Dental Advice from Doctor Humphrey

a.) Pulpitis: If you drink something very cold, and you feel a sharp, short pain, that is reversible pulpitis. The nerve is trying to repair itself, most commonly from recent dental treatment, a fracture, or trauma. Treat your tooth like a sprained  ankle. Take Advil and stay off it. If the tooth doesn't start to feel better after a couple weeks or worsens and the pain to cold lingers, or the pain is felt even with room temperature water, see your dentist. You may have a fracture, or irreversible pulpitis; the tooth cannot heal itself and root canal treatment is required.

b.) Dentinal Sensitivity: Exposed roots at the gum line or between the teeth, can also be sensitive to cold or flossing from grinding, heavy brushing, tobacco, recent dental treatment. Try to locate the tooth. Is the pain from the root area or from the whole tooth? Do you see a black area or hole? If not, and the pain is only from the root, use a very strong pure topical fluoride gel, such as Gel Kam®, and toothpaste for sensitive teeth along the root and between the teeth with a small interproximal brush, until sensitivity goes away. Gel Kam® also comes unflavored, and should be used at room temperature

a.) Reversible Pulpitis- exposing a tooth to heat elicits a sharp, short, non lingering pain. The nerve is telling you that it is being irritated from a deep cavity, a fracture, recent dental treatment, or trauma.

b.) Irreversible Pulpitis/Pulp Necrosis- the delayed pain from hot now lingers or throbs for over a minute signaling that the soft tissue nerve has died and is forming an abscess. Both conditions are serious requiring immediate dental treatment.

a.) Slight pain from this is usually from an irritated or inflamed periodontal ligament that which holds the root to the bone. Common causes are from bruxism or grinding/clenching, sinus infection, orthodontics, trauma, or dental treatment. A simple cavity would not be the cause. It should go away with time especially if you can fabricate a temporary night guard to alleviate the stress. Take Advil, don't chew gum, and have a soft diet.

b.) Severe pain to tapping, with other symptoms, may indicate an abscess. See your dentist.

a.) Biting down pain-The PDL is irritated. Common causes, involving more than one tooth, are grinding/clenching, sinus infection, or orthodontics. When only one tooth is sensitive, trauma, or fracture is most likely. In some cases, with more severe pain, an abscess may be present. A high spot on a filling or crown/cap can also mimic this symptom, but could be easily remedied with an adjustment by your dentist. A growth or tumor may push a tooth up, and abscess tends to burst out the side.

b.) Lifting off pain- almost always a fracture which causes more pain as the bite is released than when biting down on the object, requiring a crown to prevent further fracture movement. Usually the tooth will only hurt when biting on one edge or when chewing at a certain angle in cases of a fracture.

a.) Sinus problems: If your tooth feels long, aches, itches in the gum, vibrates when you walk, worsens when upside down, and putting pressure on your face next to your nose hurts, you very likely have a sinus infection. Pressure will be felt, but it won't appear swollen. In some cases, teeth may also become sensitive to cold due to increased bruxism; Your body's way to relieve sinus pressure. Breathing steam, using a decongestant and nasal spray to open passage ways to the sinus for drainage, and taking Airborneª to improve your immune system, will help. See your dentist or physician for treatment and antibiotics if it lingers, especially if pain developed after recent surgery.

b.) Dental abscess: constant ache, unlike with a sinus infection where a few teeth hurt, one tooth will start to ache keeping you awake at night. Check if you see a large hole on the tooth, or if any teeth are loose or sensitive to heat. You may need root canal therapy.

c.) Shingles, mumps, or neuralgic pain disorders- seek medical advice.

a.) Bruxing and dental treatment can cause myofascial pain, or cheek pain. It may feel like a big knot when the muscle spasms in your cheek. It hurts to chew, but warmth makes it feel better. If none of your teeth severely hurt, nor does pushing along the gum area, take Advil, use a temporary store bought night guard, and put warm, wet compresses on face. You can get a mild muscle relaxant from your health care provider, like Valium, if needed. Massage and stretch the area. Soft diet, no gum chewing, or clenching. If symptoms recur, see dentist for permanent occlusal guard, bite equilibration or rehabilitation, or orthodontic treatment.

b.) Abscess- If a lot of pain is coming from a tooth such as tenderness or swelling in the gum underneath and it is discolored or slightly loose, you most likely have an abscess. The swelling will increase with applied heat. Use ice only if it lessens the pain. -see your dentist.

c.) Pericornitis- A gum infection from erupting lower 3rd molar. For immediate relief, you may have the upper opposing 3rd molar removed if it is biting on the lower tissue, and the lower 3rd molar scaled and irrigated with hydrogen peroxide. Take antibiotics such as pen vk 500mg or clindamycin 300mg four times a day if severely infected. The lower molar should be removed when symptoms resolve.

d.) Shingles, tumors, or neuralgic pain disorders- seek medical advice from an ENT doctor

a.) Pain-from yeast, trauma, or other medical conditions- seek medical advice if doesn't go away in a few days.

b.) Coating or discoloration (white or black)- can be from plaque, yeast, or over grown tongue fibers (AKA Hairy Tongue) of which can temporarily stain over time, or when using rinses such as Peridex®. Brush the tongue with a mix of hydrogen peroxide baking soda and scrape the tongue daily with a hygiene device to remove plaque. For yeast use topical anti-fungal. Consult dentist. White lines are typically from a non-pathologic disorder "Geographic Tongue."

c.) Sores- some are canker sores which can reoccur, but are not contagious, possibly the result of an allergy, stress, acid reflux (read our dental news page), or vitamin deficiencies. Trauma from injury or rubbing tongue against a rough tooth will cause an ulcer. Rinse with salt water, use finger nail file to take off sharp edge of broken tooth if you can't see a dentist, put wax or gum on the inside of teeth to keep tongue away for a day or two. Have teeth reshaped or adjusted, possible needing orthodontics to correct bite.

d.) Cancer- usually painless, a unilateral sore or thick patch of skin that persists. Tongue carcinoma is usually located on one side or under the tongue. It may look white, red, or a mixture. High risk people are generally over 40, smokers, consume alcohol or drugs, poor oral hygiene, poor nutrition or health, and sometimes with family history. For people that are not in this group, look for other causes first, like a sharp tooth or filling, liquid or pizza burn, or benign disorders such as Geographic Tongue or Lichen Planus, before getting a biopsy. Many dentist can screen for cancer, or you may seek medical attention through an Oral Surgeon or ENT.