TOOTHACHE

Sufferers from toothache know how extraordinarily painful it can be.
Furthermore, it seems that toothache occurs at the most inconvenient times,
such as on holiday, at a dinner party or in mid-flight across some ocean.
Toothache occurs when the pulp or "nerve" of a tooth is disturbed or becomes
infected.  In the portion of the tooth that one can see , the pulp is
surrounded first by a layer of dentine and a thin but hard, protective, enamel
covering.  Under the gum line the enamel covering is a thin firm layer called
cementum.  If these coverings are disrupted either as a result of an accident 
or dental decay, pain can result.
In some circumstances, decay has only to penetrate through the enamel into the 
softer, underlaying dentine for discomfort to occur.  Dentine contains millions
of tiny canals that can transmit painful sensations to the underlaying pulp.
These sensations can be triggered by hot, cold, sweet or sour foods and drinks.
If the decay is removed before it has penetrated too far, the tooth will 
return to normal.
Once decay reaches the pulp, the tooth is in a bad way.  The pulp can become
infected and inflamed and begin to swell.  Because it is enclosed in a tiny 
chamber there is virtually no space for this swelling to take place, so the 
inflamed pulp is pressed against the hard walls of the chamber.  This is 
painful and the whole tooth can ache and throb.
It gets really serious if the infection spreads through the tiny opening at
the root end of the pulp chamber.  In this circumstance an abscess involving 
the jaw bone can develop.  An abscessed tooth is extremely sensitive to 
pressure or chewing and the discomfort is aggravated by heat and tends to be
relieved by cold.
Remember that teeth with infected pulps, even abscessed ones, can be saved. 
It may take several visits to the dentist but there is no substitute for your own teeth. 
Extraction should only be the last resort.
 

TREATMENT

A tooth with an infected pulp is treated by a procedure called root canal 
therapy.  After giving you a numbing local anaesthetic, the dentist cuts a 
very small access cavity into the tooth. The pulp chamber is cleaned out 
using special instruments and an antiseptic dressing is placed to kill any 
bacteria present. Once the tooth is free of pain and infection, the pulp 
chamber is filled with a special material.
Accidents to teeth can cause toothache.  A chipped front tooth with the dentine
or pulp exposed can be painful.  Sometimes a blow to the tooth may not
cause any obvious injury but may result in the pulp of the tooth becoming 
inflamed.  This may subside or lead to later problems.  While it may not be 
possible to avoid all injuries to teeth, it makes sense to wear a custom-
fitted mouthguard whenever contact sports are played.

As with all things dental, prevention is better than cure.  Those who have 
been reared in a community with fluoridated water,  who use a fluoride toothpaste and
practise good plaque control probably do not know what toothache is like.
 

TOOTH SENSITIVITY

It is estimated that 20 percent of adults suffer at some time or other from 
a more subtle type of toothache when they eat hot, cold, sweet or sour foods
and drinks.  With age, the gums begin to recede, exposing the roots of the
teeth.  Because the root portion of the teeth does not have the advantage of 
hard enamel covering, the surface (cementum) is easily abraded away.  When 
this occurs, the sensitive underlying dentine is exposed.
This situation is often aggravated by using the wrong toothbrush technique, 
particularly a scrubbing or "east west" action.  If the exposed dentine is 
kept plaque-free by careful toothbrushing and flossing, sensitivity will be
minimal. However if plaque is allowed to accumulate, sensitivity will be increased.
A number of toothpastes are designed to reduce the sensitivity of exposed
dentine at the gum line.  Many people find them effective.  It is a good idea 
to alternate them with a regular fluoride toothpaste to ensure that the 
remaining teeth are getting adequate fluoride protection. 

NUTRITIONAL SAFEGUARDS

With emphasis being placed on sound nutrition, fruit should
be an important part of the daily diet.  However, some people tend to avoid
pineapples, oranges, lemons, grapefruit, etc., if they have sensitive teeth.
If you suffer in this way, clean your teeth with a fluoride toothpaste before
eating fruit.  The fluoride from the paste will help protect the dentine 
against the acids found in some fruits.  To help neutralise any remaining acids
in the mouth,  finish off by eating a piece of cheese.  Cheese has been found
to have good "anti-acid" properties. A spoonfull of bicarbonate of soda in a 
half glass of water can also be used as a mouthwash after eating acidic fruits.
It is not possible to cover here all the possible causes of toothache.  Some 
are not attributable to tooth problems at all.  For example, sinus trouble can
cause a dull throbbing pain in the upper back teeth.  Whatever the cause, that
pain is natures warning - don't ignore it.