SOMETIMES patients only want to ask their dentist a question because of a problem they currently encounter. Logically, why should they visit the dentist, pay consultation fees and wait, and occasionally for up to an hour, just for simple information which they can utilise to decide a course of action or have an idea of the dentist’s diagnosis and treatment plan ahead of their scheduled date? Hence, this column today seeks to answer some common questions posed by patients.

Atypical Toothaches
I feel pain in some of my teeth. I checked it out with my dentist and am still having mild pain and irritated by it. I want to extract those teeth. Why is my dentist refusing to do it?
A less common condition is an atypical toothache. The pain is chronic, and usually, no obvious cause exists. Extracting the teeth usually does not solve the problem as the pain tends to stay because the complexity of the problem can even include psychological implications. Symptoms generally consist of a distressing continual pain condition from a tooth or teeth which stays longer than four months while the tooth/teeth and surrounding gum and bone look normal.

Facial Nerve Pain
I suffer from spontaneous sharp, electric-like pain on my face. This can be several times a day, of very short duration. So far, the condition has not improved and can even happen when I wash my face or mouth. Is this common?
This could be an uncommon condition of the nerves that tends to affect older age groups. The most common disease in this group is called Trigeminal Neuralgia. The features are sudden pain of varying intensity on the face or jaw which is triggered by jaw movements or touch and is of short duration. This can recur several times a day and can be very severe or throbbing but often comes and goes. The definite cause of neuralgia has never been proven, although it is commonly taken to be due to nerve instability. Medication is the treatment of choice. However, imaging of the head may be recommended to rule out any brain lesion.

Gum Infections
I have had very severe pain, ulcers, and bleeding gums for the past three days. My whole mouth is sore and I cannot eat properly. My spouse tells me I have bad breath. What could I be suffering from?

The condition you described is termed Acute Necrotising Gingivitis. The general symptoms involve ulcers on the tips of the gum between the teeth and along the gum line. The gums also bleed with sudden onset, pain, increased saliva foul odour, and a metallic taste. Repeated infections lead to bone loss or periodontitis, with additional features including enlarged gum margins and triangular gaps between the teeth. The teeth sometimes appear longer. Factors that increase the likelihood of this infection are poor oral hygiene, smoking, systemic diseases e.g. Diabetes, and stress. Treatment consists of proper tooth brushing and mouth rinsing, professional cleaning of gum areas, antibiotics, oxidizing antiseptics, and gum surgery.

I have had pain and gum swelling near my tooth for the past few months. It lasts for a few days and then disappears. Why is this so?
What you have is a gum abscess, commonly referred to as “gum boil”. Most gum diseases are without symptoms. However, acute periodontal abscesses can predominantly feature pain. In these cases, we observe localised gum swelling, red and tender to touch and this appears suddenly. Then the tooth shakes and can be tender on biting. There is soreness at the site resulting in throbbing pain, pus discharging from the gums, and loss of supporting bone (Detectable from X-Rays).

Impacted Wisdom Tooth
The last tooth in my lower jaw is causing some discomfort. I can only see part of the food and food gets trapped in the overlying gum. Occasionally, the overlying gum swells a little and the sides of my neck appear swollen too. Do I need to remove this tooth?

Wisdom teeth appear during early adulthood; in some, the jaw size does not allow its proper eruption. This leads to impaction against the tooth in front of it. Surgical removal of wisdom teeth is a common procedure. The symptoms of when an impacted becomes infected are:

1. Pain on the lower jaw usually found around the last molar teeth
2. Pain can be acute and mouth opening may be limited
3. Possible swelling
4. Lymph nodes in the neck may swell
5. Touching the region around the molar can be painful.

This occurs because food is trapped in the area, there is an infection of overlying gum, triangular gaps form between the teeth, and decay of the offending wisdom tooth as well as the adjacent one. Treatment consists of:

1. Cleansing of the gum area with a gargle or mouthwash
2. Antibiotics may be required for serious infection
3. Extraction or trimming of the opposing tooth to reduce biting on the swollen gum
4. Surgical removal of the upper wisdom tooth