Questions and answers about tooth worries including pain, infection, bad breath, underbites, anesthesia and discoloration

June 29th, 2010

Q&A with our dentist

Dr Keith Cohen answers online readers’ questions about tooth pain, bad breath, a developing underbite, milk tooth discoloration, root infections, and anesthesia and asthma worries.

Developing an underbite

Q: I am 62 and have badly worn teeth. I used to have an even bite, but now have an underbite due to excessive wear. My teeth are also getting smaller by the year. A consultant at the dental hospital advised me that the condition cannot be stopped. My lower jaw is starting to jut out and my upper lip is losing its support. I am desperate to restore my former appearance. My teeth are fairly good; I wear a night shield and have not had a lot of work done on my teeth. What can I do about this situation?

A: Tooth wear is a relatively common problem and the teeth can often be worn down to gum level in severe cases. You can reduce the damage by wearing a hard or soft night guard. Based on how many teeth are missing and how much tooth structure is remaining, you can opt for restoration which includes wearing dentures over the worn teeth. This kind of treatment can be undertaken by dental specialists or the prosthodontics department in a dental hospital.

Bad breath

Q: Although I have an excellent oral hygiene routine, I have very offensive breath. It is really affecting my life. I even removed my tonsils in the hope that it would help. I do not know what more to do. Can you help please?

A: Bad breath, also known as halitosis, can be caused by different factors. It is mostly due to organisms in the mouth and can be related to poorly fitted crowns and filings, gum disease and different kinds of diets. It is well known that drinking alcohol, smoking, and eating garlic and onions, all cause bad breath. This dental problem can also be caused by lung and nose infection, uncontrolled diabetes, intestinal problems, and other medical conditions.

Clearly, you will have to resolve the dental problem first. Many people underestimate the skill required for good oral hygiene and regularly miss out certain teeth or do not clean in between their teeth.

You should check with your dentist for his/ her opinion about the bad breath and see if you have gum disease or anything else that may be causing the condition.

Look into your diet and for a time try to avoid spicy and strongly flavored foods, alcohol and smoking. Also consider improving your oral hygiene as much as possible: brush your tongue or use a tongue cleaner. Sugar free chewing gum and an anti-septic mouthwash can also be helpful.

Tooth pain

Q: I have an ejected crown which could not be reinserted because the stump was fractured and it had to be extracted. Now the next tooth has become painful when touched. Is it possible that this tooth is fractured also?

A: The next tooth might be fractured, but it is unlikely, unless you suffered a knock to the teeth. Other possible causes for the pain are either a root canal problem or gum disease which your dentist should be able to diagnose quite easily by examining the teeth and getting an X-ray of them.

Anesthesia and asthma worries

Q: I need to take out a tooth from the back of my lower jaw but I am worried about the anesthesia freezing my tongue. I have asthma and I am concerned that it will affect my breathing. Is there any base for my worry?

A: Normally, local anesthesia in the jaw can freeze one side of the jaw and tongue. This can be avoided, according to the kind of treatment you require. Regardless of this, it will not induce an asthma attack. If you are still concerned about this, arrange a consultation appointment with your dentist and discuss your medical history and any apprehensions beforehand. This will allow your dentist to alter the treatment in a way that will suit you.

Root infection

Q: On a recent holiday, I received a course of antibiotics (penicillin) and when returning, a course of metronizadole for an infection under the root of a posted tooth supporting a six-tooth bridge that no one wants to try to remove. An apecoectomy has been suggested but it has been five weeks and there is no discomfort. Is it possible that the infection problem could have been cured by the antibiotics permanently?

A: Antibiotics only actually remove acute symptoms of infection. However, the original problem will still be there and is likely to persist. This can be seen on an X-ray image. If the bridge is satisfactory it is best to leave it in place. Treating this problem depends on the exact cause which is likely to be either from the root canal or the gums.

Discoloured teeth

Q: I am 62 years and have most of my natural teeth. My four front teeth are crowned but the two front ones are whiter than the others and they really stand out. Is there a way to tint them so they match the others or can I replace them?

A: The colour of ceramic or resin materials cannot be altered easily so your only option is to either change the crowns or bleach the surrounding teeth. If somebody is going to have restorations and bleaching, it is best to have tooth whitening done first. Only then should they match the colour of the crowns to the bleached teeth.

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