WHY DO we get excruciating toothache, especially at night?
In order for us to understand why, we first have to know a few basic facts about dental anatomy. Now, the dental pulp, a soft tissue that contains nerves, arteries, veins and lymph vessels, extends from the tip of the tooth root (where it connects to the tissues of the jaw) through the centre of the tooth into a chamber of the crown (the part seen in the mouth). The pulp is like the brain of a tooth.
A deeply penetrating cavity or a fracture of the tooth will expose the pulp to bacteria from the saliva. A pulp so diseased or injured and unable to repair itself degenerates, dies, and becomes a source of infection.
But before that stage, there is often a condition called acute pulpitis, which is characterized by intense pain (spontaneous toothache) experienced frequently at nights. Pulpal infection can then lead to dental abscess, which, if it involves the brain (encephalitis), although relatively rare, can lead to death.
Pain and swelling may accompany a pulpal infection, but even if there is no pain, certain by-products of any dental infection can injure the bone that supports a tooth in the jaw. In addition, the tooth may become discoloured. In fact, this is one of the most common causes of permanent discolouration.
If a damaged or diseased pulp is not removed and the appropriate treatment done, the tooth may eventually be lost. Root Canal Treatment (RCT) may require from one to several appointments, during which the diseased pulp is removed, and the pulp chamber and root canals of the tooth are cleaned, disinfected and sealed with root canal filling. The crown of the tooth can then be restored to its natural colour and full function by bleaching and filling, or by the placement of a crown.
A condemned tooth that has been redeemed by RCT can last many years in the mouth that receives proper care.
But what is meant by proper care? Proper care means that the gums and bones surrounding the teeth are kept clean and healthy by good practices, and periodic professional checkups.
In spite of the efforts of the patient, natural teeth and other oral structures may be lost because of dental decay, periodontal (gum) disease, injuries, cancer, surgery or congenital (birth) defects and abnormal development. Prosthodontic treatment can restore broken-down teeth, and replace missing teeth and associated oral and structures. Incidentally, the replacement of artificial eyes, nose, ears, eyebrows etc also fall into the scope of dentistry.
Crowns (caps) are used to restore teeth that are badly decayed or accidentally broken. Crowns may also be used to improve the patient’s appearance, and correct minor malocclusions (discrepancies in alignment of teeth). It is worthy to note that many TV and movie stars who flash beautiful smiles on the screen, portray teeth which, in fact, are perfectly aligned false crowns.
Fixed partial dentures (bridges) are used to replace missing teeth, and are made by placing a crown on the teeth adjacent to the lost tooth and suspending an artificial tooth or teeth between the crowns.  Alternatively, this author does dental implants to solve the problem.
Bridges may be quite large, involving many of the teeth in either the upper or lower jaws. For some problems, such as unattractive teeth, very few teeth, or periodontally involved teeth, a removable partial denture may be recommended.
Removable partial dentures in this country are very common, unlike in the developed countries, because they are considerably cheaper and easily available. This may be the preferred treatment, even when only one or two natural teeth remain healthy. Unfortunately, the disease conditions may dictate the extraction of all the teeth and the use of complete dentures.
Sometimes, in an attempt to help preserve the bone under the gums, which ‘melts’ away when the teeth are extracted, roots of the teeth are saved and the denture rests on the healthy roots (over-dentures). Usually, a patient can bite more forcibly when the denture is supported by the roots; the denture holds better, and the facial appearance is more normal.