Common Oral Conditions

1. Canker Sores

   A canker sore is a painful, open sore in the mouth, which is white or yellow and surrounded by a bright red area. Canker sores are a common form of mouth ulcer. They occur in women more often than men. They may occur at any age, but usually first appear between the ages of 10 and 40.

   Canker sores usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums. Canker sores can run in families. They may also be linked to problems with the body’s immune (defense) system. The sores may occur after a mouth injury due to dental work, aggressive tooth cleaning, or biting the tongue or cheek.

   Canker sores can be triggered by emotional stress, dietary deficiencies (especially iron, folic acid, or Vitamin B-12), menstrual periods, hormonal changes, food allergies, and similar situations. They occur most commonly with viral infections.

2. Cold Sores

   Herpes labialis is an infection caused by the herpes simplex virus. It leads to the development of small and usually painful blisters on the skin of the lips, mouth, gums, or lip area. These blisters are commonly called cold sores or fever blisters. It is an extremely common disease caused by infection of the mouth area with herpes simplex virus, most often type 1. Most Americans are infected with the type 1 virus by the age of 20.

   The initial infection may cause no symptoms or mouth ulcers. The virus remains in the nerve tissue of the face. In some people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious. Herpes viruses are contagious. Contact may occur directly, or through contact with infected razors, towels, dishes, and other shared articles.

   The first symptoms usually appear within 1 or 2 weeks — and as late as 3 weeks — after contact with an infected person. The lesions of herpes labialis usually last for 7 to 10 days, then begin to resolve. The virus may become latent, residing in the nerve cells, with recurrence at or near the original site. Recurrence is usually milder. It may be triggered by menstruation, sun exposure, illness with fever, stress, or other unknown causes.

   Untreated, the symptoms will generally subside in 1 to 2 weeks. Antiviral medications given by mouth may shorten the course of the symptoms and decrease pain. Sores caused by Herpes often come back again and again. The antiviral medicines work best if you take it when the virus is just starting to come back — before you see any sores. If the virus returns frequently, your doctor may recommend that you take the medicines all the time

   Wash blisters gently with soap and water to minimize the spread of the virus to other areas of skin. An antiseptic soap may be recommended. Applying ice or warmth to the area may reduce pain. Take precautions to avoid infecting others. Please ask your Dr.Chirnalli if you are interested in recommendations for treating cold sores.

3. Dental Abscess

   A pocket of infected liquid (pus) that collects in a small area within the body is known as an abscess. In the mouth, abscesses can occur at the end of a tooth’s root or in the space between the teeth and gums. Infection may spread to the tissue and bones surrounding the tooth. If left untreated, it may also spread throughout the body.

   Dental abscesses occur when bacteria enter certain areas (e.g., pulp of the tooth, deep gum pockets) of the mouth. Typically, decay or cracks in a tooth’s enamel allow bacteria access to the inner tooth (pulp). Gum disease can create deep spaces between the teeth where bacteria may thrive and develop into an abscess.

   Dental abscesses usually cause significant pain. This pain may be sharp or throbbing and is usually persistent. Additional symptoms of a dental abscess can include fever, sensitivity to hot and cold, a visible boil in the gums near a tooth (which may rupture and leak fluid), or red, swollen gums. Patients who experience dental pain, or who have visible signs of an abscess, should consult their dentist immediately. Even if the pain goes away, any infected tissue needs to be removed and the cause of the abscess treated.

   A dentist can usually diagnose an abscess based on examination of the patient’s mouth, which may include gently tapping a patient’s teeth (to identify the extent of damage to the pulp) and x-rays (to determine if bone loss have occurred). In addition, patients are usually asked to provide details about their symptoms.

   Treating an abscess includes draining the abscess and treating the cause of the infection. These are often done at the same time. This allows the pus to drain from the tooth root while removing diseased tissue that led to the abscess. When the tooth damage is severe, tooth extraction may be required. Follow-up care may include antibiotics to eliminate the spread of infection, saltwater rinse to soothe inflamed tissue and follow-up x-rays to ensure proper bone and tissue re-growth in the area.

   A dental abscess can be prevented by preventing its causes – primarily tooth decay. Thus, practicing daily brushing and flossing and committing to regular dental visits can help prevent dental problems that may lead to infection.

4. Gingival Recession

   The occurrence of gingival recession is a precursor to the loss of cementum, the exposure of dentin, and the subsequent development of hypersensitivity. Recession can occur for a variety of reasons. Excessive and abrasive use of any oral hygiene device can lead to gingival recession, although toothbrush type and the technique used are the primary contributing factors. However, it is not believed that the toothbrush alone causes loss of enamel or cementum. Gingiva can be lost secondary to tissue destructive processes of periodontitis, necrotizing ulcerative gingivitis (NUG), and viral disorders, such as HIV. Surgical and nonsurgical periodontal treatment can result in gingival recession and root exposure. Certain other surgical and restorative procedures, such as crown preparations, may also contribute to gingival recession and root exposure.

5. Pericoronitis

   Pericoronitis is a dental disorder in which the gum tissue around the molar teeth becomes swollen and infected. This disorder usually occurs as a result of wisdom teeth, the third and final set of molars that most people get in their late teens or early twenties.

   Pericoronitis can develop when wisdom teeth only partially erupt (break through the gum). This allows an opening for bacteria to enter around the tooth and cause an infection. In cases of Pericoronitis, food or plaque (a bacterial film that remains on teeth after eating) may get caught underneath a flap of gum around the tooth. If it remains there, it can irritate the gum and lead to Pericoronitis. If the Pericoronitis is severe, the swelling and infection may extend beyond the jaw to the cheeks and neck. Symptoms of Pericoronitis include:

   • Painful infection
   • Swelling in the gum tissue (caused by an accumulation of fluid)
   • A “bad taste” in the mouth (caused by pus leaking from the gums)
   • Swelling of the lymph nodes in the neck
   • Difficulty opening the mouth

   If the Pericoronitis is limited to the tooth (for example, if the pain and swelling has not spread), treat it by rinsing your mouth with warm salt water. You should also make sure that the gum flap has no food trapped under it. If your tooth and jaw or cheek are swollen and painful, you should see your dentist right away. He or she can treat the infection with antibiotics. You can also take pain relievers such as aspirin, acetaminophen, or ibuprofen. The dentist may also prescribe a pain medication. If the pain and inflammation are severe, or if the Pericoronitis recurs, you will need oral surgery to have the gum flap or wisdom tooth removed.

6. Periodontal Abscess

   A periodontal abscess is caused by an infection in the periodontal tissues. This infection is usually the result of long-continued irritation by food debris; deep deposits of calculus; or a foreign object such as a toothbrush bristle or a popcorn husk being tightly packed into the interproximal spaces or between the tooth and the soft tissues. Periodontal abscesses almost always happen in people who have existing periodontal disease that is advanced enough to have resulted in some loss of bone around the root of the tooth. An area in which bone is missing around a tooth root is called a periodontal pocket, and a periodontal pocket can be very hard to clean. The bacteria living in the pocket change in time and more destructive species move in. Byproducts of the bacteria cause more bone to dissolve.

   Periodontal infection can be present without pain. If there is pus forming, and it is trapped under the gum, the pain can be quite bad. The infection can spread and seem like it is going into your ear or under your lower jaw and down into your neck. It may be hard to open you mouth because of the inflammation and swelling. If your problem seems to be a periodontal abscess, the dentist will probably place you on an antibiotic. The gum area may be cleaned out, debris removed and the pus allowed to drain. You should start to feel better relatively quickly but it is important to realize that there was an underlying periodontal problem that needs to be addressed.

7. Sensitive Teeth

   Sensitive teeth are usually caused by exposed dentin, the layer next to the enamel. A lot of things can cause dentin to be exposed. One of the most common is improper tooth brushing method. Too much pressure applied during tooth brushing using a hard bristled toothbrush causes abrasion on the enamel layer, exposing the dentin layer beneath it. Most common example of this is cervical abrasions, found in the “neck” portion of the tooth’s crown. The tooth can also be bruised or abraded from dental instrumentations, especially after a restorative procedure. Accidental biting on hard substances can also bruise the tooth. Tooth sensitivity can also occur because of exposure of the root portion of the tooth due to gingival recession. Pain from sensitive teeth is not always constant. It can come and go. Constant pain could be a sign of a more serious problem. It is important to discuss your symptoms with your dentist to determine the cause and proper treatment.

   Hypersensitivity affects 45 million adults in the United States, 10 million are chronically affected. Tooth sensitivity is tooth discomfort that can occur after eating cold or hot foods, liquids, or even breathing cold air. This problem often happens when gums recede. The gum tissue acts like a protective blanket to cover the roots of the teeth. As the gums recede the underlying tooth roots are exposed. They are not covered by hard enamel. Thousands of tiny dentinal tubules (channels) leading to the tooth’s nerve center (pulp) are then exposed. These tubules allow more stimuli like heat, cold or pressure to reach the nerve in the tooth and you feel pain. Think of your gums and the enamel on your teeth as a down comforter covering and protecting your body from the cool winter air.

   There are many other causes, some of which can require a more comprehensive treatment plan…

   • Broken, chipped or fractured teeth
   • Nerve damage in the root
   • Grinding and/or clenching the teeth
   • Gum disease
   • Receding gums, gum disease and/or oral habits

   The key to preventing tooth sensitivity is to keep your gums healthy by reducing the pressure you use while brushing and to maintain good oral health habits. This means brushing all your teeth for 2-3 minutes, not the usual 30- 45 seconds that most people brush. Flossing is crucial in order to reach 35% of the tooth surfaces where brushing cannot reach.

   Sensitive teeth are one of the most common complaints among dental patients. If the bristles on your toothbrush are pointing in multiple directions, you’re brushing too hard. If a tooth is highly sensitive for more than three or four days and reacts to hot and cold temperatures, it’s best to get a diagnostic evaluation from your dentist to determine the extent of the problem. Before taking the situation into your own hands, an accurate diagnosis of tooth sensitivity is essential for effective treatment to eliminate pain. Because pain symptoms can be similar, some people might think that a tooth is sensitive, when instead, they actually have a cavity or abscess that’s not yet visible.

   Sometimes after Dental Treatment such as Cosmetic Dentistry, teeth are sensitive to hot and cold. This should not last long, but only if the mouth is kept clean. If the mouth is not kept clean the sensitivity will remain and could become more severe. If your teeth are especially sensitive consult with your doctor. They may recommend medicated toothpaste, fluoride or mouth rinse made especially for sensitive teeth. If you are diagnosed with dentin hypersensitivity, your dentist may apply a desensitizing agent or a protective coating.

8. TMD/TMJ

   TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for Temporomandibular Joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important. Please tell us if you are experiencing symptoms. No one treatment can resolve TMJ disorders completely and treatment takes time to become effective.

9. Trouble with Your Jaw

   TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the "cushion" of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or trouble opening your mouth wide.

10. You Have a TMJ Disorder?
    • Are you aware of grinding or clenching your teeth?
    • Do you wake up with sore, stiff muscles around your jaws?
    • Do you have frequent headaches or neck aches?
    • Does the pain get worse when you clench your teeth?
    • Does stress make your clenching and pain worse?
    • Does your jaw click, pop, grate, catch, or lock when you open your mouth?
    • Is it difficult or painful to open your mouth, eat or yawn?
    • Have you ever injured your neck, head or jaws?
    • Have you had problems (such as arthritis) with other joints?
    • Do you have teeth that no longer touch when you bite?
    • Do your teeth meet differently from time to time?
    • Is it hard to use your front teeth to bite or tear food?
    • Are your teeth sensitive, loose, broken or worn?

    The more times you answered “yes,” the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

    Treatment

    If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed but are reserved for severe cases. Apex Smiles will refer you to an oral and maxillofacial surgeon if more in depth treatment is necessary.

11. Bruxism

    Bruxism is the clenching or grinding of the teeth, which occurs primarily while you are sleeping. The symptoms of bruxism are:

    • a sore, tired jaw
    • difficulty opening and closing your mouth
    • sensitive teeth
    • earaches or pain in your jaw joint

    The pressure on your teeth is many times greater during bruxism than during normal chewing. If left untreated you may experience:

    • flattened or worn-down teeth
    • chipped and broken teeth
    • loose teeth
    • damage to the bone around your teeth
    • damage to the bone around your teeth

    Though all the causes of grinding are not known, stress is often a factor. There are a variety of stress-reduction techniques that may be helpful, or medication might be recommended to temporarily reduce stress or to reduce pain and soreness.

    Spaces, worn teeth, or teeth that are out of alignment may cause grinding and clenching. Crowns, bridges, or other Dental Restorations such as Dental Implants in Apex and Cary NC can restore your bite and eliminate the pattern of grinding and clenching. One of the most common and effective ways to stop the damage caused by grinding and clenching is the use of a nightguard. A nightguard is a plastic device that fits over your teeth and is worn at night to protect them from the damage caused by grinding. There are many types and styles of nightguards. Some are hard and some are soft; they may be worn on the top or the bottom teeth. Without treatment, the constant clenching and grinding of your teeth can cause widespread damage in your mouth. Dealing with the problem early on can restore harmony and prevent many future problems.

    Treatment

    There are various treatment options to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Wendel Family Dental Centre will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.

    The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

    • Resting your jaw
    • Keeping your teeth apart when you are not swallowing or eating
    • Eating soft foods
    • Applying ice and heat
    • Exercising your jaw
    • Practicing good posture

    Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint or nightguard fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relieves pressure on parts of your jaw and aids in disk repositioning. An orthotic stabilization appliance is worn all-day or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear.

    Bite adjustment

    Bite is considered to be healthy when all or most of the teeth are present and not destroyed by normal daily usage. It is destructive when teeth show wear, looseness or when TMJ (jaw joint) damage is seen. Bite therapy helps restore a bite that can function without damage and destruction.

    The therapy may include:
    • Reshaping the biting surfaces of the teeth and eliminating spots of excessive pressures where the teeth are brought into contact. This is done by carefully dividing bite pressures evenly across all of the teeth.
    • Bite splint therapy using a custom fitted and adjusted plastic bite guard to keep the teeth apart, day, night or both.
    • Braces, to reposition mal-aligned or drifted teeth.
    • Replacement of old, worn out or damaged fillings.
    • Reconstruction of badly worn and damaged teeth.
12. Dentures

    Dentures are prosthetic devices constructed to replace missing teeth, which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable; however, there are many different denture designs, some which rely on bonding or clipping onto teeth or dental implants. There are two main categories of dentures, depending on whether they are used to replace missing teeth on the mandibular arch or the maxillary arch.

13. Crowns

    Crowns or “caps” are restorations that cover and restore a tooth’s form, function and esthetic appeal. Most dentistry looks like dentistry. Our goal is to provide dentistry that is undetectable. We replace existing crowns and fillings with restorations that look and feel like your natural teeth. For teeth that are malformed, fractured, cracked, weakened by root canal therapy or contain large fillings that have been lost or broken, crowns are a viable long-term solution. Many people have unexplained pain from filled back teeth, which can be due to hairline cracks of the tooth. Placing crowns on these teeth may relieve the symptoms.

    Placement of crowns can correct bite problems created by worn out fillings or severe abrasion secondary to tooth grinding. We are known for the high quality of our work and have had some amazing results. It is not unusual for these treatments to last more than 10 years. Smoking, tooth grinding and poor oral hygiene will significantly reduce longevity.

    Fitting a crown requires at least two visits to our office. Initially, we will remove decay, shape the tooth, and fit it with a temporary crown. On the subsequent visit, two weeks later, we will remove the temporary crown, and then fit and adjust the final crown. Finally, we will cement the crown into place and you will have a new beautiful looking tooth.

    Key Benefits
    • Offers support to misshapen teeth , Discolored Teeth or badly broken teeth.
    • Looks completely natural.
    • Fixes “smile” and functional chewing problems.
    • Used to replace removed tooth structure after a root canal and to prevent breakage after a root canal.
    Gold crown

    Usually fabricated from a gold alloy, they are often used on back teeth in special circumstances. Gold crowns have largely been replaced by their porcelain counterparts.

    Porcelain Fused Metal Crowns

    Another type of restoration is porcelain-fused-to-metal, which provides strength to a crown or bridge. These restorations are very strong and durable. More of the existing tooth must be removed to accommodate the restoration. Although they are highly resistant to wear, porcelain restorations can wear opposing natural teeth if the porcelain becomes rough. There may be some initial discomfort to hot and cold. While porcelain-fused-to-metal restorations are highly biocompatible, some patients may show an allergic sensitivity to some types of metals used in the restoration. Wendel Family Dental Centre uses only High Noble Metals

    All Porcelain Crown

    All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and Dental Crowns Cary NC. They are used as dental inlays, onlays Apex NC, Crowns and Veneers Cary NC. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel.

14. BRIDGES

    Non-removable tooth replacements include bridges or “fixed partial dentures.” They replace missing teeth by attaching to abutments, which are either natural teeth, Dental Implants Cary NC or a combination of the two. Fixed bridges are made by placing crowns on the abutments and fusing the crowns to the tooth replacement (called a pontic). This bridge is then bonded onto the abutments.

    The procedure usually takes two appointments to complete. At the first appointment, the abutment teeth on either side of the gap are prepared by removing a portion of the enamel and dentin. Since the bridge must be fabricated very precisely to ensure correct fit, accurate impressions of the prepared teeth are taken and sent to a dental laboratory where the bridge will be constructed. A temporary bridge will be made and temporarily cemented while your permanent bridge is being fabricated. The process takes about two weeks. At your next visit, the bridge is adjusted for fit. The bite refined and the bridge cemented in place.

    We can make bridges gold, porcelain-fused-to-metal, and porcelain. Please refer to the section about Dental Crowns for more detail.