Dental pain

Who has not experienced the occasional ache of a dental cavity? A dental cavity (also known as caries) is a hole that damages the structure of a tooth.

Despite being preventable, dental caries is perhaps the most prevalent chronic disease in both children and adults. The CDC reported that 76% of 12 to 17 years old adolescents have had at least one cavity and 94% of all United States adults ages 18 and older have had cavities. 

We have seen significant improvements over the past 50 years in the United States from almost universal water fluoridation to improved treatment option. 

Unless treated early and effectively, the damage from caries is both irreversible and cumulative. Dental cavities have both immediate and long-term consequences. Anyone who has suffered from a cavity or broken tooth knows the aching and increased irritation it causes. 

Pain, sensitivity to hot and cold food and drinks, infection and possible tooth loss are direct consequences of dental caries. Longer-term outcomes include continued pain (acute or chronic and dull), decreased hygiene because it hurts to brush, halitosis (bad breath), diminished nutritional status leading to malnutrition, poor appearance, alterations in speech, and periodontal disease.

These then can lead to further problems such as inattention and distress at work or school, greater pain, loss of more teeth, continued degradation of appearance which has psychological and emotional effects. Research into the link between oral health and systemic illnesses such as heart disease continues to be a hot topic. Good dental health is vital for good general health.

We all have bacteria in our mouths. These bacteria change all foods (especially sugar and starch) into acids. The bacteria, food, saliva, and acid combine to form plaque that sticks to the teeth. The plaque can begin to accumulate in just twenty minutes after eating. 

If this is not removed with regular brushing and flossing, it hardens into tartar which can irritate the teeth and gums causing tooth decay and gingivitis, an inflammation of the gum tissue. 

The acids in the plaque dissolve the enamel surface of the tooth and create holes in the tooth. The tooth decays and, if left untreated, an abscess can develop, or the internal structures are damaged enough to cause tooth loss.

Aging teeth must be cared for to protect against gum disease as well as tooth decay. Good teeth and proper nutrition are as important for seniors as for children. Disease prevention, as always, is “the ounce of prevention being worth the pound of cure.” This certainly includes tooth and gum disease. 

Of course, the No. 1 prevention strategy is good oral hygiene. Regular brushing at least twice daily, flossing at least once daily and regular dental exams with professional cleaning every six to twelve months are the foundation of good dental health. 

Sealants are popular for children, but older people also benefit from the protective coating the sealants provide. Fluoride protects the enamel from the acids in plaque. In addition to the fluoride in our water supply, it is often added to toothpaste and mouthwash for a topical application. 

As with all health issues, diet plays an important role in good dental health. A good diet promotes good general health which promotes better dental health. Chewy foods, sticky foods, even healthy snacks such as raisins and other dried fruits should be eaten as part of a meal rather than as a snack. 

They stick to the teeth and the action of chewing other foods and drinking liquids helps to loosen them from tooth surfaces. Frequent snacking creates a constant supply of acid, potentially harming the teeth surfaces. This includes sugary candies, chewing gum, and mints. 

Tobacco (smoked, chewed, and vaped) harms teeth in many ways also. Tooth discoloration, bad breath, increased sensitivity due to enamel wear, more plaque formation, inflammation of salivary glands, delayed healing after dental procedures, and the development of leukoplakia (white patches that can be a precursor to mouth cancer) are all potential consequences of tobacco use to dental health. Every year, thousands of people die from mouth cancer, triggered by tobacco use). Smokers have a 10 times greater risk of oral cancers than nonsmokers.

A destroyed tooth does not heal itself, but cavity progression can be stopped with dental treatment. The goals of treatment are always to preserve the tooth whenever possible and to prevent the complications of infection, pain, etc. 

Treatment strategies include fillings, crowns, and root canals, all of which are virtually painless today with adequate topical anesthesia. The old days of painful injections, frequent extractions, and loud and frightening drilling are gone. Dental care is easy, and almost relaxing in the hands of a good dentist and hygienist. 

There is no good reason to tolerate cavities, sore gums, or a toothache. Most COVID-19 restrictions have been lifted so if it has been more than a year since your last dental check up, make that appointment for a cleaning and exam this summer. 

Mia Smitt is a longtime nurse practitioner. She writes a regular column for Tucson Local Media.

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