THERE are times when patients only want to ask their dentist a question because of a problem they are currently encountering. Logically, why should they visit the dentist, pay consultation fees, and wait—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 had checked it out with my dentist and I am still having mild pain and am irritated by it. I want to extract those teeth. Why is my dentist refusing to do it?

A less common condition is the atypical toothache. The pain is chronic and usually has no obvious cause. Extracting the teeth usually does not solve the problem, as the pain tends to persist, and the problem’s complexity can even include psychological implications. Symptoms generally consist of a distressing, continuous pain condition from a tooth or teeth that persists for more than 4 months, while the tooth/teeth and surrounding gum and bone appear normal.

Facial Nerve Pain

I suffer from spontaneous, sharp, electric-like pain on my face. This can be a few times a day, for a 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 nerve condition that tends to affect older age groups. The most common disease in this group is called Trigeminal Neuralgia. The features are sudden, brief pain of varying intensity in the face or jaw, triggered by jaw movements or touch. This can occur several times a day, be very severe or throbbing, but often comes and goes. The definite cause of neuralgia has never been proven, although it is commonly attributed to nerve instability. Medication is the treatment of choice. However, head imaging may be recommended to rule out a brain lesion.

Gum Infections

I have 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 include ulcers on the tips of the gums between the teeth and along the gum line. The gums also bleed with sudden onset of 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 which 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, oxidising 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 a “gum boil”. Most gum diseases are without symptoms. However, acute periodontal abscesses can predominantly feature pain. In these cases, we observe localised gum swelling that is red and tender. This situation appears suddenly. Then the tooth may shake and be tender on biting. There is soreness at the site, resulting in throbbing pain, pus discharge from the gums, and loss of supporting bone (detected on X-rays).

Impacted Wisdom Tooth

My last tooth in my lower jaw is causing some discomfort. I can only see part of the tooth 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, and in some cases, the jaw size does not allow for their 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 tooth becomes infected are:

• Pain on lower jaw is usually found around last molar teeth
• Pain can be acute and mouth opening may be limited
• Possible swelling
• Lymph nodes in the neck may swell
• Touching the region around the molar can be painful