TOOTH
DECAY AND PERIAPICAL ABCESS _____________________________________________________ |
Dental caries (tooth decay) is by far the most common dental emergency seen in the dental office. Cavities are the result of metabolism of carbohydrates by bacteria in dental plaque and the action of subsequent acid produced on the teeth. This decalcification begins on the surface of teeth, and if not treated in its early stage, can result in exposure of the interlayer of hard innervated tissue known as dentin, and eventually the nerve in the pulp chamber. The pulp chamber is the innermost portion of the tooth where the principle nerve and blood vessels terminate
Dental
caries may be seen as white areas on the surface
of the tooth in the beginning stages. These
areas of decalcification will often become darker
as the decay progresses. Often, the caries will
extend to the inner layer of the tooth structure
resulting in pain, and further disintegration
of both the external and internal portions of
the tooth. There are two classifications that
are based on the type of surface on which the
decay is found, 1. Smooth Surface Caries, when the decay is on the smooth a surface of the tooth and 2. Pit and Fissure Caries when the decay is in
a groove or pit on a tooth
.
Symptoms
of Dental Caries |
The most obvious symptom of a toothache resulting from dental caries is pain. Often in the beginning of a toothache the pain is periodic, coming and going. However, in most cases these episodes become more frequent and of longer duration and eventually the pain becomes constant.
Tooth decay may be associated with an existing restoration (a filling, etc.) with decay under or around it, or with a virgin tooth with no restoration.
The pain from a toothache should be differentiated
from other conditions that may cause pain and/or
swelling in the dental arch. Most commonly these
are cracked teeth, lose (mobile) teeth, and
periodontal disease with an associated condition.
When the decay is large and the tooth is badly
broken down, you can suspect that the source
of pain is a tooth ache. However, pit and fissure
cavities may
appear small on the surface, but often pyramid
into a large lesion as the decay goes deeper
into the tooth structure.
Periapical
Abcess (Abcess caused by tooth decay) |
Periapical abcesses are characterized by acute inflammation and swelling in the area of the bottom or apex of a tooth. Frequently the abcess manifests itself as a swollen area of tissue below a badly decayed tooth.
Generally the abcess follows chronic episodes of toothaches that have gone untreated.
The associated tooth is painful to touch and may be elevated in the socket.
While it is not common to have systemic problems associated with this condition there may be fever and lymphnode involvement.
If the periapical abcess is chronic there may be no clinical features due to localization. Note: If swelling is present do not iniate treatment with the following medications. Contact a local emergency facility or call us on the referral number so that antibiotic therapy can be iniated.
Temporary
Treatments for Tooth Decay |
There
are a number of medications that may aid in
providing temporary relief of dental pain caused
by decay until a dentist can be consulted. The
following can be found over the counter in most
pharmacies. Caution: Products containing Eugenol should
not be used by those persons who are allergic
to Eugenol, or when there is throbbing or swelling
in the affected area.
Tempanol (U.S.
DenTec Corporation)
Tempanol is a temporary filling
material that contains zinc oxide and eugenol
(oil of clove). These medicaments have been
used in dentistry for years in a number of applications.
Application as a toothache medication: Following the manufacturers directions, all
food debris should be removed from the cavity
by rinsing with slightly warm water. The area
is then pat dry using a cotton swab. A cotton
swab is then saturated with the liquid in the
kit. The liquid is then carefully placed in
the cavity. Caution should be used to avoid
touching the surrounding tissue and tongue.
After the application remove the cotton swab, a fresh swab should be used with each application.
This product is not to be used more than four
(4) times a day without consulting a dentist
or physician.
This
product should not be used if the affected area
has swelling or throbbing.
It should be noted that placement of the temporary
filling material over the cavity sight may enhance
the effectiveness of the liquid component, however,
excess liquid should be removed.
Like Tempanol, Dentemp contains zinc oxide and eugenol. However, it does not contain the filler material used as a temporary filling in Tempanol. This medicament can be found in many pharmacies in the United States and may provide temporary relief from dental pain. Its formulation is the same as that used by most dentists as a sedative filling. As with the sedative filling material found in the dental office, it must be mixed by the user. Thus, The directions must be read completely and carefully before using.
In some areas, the aforementioned products may not be readily available. One alternative may be to use ordinary Oil of Cloves. A small bottle can be purchased in almost any pharmacy. Place a small amount on a small cotton pellet, dry the pellet slightly so as to not over saturate, and place it directly into the cavity. The use of clove oil for temporary toothache relief is historic.
Orajel belongs to a family of toothache medications that have a topical anesthetic as the active ingredient. Most commonly that anesthetic is Benzocaine.
Application: Following the manufacturer's instructions open the tube, place a small amount both inside the cavity and on the gums. This medication as with other medications, should not be used by persons allergic to there ingredients, such as Anesthetics in the "caine" family including benzocaine, procaine, and butacaine, ect.
Do not use this product repeatedly, do not use more than four (4) times a day without consulting a dentist. It is intended for temporary treatment. Consult with a dentist as soon as possible.
Anbesol like oragel uses Benzocaine as an active ingredient.
Application: The application of anbesol is identical to that of Orajel. However, it should be noted that with both products children under the age of 12 years old should be closely supervised.