Tooth Abscess

About Tooth Abscess:

Abscess can occur in the mouth from infections between the teeth and gum, or in the root of the tooth itself. They are most frequently caused by severe tooth decay in which the enamel is opened or broken and bacteria infect the pulp of the tooth. They can also be due to local trauma when a tooth is chipped or broken. They are extremely painful, and can spread to the supporting bone structure of the teeth if not properly dealt with in enough time. The pain associated with an abscess isn't limited to the immediate area where it's located. More pain may occur when you close your mouth tightly or bite down. Therefore you will likely experience pain when eating, not only if food touches or irritates the abscess, but from chewing as well.

Indications of tooth abscess:

The symptom of abscessed tooth is a severe toothache. This is due to the inflamed, infected area pressing on the nerve and root of the tooth. In many cases, the root can die as a result of the infection and the pain may subside. However, this does not mean that the infection is gone. It can stay active and continue to destroy gum tissue and spread to the bone where it can do further damage, potentially resulting in tooth loss. Other symptoms you may notice include:

• Tenderness with touch 
• Pain
• Nausea
• Swollen neck glands 
• Gum inflammation/swelling
• Swelling in upper or lower jaw
• Redness of mouth or face
• Vomiting
• Fever
• Chills
• Diarrhea
• Pus drainage or open sore in mouth
• Difficulty fully opening your mouth
• Breath odor
• Sensitivity to hot or cold
• Shooting or throbbing pain when chewing

Disadvantages of tooth abscess:

Disadvantages of an abscessed tooth reach far beyond the pain and discomfort of the abscess itself. If they are left untreated, the infection can spread to other teeth, or other tissues of the mouth and face. This can cause severe swelling, and in some instances if it is untreated for long enough the swelling can even cut off airways and cause death. The infection first spreads into the jaw bone and supporting structure for the teeth. Once this happens, loss of teeth can be expected as the bone is eroded. At this point it can spread to the rest of the bone structure of the face and continue to destroy tissue along the way, sometimes even resulting in facial disfigurement from bone loss.

Causes of tooth abscess?

~Offender when it comes to abscessed teeth is poor oral hygiene. When you don't execute proper oral hygiene, the harmful bacteria that live in the mouth can build up to dangerous levels. These bacteria eat leftover food particles and sugars from your diet and produce acidic waste that can destroy the enamel of your teeth. This is how cavities form, and they create an open door for infection. As cavities go deeper into the tooth, the same bacteria that caused the cavity gain access to the nerve and the pulp of the tooth. At this point, the infection can spread to the root of the tooth and the supporting bone beneath it. As the infection spreads and more tissue is destroyed, pus will collect at the site and create an abscess.

Preventions:

To prevent abscesses from developing is to implement a solid oral hygiene plan that will prevent bacteria from causing the decay that leads to infection. Be sure that you brush at least twice a day, use an antibacterial mouthwash twice a day to get to the areas you can't brush, and floss at least once a day to remove food particles that bacteria feed on from between the teeth. Visit your dentist for regular checkups every 6 months, and have any cavities treated right away to prevent infection from occurring. If abscesses form regularly, you may need to seek further treatment to determine whether or not there is an underlying medical condition that causes them.

BRUSHING TECHNIQUES

Modified Bass Method:

• MECHANICAL PLAQUE REMOVAL BY THE INDIVIDUAL Includes :

-Tooth brushing.

-Flossing.

• TOOTH BRUSHING TYPES & TECHNIQUES :

Design variations in tooth brushes include:

-Dimensions of the head.

-The length.

-Diameter.

-Modulus of elasticity of the filaments & their numbers, distribution & angulations.

MODULUS OF ELASTICITY: is the mathematical description of an object or substance's tendency to be deformed elastically (i.e., non-permanently) when a force is applied to it.

• Current opinions favors a soft textured , nylon, multi-tufted brush with a short head. There is no clear-cut evidence that one particular type of tooth brush is superior to others with respect to plaque removal and prevention of gingivitis. *Frequent use of hard textured brush has been linked to gingival recession.

• Tooth brushing method: Are categorized according to the direction of brushing stroke.

1.Vertical.

2.Horizontal.

3.Roll technique.

4.Vibrating technique (Charters, Still man, Bass).

5.Circular technique.

6.Physiological technique.

7.Scrub brush method.

• Horizontal Scrub: Position of the bristles is 90 degree to tooth & horizontal strokes are done & it’s claimed that this technique achieves only supra gingival cleaning.
• Fones (Circular tech): Position of the bristles is 90 degree to tooth & brush is moved in large circles over teeth and gingiva. It also achieves supra gingival cleaning.

• STILL MAN: Bristles are positioned 45 degree to apex, part on the gingival margin & part on the cervix of tooth & brush is moved in a vibratory pulsing motion ,while in modified still man brush is swept occlusally ,thus cleaning supra gingival area.
• Charters method: Bristles are positioned 90 degree to tooth & brush is moved in a circular vibratory motion thus causing gingival stimulation & inter proximal cleaning. In modified Charter the brush is sweep occlusally & thus achieving supra gingival cleaning.

-          BASS METHOD: Bristles are positioned at 45 degree to the apex & vibratory horizontal motion is given thus achieving sub gingival cleaning & gingival stimulation, while in modified BASS method tooth brush is swept occlusally thus achieving supra gingival cleaning.

Bass method is the technique widely recommended by the dentist & hygienists

POWERED TOOTH BRUSHES

• There is evidence that suggest powered tooth brushes will improve plaque control in specific patient groups, those with orthodontic appliances; children & adolescents ;those with a physical or learning disability & Institutionalized patients who are dependent upon their care providers to brush their teeth.
• The brush heads are more compact than compared to the conventional tooth brush. Bristles are also arranged as more compact single tufts which facilitate inter proximal cleaning and brushing in less accessible areas of the mouth.

• The circular brush heads have oscillating, rotational, or counter rotational movements.
• Newer versions includes following features:

-An active brush tip to facilitate plaque control around posterior teeth.

-An orthodontic brush head for cleaning around the components of orthodontic appliances.

-Rotating or spiraling filaments for improved inter proximal cleaning.

 

A clicking mechanism to warn when a pre-determined brushing force has been reached.

-Timers, which usually indicate a brushing time of 2 minutes.

Cleaning between the teeth:

• The need for effective inter dental cleaning has led to the manufacture of various devices. This should be recommended in accordance with the individual dexterity & inter dental anatomy.
• WOOD POINTS(TOOTH PICKS):Triangular wood points are superior to  round or rectangular shaped ,but are effective only where sufficient inter dental space is available. But there is evidence that they should not be used

• DENTAL FLOSS: When tooth brushing is accompanied by flossing, more plaque tends to be removed from the proximal surface than by tooth brushing alone. There is little apparent difference in the cleaning ability of waxed & un waxed floss, nor is there any difference between dental tape and waxed or un waxed dental floss with regard to their effectiveness at reducing inter dental gingival bleeding.

• Interspace brush( single tufted tooth brush): This device was introduced to improve the access to tipped, rotated or displaced teeth & teeth effected by gingival recession. The interspace brush is of limited value on its own at cleaning proximal surfaces except for surfaces adjacent to an extraction space.

• INTERDENTAL  Brush (Bottle  brush):Open interdental brushes are cleaned more thoroughly by the inter dental brush which is manufactured in different shapes & sizes. The larger type is held by it’s wire handle while smaller versions are attachable to a metal or plastic handles. Studies comparing interdental brush with dental floss have shown it to be superior in cleaning large interdental space & suggest when used habitually supra gingival 

Proximal surfaces can be kept free of plaque & subgingival plaque to a depth of 2-2.5 mm below the gingival margin. However patients with gingivitis ,swollen papillae may initially limit the choice of interdental aid to dental floss. If however any proximal attachment loss has occurred, the gingival recession which will inevitably occur with the treatment, should , in  due course, allow interdental brushes to be used instead. 

DENTAL CARIES AND PERIODONTAL DISEASE IN PAKISTAN

The survey reports that dental caries (tooth decay) is the single most common chronic childhood disease in the country --5 times more common than asthma and 7 times more common than hay fever. Almost 50 percent of the 12 and the 15-year-old children have two teeth involved in the disease process. On the positive side more than 50% of the children between the ages of 12-15 years are caries free and on the negative side 97% of all carious lesions in these age groups are untreated. For the 35-44 year old group half of the lesions are untreated while in more than 90% of cases the treatment offered in extraction. The difference in caries experience for rural and urban areas is of particular interest. In rural areas, caries was found to be more prevalent in the surveys done in the past; similar higher levels of caries in the rural population were also noted in the present survey. The

data also shows that caries is very strongly age related and the average number of affected teeth goes up to almost 18 teeth per individual over the age of 65.

Most adults show signs of periodontal or gingival diseases. It is evident from the above data that periodontal health of the nation is very poor with only 28% of the 12 year olds having healthy gums and more than 93% of the 65 year olds have some gum or periodontal disease. These results indicate that periodontal disease including inflammation of gums and calculus is endemic in Pakistan. Like caries the level of gingival and periodontal disease is higher in the rural population of the country. Severe periodontal disease (measured as 6 millimetres of periodontal attachment loss) affects

about 17 percent of adults aged 65+. These data indicate that oral diseases are progressive and cumulative and become more complex over time.

The survey also showed that almost one percent of the 35-44 year olds and 20% of persons aged 65 years or above were edentulous (no teeth). Of the edentulous senior citizens more than one third had no dentures, while in the 35-44 year old group 35% required replacement of missing teeth and only 5% were wearing them. Chronic disabling diseases such as temporomandibular joint disorders affect 21% of the elderly and

compromise their oral health and functioning. The burden of oral problems is extensive and may be particularly severe in vulnerable populations like the rural poor. The public health capacity for addressing oral health is

dilute and not integrated with other public health programs. The public health infrastructure for oral health is insufficient to address the needs of disadvantaged groups, and the integration of oral and general health programs is lacking. Resources are limited in terms of personnel, equipment, and facilities available to support oral health programs.

There is also a lack of available trained public health practitioners knowledgeable about oral health. A national public health plan for oral health does not exist. This report presents data on access, utilization and financing of oral health care; provides additional data on the extent of the barriers; and points to the need for public-private partnerships in seeking solutions.

Oral diseases, particularly caries and periodontal disease, burden people in Pakistan excessively. Oral health has had low priority in the health activities of Pakistan, which has resulted in large unmet needs of the population and over 90% of all oral diseases remain untreated. From young adults to the 50 year olds lack of perception of their dental needs appears to be the most frequent reason for not going to the dentist. This lack of perception of needs, or ‘absence of toothache’, causes delays in seeking treatment and the

majority of patients present teeth at an advanced stage of decay which is usually beyond repair. One undesirable consequence of these delays is the observation that more than 90 % of all treatment given in the public dental clinics is tooth extractions. Moreover, preventive services (examination, scaling and prophylaxis) form less than 3 % of services at the public dental clinics and are testimony to the abysmal lack of oral health education,

preventive practices and the lack of dental health promotional programs in the country.

There is a paucity of data on oral health issues in Pakistan. The available data on dental caries prevalence show that Pakistan can be classified as a low caries country, on the positive side 50% of the children between the ages of 12-15 years are caries free and on the negative side 97% of all carious lesions are untreated (Maher 1991; Khan et al., 1990;

Khan 1992). There has been no pathfinder survey for the children since 1988 and no new published data on dental disease since 1992. Only one article on caries levels in the urban centers of Pakistan has been published in 2001 (Haleem & Khan 2001), which shows that this level has been static for more than a decade.

Khan et.al reported that 14-37% of 12 years old children had gingivitis and 11-37% of 15 years old had gingivitis whereas in both age groups 25-29% were with health gums.

There has, however, been no published data on the periodontal health of the nation since the last pathfinder survey of 1988.

Straightening teeth (orthodontic treatment)

Orthodontics is the branch of dentistry that specialises in straightening teeth. An orthodontist is a dentist who specialises in the prevention or correction of irregularities of the teeth. Orthodontic treatment usually involves wearing a brace (appliance). This puts gentle pressure on specific teeth to move them into the ideal place.

Orthodontic treatment is quite slow, and usually takes one to two years, depending on the severity of the problem. There are different kinds of braces. Some can be removed while others are fixed in place.

Removable braces are made of plastic and usually have wire clips and springs to move specific teeth. Removable braces may also be made from a clear, see-through plastic, which is nearly invisible. They are mostly used to move upper teeth. A removable brace must be taken out to be cleaned, but it should be worn at all other times, including meal times and at night.

Fixed braces (sometimes known as 'train tracks') can't be removed except by your orthodontist. They are made of small brackets that are stuck with filling material to the teeth and joined together with a wire. Fixed braces can be used on upper and lower teeth. Once the treatment is finished, the brackets and filling material are cleaned off the teeth.

Orthodontic treatment is not suitable for everyone, so ask your dentist to explain the options available for you.