dental treatment 

Treatment Planning
Complete assessment of your medical health, oral health, the way your teeth align together and bone volume will be carried out to create a personalized treatment plan.

Surgical Treatment
A minor surgical procedure is carried out to set titanium fixtures into bone. If bone and/or soft tissue is inadequate, there might also be a need for additional bone or soft tissue grafting procedures.

Restorative Treatment
After integration of the implant fixtures to bone, ‘new permanent teeth’ will be designed and constructed.

Discolored Teeth

Overview

Discoloured teeth can be due to extrinsic and intrinsic stains. Extrinsic stains occur on the exterior of the tooth and are relatively easy to remove by scaling and polishing. In contrast, intrinsic stains, which occur in the interior of a tooth, cannot be removed by scaling and polishing. Although, bleaching can lighten the discoloration.

Causes(Extrinsic Stains)

-Coloured compounds present in foods and beverages (eg. coffee, tea, red wine, colas, curries)

-Tobacco

-Poor oral hygiene

-Chromogenic (stain forming) bacteria which act on certain foods to produce black stains

Causes(Intrinsic Stains)

-Natural aging of teeth(Teeth tend to yellow with age)

-Trauma to teeth (Dead nerve/pulp causes the tooth to turn a dark colour)

-Tooth decay (caries)

-Genetic factors

-medication or chemicals e.g. tetracycline, excessive fluoride consumed during the formative years

-illnesses which affect tooth development eg high fevers, metabolic disorders

-teeth which no longer have a functioning pulp will change colour after some time(Root Canal Treatment)

Symptoms

Apart from looking unsightly, extrinsic stains do not result in any symptoms. In contrast, intrinsic stains arising from tooth pathology, eg decay, will form with the corresponding symptoms.

Prevention(Extrinsic Stains)

-Avoiding smoking, and reducing consumption of coffee, and foods with coloured compounds

-Good oral hygiene

-Regular visits to the dentist for scaling and polishing

Treatment

Bleaching or teeth whitening can improve the colour of teeth. Teeth resistant to bleaching can be veneered or crowned.

Impacted Wisdom Teeth

Overview

Wisdom teeth generally appear between 17 to 25. Occasionally, the jaw size prevents proper eruption of wisdom teeth. Sometimes it grows sideways and comes up against the tooth in front of it.  Surgical removal of wisdom teeth is a routine and simple procedure.

Features

-Lower jaw pain often occurs in surrounding area of last molar teeth

-Pain can be sharp, sometimes with restriction of mouth opening

-Swelling

-Swollen lymph nodes

-Area surrounding the molar may be sensitive and tender 

Causes

-Impaction of wisdom tooth resulting in food being trapped

-Infection of overlying gum

-Triangular void between teeth

-Decay of wisdom tooth and neighbouring tooth

Prevention

-Santizing of the gum area with gargle or mouthwash

-Antibiotics might be needed for serious infection

-Extraction or trimming of the opposing tooth to decrease biting on swollen gum

-Surgical removal of the upper wisdom tooth

Toothache

Overview

Rapid agonizing pain or toothache may result from spread of decay in the tooth. Often, root canal treatment is necessary. If you observe mild symptoms on the teeth, a check-up with your dentist will aid in preventing a larger problem from arising.

Features

-Tooth sensitivity to hot or cold food

-Acute pain from tooth or jaw from mild to high intensity 

-Pain may be worse at night

-Pain will probably last up to a couple of days or longer

-May be isolated to one tooth or advance over a wide area

-Swelling may occur

Causes

Tooth Decay

History of trauma to teeth

Cracked tooth from excessive wear; biting on hard foods

Prevention

-Treat carious cavities.

-Root canal treatment 

-Drainage of swelling

-Antibiotics

-Tooth extraction

-Painkillers may provide temporary relief

Tooth Decay

Overview

Tooth decay is one of the most prevalent chronic diseases in the world and occurs to people of all ages. Cavities are the end result of the disease. The good news is, early caries lesions can be amnaged so they dont progress to form cavities which then require fillings.

Occurence

Plaque, a sticky film of bacteria regularly forms on the surface of teeth. When you take in foods containing sugars or acids, the bacteria in the plaque produce acids which attack the tooth enamel, leading to depletion of minerals.

In the initial stages of disease, the mineral loss can be seen noticeably as a white spot lesion on the tooth surface. When the oral environment remains acidic, mineral loss from tooth persists until the white spot lesion develops into a small carious cavity. If the condition is ignored, the cavity becomes bigger and bigger.

Symptoms

-Tooth sensitivity when consuming hot/cold/sweet foods

-Tooth ache 

-Visible pits or holes in the teeth

-Pain when biting

-Bad breath or foul taste in the mouth

Causes(Acidic Oral Environment)

-Diet (combination of sugar and acid-containing foods and drinks)

-Poor oral hygiene

-Genetic predisposition

Importance of Saliva

-Eliminates leftover food debris in the mouth, removes the bacteria's nutrient-source and hence curb its multiplication. This prevents infections

-Aids in digestion of food and drink intake

-Conservative function rebalances the pH level in the mouth to a healthy level to deter bacteria activity

-Contains antibacterial agents which aid in controlling the caries-causing bacterial population

-Consists of minerals such as flouride, calcium and phosphate which are required to remineralize damaged tooth enamel