Various Dental Problems

Impacted Wisdom Teeth

Wisdom teeth usually erupt between the ages of 17 to 25. It is the third molar of permanent teeth. There are 4 wisdom teeth, located at the ends of the upper and lower jaws. It is common to have one or more wisdom teeth missing. For some people, their wisdom teeth can normally erupt, while for some others, their wisdom teeth may not successfully erupt and may become impacted.
Cause of impacted wisdom teeth
Wisdom teeth often do not have enough room to erupt because modern human beings have a smaller jawbone. This causes wisdom teeth to grow slanted, horizontally, or even to be completely buried inside the jawbone.
Possible consequences of impacted wisdom teeth
– Pericoronitis
Usually seen in the lower jaw
Food debris and bacteria are easily trapped in the space between the crown of the wisdom tooth and the overlying gingiva (gum), resulting in the infection of the surrounding tissues (Pericoronitis). Furthermore, the infected, swollen overlying gingiva is easily hurt by the opposing upper tooth making it difficult to recover.

Pericoronitis has the following signs and symptoms:
  • Pain and swelling of the cheek Photograph of a person with the left cheek swollen.
  • Difficulty in opening the mouth
  • Pain when swallowing
  • Swollen lymph nodes in the neck
  • Fever
  • Bad breath
Tooth decay
Since it is difficult to clean the surfaces between the impacted tooth and the adjacent tooth in front, dental plaque will accumulate there and cause tooth decay on these tooth surfaces.

Photograph of an impacted wisdom tooth growing slanted towards its adjacent tooth. The adjacent surfaces of the teeth are decayed.
Root resorption of the neighbouring tooth
The inflammation of the surrounding tissues caused by the dental plaque, together with the pressure of the wisdom tooth pushing on the adjacent tooth in front, may cause the root of the adjacent tooth to resorb.

Photograph of an impacted wisdom tooth growing slanted towards its adjacent totoh. The root of the adjacent tooth is resorbed.
If the impacted tooth is completely embedded in the jaw bone, or if the partially erupted wisdom tooth has no discomfort and doesn’t cause any problem to adjacent tissues, it may not be necessary to remove it. However, one must keep good oral hygiene to prevent any problem. On the other hand, if the impacted wisdom tooth causes frequent discomfort or causes severe problems, it may have to be extracted.
Consider removal of impacted wisdom tooth
– Severe problems associated with wisdom tooth
  • Frequent inflammation of gingivae covering the wisdom tooth causing recurrent Pericoronitis
  • Suffered from severe Pericoronitis
  • Severe decay, gum disease, pulpitis or periapical infections of wisdom tooth
  • Impacted wisdom tooth causing root resorption of adjacent teeth
  • Cyst around the wisdom tooth can damage the structure of jawbone. (If there is a cyst formation, the cyst together with the impacted wisdom tooth must be extracted.)
Prior to the following treatments
  • Extraction of mal-positioned wisdom tooth prior to orthodontic treatment
  • Radiotherapy
  • Jawbone reconstruction surgery
Procedures on surgical extraction of impacted wisdom tooth :
It has to take balance between the risks and benefits of the surgical extraction of tooth. In some cases, the impacted wisdom tooth is deeply embedded in the jaw bone and its roots are close to main nerve, surgical extraction may impose risk of damaging the nerve, leading to numbness of the mouth. Therefore, the decision on removal or not or when to remove the wisdom tooth is dependent on clinical situation.
The dentist will take radiographs to confirm the position and shape of the wisdom tooth, and explain to the patient on the situation, procedures and any risks. Usually, the procedures will be done under local anesthesia (numbness of mouth only), but in some cases, it may be done under general anesthesia or under sedation. The procedures should be painless.
There are five main steps:
  1. Raise the gum flap
  2. Remove the covering bone
  3. If needed, cut the tooth into few parts
  4. Rinse and clean the wound
  5. Close the wound with sutures, and stop the bleeding

One week after extraction, remove the sutures by the dentist who will check the healing of the wound. If the suture is of self dissolve type, then it is not necessary to remove the sutures by the dentist. However, it is still necessary to let the dentist to check the healing of the wound. In general, the wound will heal within 2 weeks.
To avoid bleeding from the wound after the surgical extraction of the wisdom tooth, you should pay attention to the followings :
– On the same day after surgery
  • Do not disturb the wound, rinse the mouth or brush the teeth
  • Take soft diet for a few days and use the teeth of the opposite side of the jaw for chewing
  • Do not perform heavy work or strenuous exercise
  • Do not smoke or drink alcoholic beverages
– On the following day after surgery
  • Resume gentle toothbrushing and chew normally
Reduce discomfort after surgical extraction of wisdom tooth
Wound pain, facial swelling and difficulty on mouth opening are common after surgery
  • On the day of surgery, apply ice pack to minimize facial swelling to the affected side of your face
  • On the second day, apply a warm towel to the swollen area to reduce discomfort
  • Maintain good oral hygiene to prevent wound infection
  • On day 3 or 4, continue to take soft diet. If there is pain from these wound ,take painkiller as prescribed by the dentist
Normally, any discomfort will slowly subside in a week after surgery. Meanwhile, consult your dentist if you have any queries.

Discoloration of Teeth

Colour of teeth
Slightly yellowish permanent teeth
Since the enamel of permanent teeth is slightly transparent, the yellowish colour of the underlying dentine is shown through it. Therefore, permanent teeth will appear slightly yellowish. As we get older, the dentine increasingly grows thicker, and it is normal that our teeth become more yellowish.
Milky white deciduous teeth
The enamel of deciduous teeth is not as transparent as our permanent teeth. That is why deciduous teeth look milky white.

Oral Trauma

Oral structure or teeth may be damaged due to an accident. The chances for the injured oral structure to be healed and the damaged teeth to be saved often depend on whether treatment is done correctly and timely.
Oral structure injury
The oral tissues or oral structures such as lips, gum, oral mucosa, alveolar bone, or even upper or lower jawbones may be injured during an impact.
Stop the bleeding by pressing on the injured area with a piece of clean gauze or towel. Then go to see a dentist immediately.
Trauma to Teeth
After a tooth is traumatized, the following situations can occur
– No apparent damage to the tooth structure
– The tooth becomes loose
– Fracture of the crown of the tooth
– Fracture of the root of the tooth
– Tooth dislocation (like lateral movement, rotation, intrusion or extrusion)
– Avulsion of the tooth (the entire tooth being knocked off)
Management after injury :
  • After injury, even though there is no apparent damage to the crown of the tooth, invisible injury to the root may still occur. Therefore, it is necessary to go to see a dentist immediately after injury. The dentist will give clinical examination and may perform the following treatment according to the situation : smoothen sharp edges of the fractured tooth and apply topical fluoride, filling, endodontic (pulp) treatment or extraction, etc.
  • Even if the tooth is vital right after the injury, it is possible that necrosis can happen within 5 years, Therefore, it is necessary to have follow-up reviews regularly as advised by the dentist.
  • If the crown of a tooth has been fractured, you should try your best to find and pick up the fractured portion of the tooth and go to a dentist immediately.
– If the whole permanent tooth has been knocked off after the injury, you should keep calm and take the following actions:
Pick up the knocked-off tooth by holding the crown, do not touch the root.
Use half a glass of plain water or milk to gently rinse off the dirt at the surface of tooth. Do not wash or scrub the root surface of the tooth to avoid damaging the soft tissues around the root.
Use the adjacent teeth as reference, put the tooth back into the socket and ask the injured person to gently bite together to hold the tooth in place. The sooner the tooth is put back, the greater the chance of it being preserved.
– If there is any difficulty in inserting the tooth into the socket, immerse the tooth in a container filled with either milk or saliva of the injured person. Make sure the tooth is completely immersed.
– Seek treatment from dentist immediately
You should seek help immediately after oral structure or tooth injury because the sooner the treatment is received, the greater the chance of preserving the teeth. Afterwards, the replanted tooth should be reviewed by the dentist regularly to ensure the success of the treatment.

Sensitive teeth

Cause of sensitive teeth
Sensitive teeth are mainly caused by exposed dentine. If enamel of tooth crown, or gum and cementum on root surface has been worn or lost, then it will lose its protective function and the dentine will be exposed. The dentine has many fine dentinal tubules connecting to the pulp. When it is stimulated by eating or drinking hot, cold, sour, or sweet food and beverages, or when it is contacted by a toothbrush or dental floss, sharp pain will be felt.
Causes of exposed dentine

– Use of a toothbrush with bristles that are too hard, or brushing with excessive force
– Frequent consumption of highly acidic food or beverages
– Habitual grinding of teeth (bruxism)

– Gum Disease or aging leading to gum recession
– The cementum covering the root is removed after receiving treatment of root planing
– According to the oral condition, dentist may apply topical fluoride varnish or perform filling on the affected tooth surface.
– The dentist may construct a “mouth guard” to prevent further wear off of teeth from habitual grinding.
– Use of desensitizing toothpaste to relieve tooth sensitivity. You should consult your dentist before purchasing or using this type of toothpaste.
  • Use a toothbrush with soft bristles
  • Brush with a gentle force
  • Avoid frequent intake of highly acidic food or beverages
    Intake of fruit juice, sports drink, soft drink, yogurt, red wine, white wine, etc., should be reduced to avoid acidic attack.
  • Avoid biting on hard food
    Bone, nut or shell should be avoided to prevent enamel from fracturing.
  • Sufficient sleep and exercise
    It helps to relieve stress and avoid bruxism (teeth grinding).