Dental Health Maintenance General & Restorative Managing Dental Problems & Emergencies

Causes and Relief & Remedy of Severe Toothache Problems

Dental decay is usually painless as it goes thru the enamel, the outer layer of the tooth.
The tooth can become “sensitive” as decay moves into the “live” dentin (inner layer) of the tooth…. sensitivity to sweet and sour as well as hot and cold is common but the tooth should not be continuously “sore” or “throb”. As the decay process gets near the nerve of the tooth, the intensity and frequency of the symptoms usually increase.

Once the decay process has reached the nerve of the tooth, extreme pain can occur at any time…the intensity can range from moderate to a very severe…extreme throbbing pain can be continuous and can resist oral pain medication. This kind of pain could subside during the daylight hours but is typically much worse during the evening and night. Once a toothache wakes you from sleep it is often relentless.


Dental Abscess


By definition, a dental abscess is a localized collection of “pus” or infected material in the area surrounding the root end of the offending tooth…pressure built up in this area can cause severe pain that can be referred to other teeth as well as other areas of the mouth and face. It’s not unusual for the patient not to know for sure where the pain is coming from or which tooth is the problem. This abscess can enlarge and extend to surrounding teeth…if the infection goes through the bone, rapid swelling of the gum and cheek can occur.



Several dental conditions have typical symptoms with different types of pain


A detailed history and examination will identify the cause of dentally-related pain in most emergency situations. Sharp, shooting pain can be caused by inflammation in the pulp or exposure of the dentine. Dull throbbing pain has several causes including ulcerative gingivitis, dental caries and food impaction. Simple treatment will usually alleviate the symptoms until patients can be seen by a dentist.



What are the common types of dental pain?

Short, sharp, shooting pain

This type of pain can be generalised or confined to one region of the mouth. The pain may be due to fluid movement through open tubules in the dentine or there may be some initial inflammatory changes in the dental pulp. It can be caused by caries, dentine exposure on root surfaces, split cusp, lost or fractured restoration or a fractured tooth.

Patients complain commonly of a sharp pain associated with hot, cold or sweet stimuli. The pain is only present when a stimulus is applied. In the case of a cracked cusp, grainy bread or hard food may create a sharp pain, that may be spasmodic, on biting or chewing.

With gingival recession, recent scaling, or tooth wear due to a high acid diet or gastric reflux, there may be generalised dentine sensitivity. However, with caries, fractured fillings and cracked cusps, the pain tends to be localised to the affected tooth.

Intermittent sharp, shooting pains are also symptomatic of trigeminal neuralgia, so care must be taken not to mistakenly label toothache as neuralgia.


Painful tooth problems



The most common dental cause of dull, throbbing persistent pain is caries. In many cases, this is recurrent and associated with an existing restoration. Where the pulp is affected irreversibly, necrosis may follow with possible development of a periapical infection. A fractured cusp involving the pulp, or a large deep restoration may also be associated with this type of pain. Affected teeth may be tender to percussion in the later stages of periapical inflammation.

There is considerable variation in the pain reported by patients, but it commonly starts as a sharp stabbing pain that becomes progressively dull and throbbing. At first, the pain may be caused by a stimulus, but it then becomes spontaneous and remains for a considerable time after removal of the stimulus. The pain may radiate and be referred to other areas of the mouth. This type of pain tends to cause the patient to have difficulty sleeping and may be exacerbated by lying down. Heat may make the pain worse whereas cold may alleviate it. The pain may be intermittent with no regular pattern and may have occurred over months or years. If there is a periapical infection present, patients may no longer complain of pain in response to a thermal stimulus, but rather of sensitivity on biting.





Treatment of affected teeth will involve either root canal therapy or tooth removal. In some patients, periapical inflammation can lead to cellulitis of the face characterised by a rapid spread of bacteria and their breakdown products into the surrounding tissues causing extensive oedema and pain. If systemic signs of infection are present, for example, fever and malaise, as well as swelling and possibly trismus (limitation of mouth opening), this is a surgical emergency. Antibiotic treatment alone is not suitable or recommended.



Should antibiotics be prescribed?


While antibiotics are appropriate in the management of certain dental infections, they are not indicated if the pain results from inflammatory (non-infective) or neuropathic mechanisms. The degree of pain is not a reliable indicator of acute infection.

There is evidence that Australian dentists and doctors are using antibiotics empirically for dental pain, rather than making careful diagnoses of the causes of the pain. Most dental emergency situations involve patients with acute inflammation of the dental pulp or the periapical tissues. Prescribing antibiotics for these conditions will not remove the cause of the problem nor destroy the bacteria within the tooth.

Antibiotics should be limited to patients with malaise, fever, lymph node involvement, a suppressed or compromised immune system, cellulitis or spreading infection, or rapid onset of severe infection.

If pus is present, it needs to be drained, the cause eliminated, and host defences augmented with antibiotics. The microbial spectrum is mainly gram-positive including anaerobes. Appropriate antibiotics would include penicillin or a `first generation’ cephalosporin, combined with metronidazole in more severe cases.

Paracetamol or a non-steroidal anti-inflammatory drug is the recommended analgesic in the initial treatment of dental pain.


Cracked Tooth Syndrome


A very common problem with “root canal teeth” and teeth with large fillings.
Toothache due to a crack will start when you chew or put pressure on the tooth … it will get worse as the crack continues to enlarge. …the fractured piece may feel loose or actually fall off and an abscess can develop at any time. It’s easy to visualize the mechanics of the problem – picture an ice cube or piece of glass with a crack…….every time you apply pressure or tap on top of the ice or glass, the crack will get bigger until the crack goes completely through. Pain from a cracked tooth can start as an occasional” twinge” or “zinger” or it can be sudden and severe and continuous from the very start.




This very common and painful condition is usually seen with a partially erupted wisdom tooth. Because there is not enough room for the tooth to come in completely, it becomes “stuck” or “wedged”. A pocket or sack develops in the gum tissue around and behind this tooth. This pocket quickly fills with bacteria and food debris. Because the mouth is moist, warm and dark (it’s a perfect incubator) an abscess can form rapidly. This pain can be very severe and continuous and is commonly sent to (referred to) the area around the ear. Pain when opening or even severe limitation when trying to open the mouth in common. We often see patients coming from an ear doctor when their real problem was a wisdom tooth.


Wisdom Tooth


Wisdom teeth are the last molars to develop and usually start to erupt in the late teens. Because they are the very last teeth, they very commonly become impacted (stuck or wedged between jaw bone, gum and the adjacent tooth). Toothache or pain from the wisdom tooth area is one of the most common emergency problems that we see.

Over 90% of the population has “wisdom tooth” problems due to lack of room for proper eruption. Wisdom Tooth Problems encompass many issues including:

Pain Constant pressure in this sensitive area frequently causes neuralgia-like pain that can radiate to the ear, side of the face and upper teeth and spread to the other lower teeth as well. Headaches are commonly associated with impacted or partially erupted wisdom teeth.

Destruction of the Next Tooth -pressure from the wisdom teeth frequently erodes or dissolves away healthy tooth structure, resulting in pain and tooth loss

Cysts…fluid -filled sacks can form and enlarge around impacted wisdom teeth. These cysts can dissolve jawbone and teeth-they commonly become infected and cause serious pain


Gum Infection -perio abscess


Gum Abscess (Periodontal Abscess – Perio Abscess)
This infected tooth may be completely free from decay and have no filling…it may feel loose and the surrounding gum can feel swollen ….a bad taste is a common feature. A defect in the supporting bone along one or more sides of the tooth forms a “pocket” with the gum that becomes filled with food and bacterial debris….an abscess can develop “overnight”. Mild sensitivity in the area can escalate to severe pain and swelling involving several teeth.


Overloaded/overstressed Tooth


Moderate to sharp discomfort to touch or pressure most commonly seen after placement of a dental filling or crown that is too “high”…. can be easily corrected by adjusting the offending filling or crown and bite.


Food Impaction and pericoronitis


Soft tissue problems that may cause dull, throbbing, persistent pain include local inflammation (acute gingivitis associated with food impaction) or pericoronitis.


Chronic Periodontitis

Chronic periodontitis with gradual bone loss, rarely causes pain and patients may be unaware of the disorder until tooth mobility is evident. There is quite often bleeding from the gums and sometimes an unpleasant taste. This is usually a generalised condition, however, deep pocketing with extreme bone loss can occur around isolated teeth. Food impaction in these areas can cause localised gingival pain. Poor contact between adjacent teeth and the presence of an occluding cusp forcing food into this gap can also cause a build-up of food debris and result in gingival inflammation.

Acute pericoronitis involves bacterial infection around an unerupted or partially erupted tooth and usually affects the lower third molar (wisdom tooth). The condition is often aggravated by the upper molar impacting on the swollen flap of soft tissue covering the unerupted tooth. There may be trismus.



Food debris should be removed and drainage established if pus is present. Irrigation with chlorhexidine and rinsing the mouth with hot salty water is recommended. Early referral to a dentist is indicated. Cellulitis can develop, requiring urgent referral to a surgeon.


Acute Necrotising Ulcerative Gingivitis


Acute necrotising ulcerative gingivitis is a rapidly progressive infection of the gingival tissues that causes ulceration of the interdental gingival papillae. It can lead to extensive destruction. Usually young to middle-aged people with reduced resistance to infection are affected. Males are more likely to be affected than females, with stress, smoking and poor oral hygiene being predisposing factors. Halitosis, spontaneous gingival bleeding, and a `punched-out’ appearance of the interdental papillae are all important signs.

The patients quite often complain of severe gingival tenderness with pain on eating and tooth brushing. The pain is dull, deep-seated and constant. The gums can bleed spontaneously and there is also an unpleasant taste in the mouth.



As there is an acute infection with mainly anaerobic bacteria, treatment follows surgical principles and includes superficial debridement, use of chlorhexidine mouthwashes and a course of metronidazole tablets. Treating the contributing factors should prevent a recurrence.


Dry Socket


A dull throbbing pain develops two to four days after mandibular tooth extraction. It rarely occurs in the maxilla. Smoking is a major predisposing factor as it reduces the blood supply. The tissue around the socket is very tender and white necrotic bone is exposed in the socket. Halitosis is very common.



The area should be irrigated thoroughly with warm saline solution. If loose bone is present, local anaesthesia may be necessary to allow thorough cleaning of the socket. Patients should be shown how to irrigate the area and told to do this regularly. Analgesics are indicated, but pain may persist for several days. Although opinion is divided as to whether or not dry socket is an infective condition, we do not recommend the use of antibiotics in its management.




This is caused by infection of the maxillary sinus, usually following an upper respiratory tract infection. However, there can be a history of recent tooth extraction leading to an oro-antral fistula. Patients usually complain of unilateral dull pain in all posterior upper teeth. All these teeth may be tender to percussion, but they will respond to a pulp sensitivity test. There are usually no other dental signs.

The pain tends to be increased on lying down or bending over. There is often a feeling of `fullness’ on the affected side. The pain is usually unilateral, dull, throbbing and continuous. Quite often the patient feels unwell generally and feverish.



Pain originating from the sinus arises mainly from pressure. Decongestants can help sinus drainage. Antibiotics probably have only a minor role in mild cases. Referral to an otorhinolaryngologist for endoscopic sinus surgery may be indicated in chronic cases.

DISCLAIMER: The following observations are intended as general information. This is not intended to serve as a guide for self-diagnosis or as a substitute for an examination by a dentist.

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Full Mouth Reconstructions General & Restorative Managing Dental Problems & Emergencies

How do you know when a crown needs to be replaced

A dental crown is a tooth cap that your dentist places over a tooth that has been broken or has significant damage due to severely removed dental decay. A dental crown covers the entire tooth to the gumline and resembles the surrounding teeth in appearance if the crown is porcelain. Crowns also come in metal designs.
The average crown should last up to 15 years , depending on where the dentist placed the crown and how you care for the dental implant. Metal crowns, though less popular than flesh-colored porcelain, may last longer naturally. Tooth grinding and lack of dental care can make a crown have a shorter lifespan.
Eventually, your dentist will need to replace your crown. Your dentist will check your dental crown as part of your regular checkup. This guide will tell you what signs to look for in dental crown failure so you can make an appointment with your dentist for repair or replacement quickly.



Signs Your Dental Crowns Needs to be Replaced or Repaired 


Why do dental crowns need to be replaced?

There can be a variety of reasons why a dental crown might need to be replaced. Some of them are:

A) Tooth decay has formed at the edge of the crown.

While a dental crown cannot decay the tooth on which the crown is cemented certainly can. If dental plaque is allowed to accumulate on a tooth in the region where the crown and tooth meet, a cavity can start.

While there can be a lot of variables with this type of situation, the worst-case scenario for your dental crown is that in order for your dentist to be able to get at and remove the decay the crown will need to be taken off and replaced with a new one.


B) The dental crown has become worn excessively.

Dental crowns are not necessarily significantly more resistant to wear than your own natural teeth, nor is it in your best interest that they should be. The ideal dental crown would be one made out of a material that has the same wear characteristics as tooth enamel. This way neither the dental crown nor your teeth would wear the other excessively.

Dental crowns can wear out, especially in those cases where a person has a habit of clenching and grinding their teeth. A dentist will sometimes detect a small hole on the chewing surface of a dental crown in that area where it makes contact with an opposing tooth (meaning a tooth that touches on the crown when you bite). Since the seal of the crown has now been lost your dentist will probably recommend that a new crown should be made, before that point in time when dental plaque has seeped in underneath the crown and has been able to start a cavity.


C) The dental crown has broken.

Dental crowns can break, or more precisely the porcelain component of a dental crown can fracture. Some dental crowns are made in a fashion where their full thickness is porcelain (all-ceramic dental crowns). If this is the case then if the crown breaks it will most likely have broken all of the ways through, thus compromising the seal of the crown and necessitating its replacement. Even with a less catastrophic fracture, it seems likely that the esthetics or function of the crown could be compromised, thus providing a reason why the crown should be replaced.


D) The esthetics of the crown has become objectionable.

Some dental crowns are replaced because, from a cosmetic standpoint, their appearance is no longer pleasing. Two situations where the cosmetic aspects of a dental crown can change with time are:


E) The dental crown’s edge has become visible and it has a grey appearance.

As time passes the gum line of a tooth on which a dental crown has been placed will sometimes recede. This is especially likely in those cases where diligent brushing and flossing have not been practised. If enough recession takes place the edge of the dental crown, which was originally tucked out of sight just under the gum line, will become visible. Many times this edge of the crown will have a grey appearance.


Inherent to porcelain-fused-to-metal dental crowns (related to their construction) is the fact that the very edge of these crowns will typically show some darkness (a hint of the grey metal that lies underneath the porcelain). If enough gum recession occurs this dark edge will become visible, thus spoiling the cosmetic appearance of the crown.

How do you know when a crown needs to be replaced

An all-porcelain dental crown does not have the same inherent edge darkness that a porcelain-fused-to-metal crown does. Gum recession can, however, reveal that portion of the tooth that lies beyond the edge of an all-porcelain crown (the tooth’s root surface). Usually, the colouration of this part of the tooth is darker (possibly even significantly) than the colour of the dental crown, thus spoiling the overall cosmetic appearance of the tooth.


F) The colour of the dental crown no longer matches its neighbouring teeth.


Also related to the cosmetic appearance of a dental crown, there can be times when, as years have elapsed, the colour of the crown no longer closely matches the shade of its neighbouring teeth. In these cases, it is not the colour of the porcelain crown that has changed but instead, the neighbouring teeth have stained and darkened.


There can be two solutions to this situation. The dental crown can be replaced with a new one that more closely matches the current colour of its neighbouring teeth. Another solution could be to use a teeth whitening process so to attempt to return the neighbouring teeth to the colour they were when the dental crown was originally placed.


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Pros and Cons of the Different Types of Dental Crowns

Tooth crowns, in general, add a good deal of strength to weakened or worn teeth. It can improve both the appearance and function of injured or damaged teeth. They cover and protect the entire surface area of the tooth, eliminating pain and restoring strength.

Depending on your habits and the condition of your gums, there can be some drawbacks. Your cosmetic dentist will advise which is best for you given many factors, including how important appearance is to you.


The following are the advantages and disadvantages of the most common crown types.


Gold Crowns


Advantage: The preparation of a tooth for a gold crown is the simplest and least complicated preparation as there is minimal tooth structure removal with as much as possible of the healthy tooth structure remaining untouched. While porcelain is hard by comparison, it may cause wear on opposing teeth over the years where gold is not as likely to do so.

Gold is also easier to fit the area where the tooth and crown meet for a better fit. Gold is also a healthier environment for the gum tissue.

Disadvantage: The biggest disadvantage to gold crowns is the cosmetic aspect unless it is being used in the back of your mouth


All Porcelain Crowns



Advantage: Porcelain crowns or new reinforced resin are considered to be the most aesthetically pleasing, as it is so easily matched in color to the surrounding teeth.

Disadvantage: The thickness of the porcelain required for pleasing aesthetics also requires that more tooth structure needs to be removed. It is more difficult for your cosmetic dentist to get an ideal fit where your gum meets the crown. Gingival inflammation appears to be more common with porcelain crowns than gold crowns. All-porcelain crowns require a higher skill level from your dentist and lab.

Today, there are dental crowns available that do not require a metal substructure and are made of only porcelain. Depending on the specific type, they get their strength either from the bond to the remaining tooth structure or from a dense tooth colored substructure. Since there is no metal, these types of dental crowns allow more light to pass through, which enables them to have more depth and vitality, much like natural teeth.

So why isn’t this type of crown used all the time? The main reason is that they are not as strong as crowns with a metal substructure. So, if a person grinds their teeth, these crowns have a greater risk of fracture. Another reason why an all-ceramic dental crown cannot be used in all situations is if the underlying tooth structure itself is dark. Very dark teeth are difficult to mask with these types of crowns because of their translucency.

In these instances, the dark color may show through the crown. So, for situations where a lot of force will be placed on the teeth (such as grinding habits) or if a tooth is really dark, a well-made porcelain crown with a metal substructure may be a better restoration.


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Porcelain Dental Crowns With a Metal Substructure


Traditionally, crowns are made of two materials:

  • porcelain, which gives it the tooth-colored appearance
  • metal substructure, which gives the crown its strength

Generally, it is this type of crown that can appear opaque. The reason for this is that while porcelain is very translucent and lets light travel easily through it, no light can pass through the underlying metal. In order to prevent the metal color from showing through the porcelain, which would make the crown seem dark or gray, the metal has to be “masked out” with an opaquing material. It is this masking or opaquing that can affect the final appearance, giving rise to the opaque or lifeless look.


Porcelain Fused-to-Metal Crowns



Advantage: Porcelain fused-to-metal crowns have a very natural appearance.

Disadvantage: They have a metal substructure and require an opaque below the porcelain. This can make the translucency of natural teeth difficult to replicate. Occasionally a darker line will be visible at the edge of the crown, near to your gum when it recedes with age.

The most common complaint associated with crowns is that they look “opaque,” “lifeless,” and “fake” compared to natural teeth. Do you need an extreme makeover to solve the problem? No!

The appearance of a crown is affected by many factors, but ultimately, the final result is determined by how the crown reacts with light. Natural teeth have a high degree of translucency, which means a certain amount of light passes through the tooth. The result of this is that the tooth appears to have depth and vitality.


How long can dental crowns last?


It would be reasonable to expect that a dental crown could last between five and fifteen years. Most likely a crown which did only last five years would be somewhat of a disappointment to your dentist

It’s probably their hope that any crown they make for you will last ten years or longer. Depending on the environment and forces the crown is exposed to (chewing, biting, accidental trauma, tooth grinding) and how well you keep the tooth to which it is cemented free of dental plaque, a crown can last somewhat indefinitely. Especially one positioned where its cosmetic appearance is not much of a concern.

For Dental Crown Treatment, Call Vogue Smiles Melbourne 9629-7664, for all your General & Cosmetic Dentistry treatment in Melbourne


Dental Health Maintenance General & Restorative Managing Dental Problems & Emergencies

Cavities or Tooth Decay Treatment

Cavities occur as a result of tooth decay. Tooth decay is the destruction of tooth structure. Tooth decay can affect both the enamel (the outer coating of the tooth) and the dentin layer of the tooth.

Tooth decay occurs when foods containing carbohydrates (sugars and starches) such as bread, cereals, milk, soda, fruits, cakes, or candy are left on the teeth. Bacteria that live in the mouth digest these foods, turning them into acids. The bacteria, acid, food debris and saliva combine to form plaque, which clings to the teeth.


The acids in plaque dissolve the enamel surface of the teeth, creating holes in the teeth called cavities, or caries



Who Gets Cavities?


Many people think cavities only affect children, but changes that occur with ageing make cavities an adult problem too.

Recession of the gums (a pulling away of gum tissue from the teeth), often associated with an increased incidence of gingivitis (gum disease), can expose tooth roots to plaque. Also, sugary food cravings in pregnant women can make them more vulnerable to developing cavities.

Decay around the edges of fillings is also common in older adults. Because many older adults lacked the benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and can fracture, allowing bacteria to accumulate in the tiny crevices causing tooth decay.



How Do I Know if I Have a Cavity?


Your dentist can discover cavities during your regular dental check-up. The tooth surface feels soft when probed by your dentist with a dental instrument.

X-rays can also show cavities before they become visible to the eye.

In advanced stages of tooth decay, you might experience a toothache, especially after consuming sweet, hot, or cold foods or drinks.

Other signs of tooth decay are visible pits or holes in the teeth.


How are cavities or tooth decay being treated?



Cavities are treated in a number of different ways depending on the extent of tooth decay. If decay is not extensive, the decayed portion of the tooth is removed by drilling and replaced with a filling made of silver alloy, gold, porcelain, or a composite resin. Restorative materials used in fillings are considered safe. Concerns have been raised over the safety of mercury-based, silver amalgams in particular, but the ADA, FDA, and other public health agencies continue to support the safety of this restorative material. Allergies to silver amalgam are rare as are allergies to other restorative materials.

If the decay is extensive and there is limited tooth structure remaining, crowns will be used. If a crown is needed, the decayed or weakened area of the tooth is removed and repaired and a crown is fitted over the remainder of the tooth. Crowns are made from gold, porcelain, or porcelain fused to metal.


Cavities or Tooth Decay Treatment

Preventing Tooth Decay  


Not only does saliva help digest food and make it possible for you to chew and swallow, it is the natural mouth cleanser. Without saliva, tooth decay and gum disease are more likely to occur. If you have a dry mouth, to combat tooth decay and gum disease, you need to be extra careful about following good oral hygiene habits, which consist of:

  1. Brushing your teeth at least twice a day, but even more preferably, after every meal and before bedtime
  2. Flossing your teeth every day
  3. Using a toothpaste that contains fluoride
  4. Visiting your dentist for a check-up and cleaning at least twice a year. At your visit, your dentist may recommend daily use of a fluoride rinse or fluoride gel to keep your teeth healthy

An ounce of Preventative dentistry is worth a pound of a cure. See your dentist regularly


Don’t Skimp on Oral Health


Right now is a difficult economic time. Many people are trying to cut corners where they think they can. Cutting costs is good for some things, but for your health it is not. Some individuals are deciding to cut their dental health care from their costs. This is a poor decision because much of the preventative care has many benefits.

Although the individual may save money by not having regular visits, two serious issues emerge. First, many health benefits are a part of having good oral health. Cutting the dentist can affect your overall physical health in many areas. The second reason this is bad is it could cost you more. If you delay a dentist visit, you may miss the early signs of a serious problem. It is possible that you may save some money now on routine checkups, but you could be setting yourself up for a situation where you have to pay for costly procedures to fix or repair a serious issue that went untreated.

For Dental Pain and Toothache problems, Call Vogue Smiles Melbourne 9629-7664, for all your General & Cosmetic Dentistry treatment in Melbourne