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This is a genuine dental emergency, especially if it is uncontrollable and after a dental extraction. Call immediately to arrange an appointment. You may require sutures or special gauze placement to help control the bleeding. Please bring a list of any medication that you may be taking.

Problems with braces can include:

• Broken braces (brackets)
• Broken wires
• Loose bands
• Loose braces
• Wires sticking out

Call and discuss the problem with your dentist. You may need to visit right away, especially if the broken/loose item is causing trauma to your cheeks, gums or tongue. If the problem with your braces was caused by an injury (such as a blow to the mouth), seek help right away.

Teeth may break for a variety of reasons including:

• Trauma
• Dental decay
• Biting on hard foods

Treatment is dependent upon the degree of the break, how much tooth is broken and how much remains. Most teeth can have treatment to help save them, but a thorough assessment is required.

Dentures can break due to a variety of reasons, including:

• Wear and tear
• Poorly fitting dentures
• Dentures that have loosened over time
• Accidental dropping of the denture

Most dentures can be repaired, but will require you to bring as much of the denture to the dentist. In some instances, the dentist may be able to repair the denture for you there and then. If the break is particularly severe, your denture may require to be sent to a laboratory to be repaired- this can take a few hours. We do not recommend trying to repair the denture with superglue.

A dental abscess is a collection of pus that can form in the teeth or gums as a result of a bacterial infection.
Bacteria are found in plaque (a by-product of food, saliva and bacteria in the mouth). Plaque damages teeth and gums and can eventually infect the soft tissue inside a tooth or gums, forming an abscess.
There are two types of dental abscess:
periapical abscess (the most common type), when bacteria infect the inside of the tooth as a result of dental decay periodontal abscess, when bacteria infect the gums Dental abscesses can be very painful and tender and can make a person feel unwell.

Outlook

Without dental treatment, a dental abscess will get worse and may lead to the destruction of surrounding bone and other serious health problems.

A dental abscess occurs when bacteria infect and spread inside a tooth or your gums.

The bacteria responsible for this are found in plaque, which also contains food particles left over from eating combined with saliva.

Periapical abscesses are much more common than periodontal abscesses.

Causes of a periapical abscess

When a periapical abscess occurs, plaque bacteria infect your tooth as a result of dental caries (tiny holes caused by tooth decay) that form in the hard outer layer of your tooth (the enamel).

Dental caries break down the enamel and the softer layer of tissue underneath (dentine) and eventually reach the centre of your tooth (pulp). This is known as pulpitis. The dental pulp in the middle of the tooth dies and the pulp chamber becomes infected.

The bacteria continue to infect the pulp until it reaches the bone that surrounds and supports your tooth (alveolar bone), where the periapical abscess forms.

Causes of a periodontal abscess

A periodontal abscess occurs when plaque bacteria affect your gums, causing gum disease (known as periodontitis).

Periodontitis causes inflammation (redness and swelling) in your gums, which can make the tissue that surrounds the root of your tooth separate from the base of your tooth. This separation creates a tiny gap known as a periodontal pocket, which can be very difficult to keep clean and allows bacteria to enter and spread. The periodontal abscess is formed by the build-up of bacteria in the periodontal pocket.

Dental abscesses require immediate treatment, as left untreated they can cause severe pain, cause facial swellings and disrupt your day to day life.

It is important to arrange an emergency appointment to avoid the potential spread of infection. Treatment is dependent upon the severity and type of abscess, but may include root canal treatment, antibiotics, deep cleaning or extraction of the tooth.

Playing football, rugby, cricket or on a set of rollerblades, sports injuries can range from minor chips of a tooth to severe cases where teeth have been knocked out, loosened or displaced. It is important with any dental trauma to arrange an assessment straight away, especially if you have disrupted the position of the tooth or knocked it out. Studies show that the highest success rates can be achieved within the first two hours.

Gum pain can arise from a variety of causes, and maybe the result of something relatively minor (for example trapped food) to something that may require active treatment (periodontal abscess). It is important to arrange an appointment immediately as often this pain may escalate and may very well be the initial signs of an underlying problem.

Treatment is dependent upon the cause, but can vary from debridement of the area and antibiotics to specialist periodontal treatments.

Gum disease refers to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds and holds the teeth in place. Gum disease is caused by toxins secreted by certain bacteria in "plaque" that accumulate over time along and under the gum line. This plaque is a mixture of food, saliva, and bacteria. An early symptom of gum disease is gum bleeding without pain. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of deep gum pockets. Bacteria in these pockets cause gum infection, swelling, pain, and further bone destruction. Advanced gum disease can cause loss of otherwise healthy teeth. Gum disease is complicated by such factors as poor oral hygiene, family history of gum disease, smoking, and family history of diabetes.

Treatment of gum disease always involves oral hygiene and removal of bacterial plaque and tartar (hardened plaque). Moderate to advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called "scaling and root planing" and "subgingival curettage." Scaling and root planing is the removal of plaque and tartar from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anaesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. Follow-up treatment, if necessary, may include various types of gum operations. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.

What are Wisdom Teeth?

Wisdom teeth are the last molars on each side of the jaws. They are the last teeth to emerge, or erupt, usually when a person is between 16 and 20.

Since wisdom teeth are the last permanent teeth to come through, or erupt, there is often not enough room left in your mouth to accommodate them. This can lead to impacted wisdom teeth - teeth that are trapped beneath the gum tissue by other teeth or bone. If teeth are impacted, swelling and tenderness may occur.

Wisdom teeth that only partially emerge or come through crooked may also lead to painful crowding and disease. Since teeth removed before age 20 have less developed roots and fewer complications, consult your dentist to have your wisdom teeth evaluated to see if they need to be removed.

Wisdom tooth pain

Food impaction and bacterial plaque accumulation may set off an infection. This may very quickly spread and become very painful. Symptoms of a spreading infection may include difficulty in mouth opening, and swallowing. This may or may not, be accompanied with a facial swelling. There is usually a significant amount of pain also which may radiate to the ear..

It is very important to arrange an appointment immediately, and you will probably require antibiotics to control the infection in the first instance, unless it is clinically appropriate to remove the offending tooth.

We follow the NICE guidelines for the extraction of wisdom teeth.

How are Wisdom Teeth Removed?

A tooth extraction is a relatively routine procedure. Your dentist or a dental specialist, called an oral surgeon, will recommend either "going to sleep" using general anaesthesia, or numbing this area in your mouth with local anaesthesia.

After the tooth is removed, you may be asked to bite down softly on a piece of gauze for a certain period of time, to limit any bleeding that may occur. Some pain and swelling may occur but it will normally go away after a few days; however, you should call your dentist if you have prolonged or severe pain, swelling, bleeding or fever.

Removal of wisdom teeth due to crowding or impaction should not affect your bite or oral health in the future.

If a tooth is completely knocked out, it should be quickly rinsed off with water, but never scrubbed. The tooth should be held by the crown (top), not the root, so you do not damage the ligaments. In a cooperative adult, the tooth should be put back in the socket.

Many people may be uncomfortable re-implanting the tooth on their own. If this is the case, be sure to transport the tooth to the doctor or dentist in saline, milk, or saliva.

You may also place the tooth between the cheek and gum line of either the person who lost the tooth or any willing adult. The mouth is the best place for the tooth because it protects the root by keeping it moist and providing protection against bacteria.

Do not transport the tooth dry. This will cause damage within minutes. Transporting the tooth in water is also not recommended.

It is important to see a dentist as soon as possible if you are unlucky enough to lose a filling or a crown. You may or may not have pain or sensitivity, but the longer you leave a tooth without a protective covering, the higher the chances of you possibly developing a problem, or exacerbating an existing problem. The loss of a filling or crown may also have occurred as a result of an underlying problem, for example dental decay.

If there is no decay, then your existing crown can normally be cemented back straight away. Lost fillings will usually require replacement of the filling, you may have the option of a temporary or definitive filling being placed.

Following dental extractions, there is likely to be some discomfort, but this should subside within 24 hours and should respond well to painkillers. If persistent pain is occurring after this period, then there is a chance that you may have developed a post extraction infection. This is much more likely if you are a smoker.

It is important to arrange an appointment to see a dentist, as left untreated these can become quite painful. Treatment normally consists of stopping smoking, irrigation of the extraction site, placement of an antiseptic dressing and use of antibiotics.

Swelling after an extraction is entirely normal, and is the body's natural response. It should normally start to settle down within three days, but if it persists after this, then it is best to arrange an appointment.

The crown of the tooth is made up of the hard, white, enamel layer and a thicker dentine layer. Both these hard layers protect the innermost soft tissues of the tooth called the pulp. The dental pulp contains blood vessels and nerves within and extends from the crown to the tips of the root or roots.

Root canal treatment involves the removal of the pulp tissues from the tooth in the event that it gets infected or inflamed. The pulp can be infected or inflamed due to either deep decay or an extensive restoration that involves the pulp, cracked or fractured tooth due to trauma, excessive wear of enamel and dentine exposing the pulp, and sometimes as a result of severe gum disease.

Signs of pulp damage may include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, swelling, tenderness of the overlying gums or a bad taste in the mouth. On the other hand, there may be no symptoms at all. If pulp inflammation or infection is left untreated, it can eventually cause pain, swelling and loss of the supporting bone.

What Are The Advantages Of Root Canal Treatment?

Root canal treatment saves teeth that would otherwise have been extracted.

After root canal treatment the tooth is pulp-less i.e. it has no vital tissues within. However, there are vital tissues surrounding the root e.g. the gum, periodontal membrane and supporting bone. A root canal treated tooth can function normally and can be maintained with routine dental care and oral hygiene measures.

How Is Root Canal Treatment Carried Out?

• Removal of the infected or inflamed pulp is the first step in saving the tooth. Under local anaesthetic an opening is made in the crown of the tooth to get access to the infected or inflamed pulp within.
• Using small, specially designed hand or rotary files, the root canals are cleaned and shaped to a form that can be sealed. Debris within the canals is removed by flushing with an anti-bacterial solution.
• The canals are finally filled or sealed with an inert material called gutta-percha. The tooth should be restored to full shape and function by either a permanent filling or a crown, depending on how much of the tooth is left. This should be done as soon as possible as there could be a risk of tooth fracture due to biting forces.
• All root canal treatment procedures are performed by isolating the tooth with a rubber dam to provide a clean and saliva-free environment. Root canal treatment may be done in single or multiple visits depending on the complexity of the tooth. In between treatment appointments, medicaments may be placed within the canals and the tooth is covered with a temporary filling.
• Often, X-rays are taken to determine the length of the root and to monitor the various treatment stages.

Is Root Canal Treatment Painful?

Root canal treatment procedures are relatively comfortable and often painless as the tooth is anaesthetised during treatment. After treatment, the tooth may be sensitive or tender for a few days due to inflammation of the surrounding tissues. This discomfort can be relieved by taking mild analgesics or painkillers available over the counter at the pharmacy. However, if the pain persists and is severe, or a swelling occurs, you should contact your dentist.

Care Of The Root-Treated Tooth

As far as possible, avoid chewing or biting on the tooth being treated until you have it permanently restored with either a filling or a crown. Excessive pressure at this stage may crack or fracture the tooth. Therefore, it is very important to restore the tooth properly as soon as possible. Most endodontically treated teeth last as long as natural teeth following permanent restoration.

Practise good oral hygiene, including brushing and flossing at all times, as root-filled teeth are as prone to decay as natural teeth. It is also important to have your treated tooth reviewed regularly by your dentist.

Facial swellings are usually a sign of a severe infection. Pus has formed and has entered the space between tissues. This may or may not be accompanied by pain, but it is very important to see a dentist straight away to assess the cause, and start any appropriate treatment. Left untreated, swellings may cause hospitalization, especially if they spread to the neck region and start to cause difficulties in breathing.

Treatment may include drainage of the swelling if appropriate (either by a small incision, or by making a small hole in the tooth) and the use of antibiotics. Sometimes, if appropriate and if clinically feasible, the offending tooth may be removed.

I had a sudden toothache on one tooth. The gums are slightly swollen. I feel the tenderness when I touch it. After a few days it subsided and I ignored it. A few days later, I had the same toothache. What can I do about this?

Sudden excruciating pain or toothache may indicate the deep spread of decay in the tooth. Often, root canal treatment is necessary. If you note mild symptoms on the teeth, a check-up with your dentist will help prevent a bigger problem from occurring.

Features:

• may start with sensitivity to hot or cold drinks and food
• sudden pain from tooth or jaw usually of moderate to severe intensity
• pain may last a few days or longer
• pain can be related to one tooth or over a wide area
• painkillers may provide temporary relief
• swelling could occur

Causes:

• decayed teeth
• history of trauma to teeth
• cracked teeth from excessive wear, chewing on hard foods

Management depending on cause:

• remove decayed area and protect tooth with filling
• root canal treatment if decay is extensive and has affected nerve of the tooth
• drainage of swelling
• antibiotics for swelling
• extract tooth if not restorable

We deal with all manner of dental trauma, from accidental trips and falls to sports injuries and assaults.

Treatment really is dependent upon the extent and degree of trauma.

Knocked out and displaced teeth can normally be replanted and splinted. If the tooth has been knocked out, it is important to care for it appropriately- keep it clean, don't scrub the root, try to keep it in the socket if possible or in milk/contact lens solution. The important thing is not to let it dry out, and to avoid further damage to the root. It is ideal to see a dentist within two hours of the incident, but sometimes this is not possible-as long as the tooth has been cared for, it may still be replanted.

Splinting takes the shape of a piece of wire bonded onto the tooth surfaces to hold the teeth in place during the healing period, which may be between two to four weeks. You will require regular assessments during this phase in order to diagnose any infections or complications that may occur, so that they are dealt with appropriately and at the earliest time possible.

Minor cracks and chips can be restored by either bonding the fractured portion back to the tooth or restoring the missing part with some composite filling material.

This can be particularly distressing for anyone unfortunate enough to experience it. A full examination is required to ascertain likely causes. Dental infections can cause radiating pain, such that it is difficult for the patient to pinpoint where the pain is coming from.

Once the source of the pain has been diagnosed, appropriate treatment may be started to relieve your pain.

On rare occasions, you may be suffering from a pain of non-dental origin which may require referral to a specialist for further assessment.