Oral Problems Q&A

Oral Problems

Ways and products to maintain oral care on the go

These days, it seems like everybody is going non-stop. But just because you’re busy or traveling — whether for work or play — that’s no excuse for neglecting your daily dental care routine. A variety of products make oral care easier when you are traveling or time-strapped:

  • A small container of floss. If you're hiking or camping or simply want to travel light, floss takes up much less space than your electric toothbrush.

  • Soft flosses can be used by anyone. They slide easily between the teeth to make flossing faster and easier.

  • Interdental brush cleaners made of nylon bristles and narrow enough to fit between teeth, combine brushing and flossing for surfaces between the teeth.

  • A small travel toothbrush that folds up. The brush will stay clean and it will take up less of your valuable space.

Another point: If you’re going to be traveling for an extended period of time, and especially if you will be traveling overseas or in the wilderness, be sure to schedule a check-up with your dentist before you go. The last thing you want is a dental health problem to erupt when you are far from reliable dental care. Problems can still occur, but you can reduce the risk by being as prepared as you can before you travel.

What to do in case of dental emergencies?

  • What to do with broken braces?

If you or your child wears braces, check the wires regularly. If a wire snaps or protrudes out and rubs against the inside of the cheek or gum, try pushing it back into a more comfortable spot using the eraser end of a pencil. If that doesn’t work, cover the protruding wire with a small piece of gauze or a small cotton ball (or orthodontic wax if you have it) and see your orthodontist as soon as possible. Do not cut the protruding piece of wire — you (or your child) could easily swallow it or inhale it into the lungs.

  • What to do if a filling falls out?

If a filling falls out, try plugging the hole with a small piece of dental wax or dental cement. But see your dentist as soon as possible, and bring the filling with you if you can find it.

  • What to do if a crown falls out?

If you have the crown, you can try to slip it back onto the tooth, using dental cement, toothpaste or a denture adhesive to hold it in place until you reach the dentist. Never try a do-it-yourself repair of a damaged tooth, filling, crown or other dental implant using super glue-this is a job for your dentist.

What are types of gum surgery?

There are several types of gum surgeries that your dentist might recommend if you’ve developed gum disease (also known as periodontal disease). The most common cause of gum disease is when excessive bacteria build up in your mouth and create excess plaque and your body is unable to fight the infection. Certain factors, however, including medications and chronic illnesses, can make someone more susceptible to gum disease even if he or she follows a thorough oral care routine.

If you’ve developed gum disease severe enough to require surgery, your dentist may discuss some of these types of gum surgery as ways to treat the problem:

  • Pocket reduction (also known as gingival flap surgery) - In this procedure, your surgeon folds back the gums and removes bacteria. The periodontist (gum specialist) secures the gum tissue against your teeth, rather than allowing it to grow back on its own.

  • Regeneration - In this procedure, your periodontist folds back the gums and removes disease-causing bacteria, then inserts bone grafts, membranes, or tissue-stimulating proteins (or any combination of the three) to encourage your gum tissues to regenerate and fit snugly around the teeth again.

  • Crown lengthening - In this procedure, your periodontist removes an overgrowth of gum tissue from your teeth, making your teeth appear longer. This procedure is used for cosmetic effects as well as to treat gum disease.

  • Soft tissue graft - In this procedure, your periodontist takes sample tissue from elsewhere in your mouth and attaches it to your gums to replace gum tissue that has receded or has been removed due to gum disease. This procedure is often used for cosmetic purposes as well as to treat gum disease because it covers areas where the root is becoming exposed and improves the appearance of the teeth.

What to expect from gum surgery?

If a thorough examination by your dentist determines that you need gum surgery, you will probably be referred to a periodontist, a doctor who specializes in the treatment of gum disease. There are several types of gum surgery. Gingival flap surgery is the type often used to treat gum disease. If you’re scheduled to undergo gingival flap surgery, here’s what to expect:

  • Before the surgery: Before any gum surgery, you will receive a local anaesthetic to numb the area. Also, your periodontist (or dental hygienist) will clean your teeth. You should expect your periodontist to ask about any medications and chronic health conditions that may impact the surgery.

  • During the surgery: The surgeon folds the gums back to form a flap in order to access the tissue below the gums. The infected tissue below and between the teeth is removed, and the surgeon then follows with tooth scaling and root planing to remove plaque and bacteria below the gum line. The scaling and planning will also smooth rough spots on the tooth roots that could promote recurrence of the gum disease.

  • After the surgery: The surgeon will put the gums back in place using stitches. The stitches may be dissolvable, or you may have to have them removed when you return for a surgery follow-up visit in seven to 10 days. The surgeon may also place a special surgical dressing called a periodontal pack, over the affected area. There is some risk of bleeding and swelling after gum surgery-contact your periodontist immediately if you experience problems. Most people have only mild to moderate pain after surgery that can be managed with over-the-counter pain relievers. If you develop moderate swelling, try applying an ice pack to the area. And if your periodontist recommends antibiotics, be sure to follow the instructions carefully.

How dental X-rays work?

When to get dental X-rays?

Dental X-rays need depends on your particular oral health. Dental X-rays are recommended to people prone to tooth decay annually to identify weak spots and treat them before the decay progresses.

There are several other situations that might require dental X-rays:

  • If you switch to a new dentist, the new dentist may want to take X-rays to help him or her become more familiar with your teeth and any problems that you have.

  • A new dentist might also ask your previous dentist to send any old X-rays in order to have a complete history of your dental care.

  • Children and teens may need X-rays more often than adults because their teeth and jaws aren’t yet fully developed. Also, your dentist will take X-rays before a procedure such as a root canal or tooth extraction.

What is dental X-rays procedure?

  1. When the X-rays pass through the mouth, the teeth and bones absorb more of the ray than the gums and soft tissues, so the teeth appear lighter on the final X-ray image (called a radiograph).

  2. Areas of tooth decay and infection look darker because they don’t absorb as much of the X-ray.

  3. Dentists can use the information from an X-ray to identify infections, abscesses and even small cysts and tumours. They also can identify developmental abnormalities, such as impacted wisdom teeth.

  4. The appearance of fillings and crowns on an X-ray depends on what they are made of. Some appear dark and some appear light. No matter what type of dental restoration or implant you have, your dentist can use X-rays to help identify any areas that need attention or adjustment.

Causes of toothaches

Toothaches have many causes, from gum disease to jaw clenching, but tooth root sensitivity can also cause a tooth to ache.

The tooth root includes the lower two-thirds of the tooth, and it is usually buried in the jawbone. But when gum disease develops, the bacteria that cause the disease can also dissolve the bone around the tooth root. The combination of dissolved bone and receding gums means that more of the tooth root is exposed. Without protection from healthy gums and healthy bone, the root often becomes sensitive to hot and cold and to sour foods. In some cases, the sensitivity is so severe that you may avoid very hot, cold or sour foods.

If the root exposure is not severe, try using a special toothpaste formulated for sensitive teeth that contains fluoride and other minerals. The extra fluoride and minerals will help to strengthen the exposed root and make it less sensitive.

Symptoms of a toothache

You’ve probably experienced tooth pain at some point, whether from a loose tooth, impacted wisdom tooth, or sensitivity when you bite into an ice cream cone or a hot potato. But tooth pain can be an early sign of tooth decay. If you notice consistent pain in a tooth that lasts for more than a day or two, see your dentist; you may need some dental work. Tooth decay causes pain in children, too, so the same rules apply. If your child complains of a persistent toothache, move up the schedule of that next dental visit to as soon as possible. Also see the dentist immediately if your toothaches (or your child’s) are accompanied by a fever, or if you have trouble breathing or swallowing.

Getting rid of a toothache

The best way to manage root sensitivity and to prevent gum disease with a consistent oral health care program of twice-daily tooth brushing. Try a soft bristle toothbrush to avoid irritating your gums, which can increase the risk of root exposure and sensitivity.

There are some steps that you can take to relieve toothaches and tooth pain until you make it to the dentist’s office.

  • Floss carefully to remove any food particles wedged between the teeth or along the gum line that could be causing pain. If your child is the one with the toothache, help him or her do a thorough flossing job.

  • Rinse your mouth thoroughly with warm water, then spit it out. This may also flush out food particles that could be causing tooth pain.

  • Try an over-the-counter pain medication.

How to stop grinding teeth?

Severe long-term tooth grinding (called bruxism) can wear away your tooth enamel to the extent that you may need crowns or other tooth repairs. Your tooth grinding may not be severe enough to cause wear and tear on your teeth, but brushing and interdental cleaning daily helps reduce your risk of complications from it.

1. What are signs of tooth grinding?

  • Achy jaw

  • Headaches

  • Earaches

2. Possible causes of tooth grinding?

  • Tooth grinding is often associated with anxiety, stress and a competitive personality type in adults, especially if it occurs at night. But it also can occur as a complication from another medical problem, or as a side effect of some psychiatric medications (especially antidepressants).

3. How to cure tooth grinding?

  • To manage bruxism, try to reduce the stress in your life (easier said than done) and ask your dentist about a mouth guard that you can wear at night to avoid damage to your teeth. You can buy over-the-counter mouth guards at sporting goods stores or drug stores, but these guards may not fit well and they are more likely to fall out at night. If your dentist recommends a customized mouth guard that’s fitted to your teeth. Whether you wear a mouth guard at night or not, it’s important to pay attention to good oral hygiene by brushing and flossing daily to help reduce your risk of complications from tooth grinding. If you do wear a mouth guard, be sure to brush and floss your teeth at night before you put it in.

And, of course, be sure to see your dentist regularly so he or she can check your teeth for signs of wear.

What are tooth abscess symptoms and how to treat them?

A tooth abscess is a pus-filled lesion at the roots of a tooth and is caused by an infection, the first sign of which is often a throbbing toothache which won't go away.


  • If you have a toothache that goes beyond mild to moderate tooth pain and reaches a level of severe, throbbing pain, it could be a sign of a tooth abscess.

  • At first, the tooth will likely be sensitive to chewing and biting, as well as to heat and cold. You also may develop a fever, swollen lymph nodes in your jaw or neck, or swelling on your face.

  • If the abscess ruptures, you’ll know because of the nasty-tasting discharge in your mouth.


Although the pain may recede if the abscess ruptures, you still need to be treated by a dentist in order to get rid of the infection, save the tooth and avoid complications. If the abscess doesn’t rupture, the infection can spread to other parts of the body. This is not a problem to ignore.

Treatment will likely include draining the abscess if it hasn’t ruptured.

Your dentist also may recommend that you take over-the-counter pain relievers, rinse your mouth with warm salt water, and take antibiotics. More severe abscesses may require a root canal to remove infected tissue, and the worst cases require extraction of the tooth.

A tooth abscess can get its start as an untreated tooth cavity, so the best way to prevent an abscess is to prevent the cavity in the first place by following a consistent oral health routine of twice daily tooth brushing and daily flossing. Regular visits to your dentist are important too, especially if you’ve been treated for an abscess. This allows your dentist to confirm that the infection has cleared.

What to know about TMJ/TMD (Temporomandibular Disorder)

The temporomandibular joint (TMJ) is the hinge joint connecting the lower jaw to the temporal bone of the skull, controlling the side to side and up and down movement of your jaw. Problems arising with the jaw, jaw joint and surrounding muscles are known as TMD or TMJ disorders.

What are symptoms of Temporomandibular Disorder (TMD)?

Pain is the most common symptom of TMD; however, some people have no pain but still have problems using their jaws. Specific symptoms include:

  • Face pain

  • Pain in the jaw joint and nearby areas, including the ear

  • Back pain

  • Inability to open the mouth comfortably

  • Clicking, popping or grating sounds in the jaw joint

  • Locking of the jaw when attempting to open the mouth

  • Headaches

  • A bite that is uncomfortable or feels “off”

  • Swelling on the side of the face, neck or shoulder

Other symptoms may include ringing in the ears, decreased hearing, dizziness and vision problems.

Keep in mind that occasional discomfort in the jaw joint or chewing muscles is common and is not a cause for concern. Many people with TMD problems get better without treatment. Often the problem goes away on its own in several weeks to months.

What causes TMD diseases and disorders?

Not all causes of TMD are known. Some possible causes are injuries to the jaw area, various forms of arthritis, some dental procedures, stretching of the jaw (as a result of movements like inserting a breathing tube before surgery), and clenching or grinding of teeth, especially during sleep.

How are TMD diseases and disorders treated?

According to the public health sources, TMD treatments should be reversible whenever possible. That means that the treatment should not cause permanent changes to the jaw or teeth. Irreversible treatments have not been proven to work and may even make the problem worse.

- Reversible Treatments:

  • Over-the-counter pain medications

  • Prescription medications

  • Gentle jaw stretching and relaxation exercises

  • Stabilization splints (biteplate, night guard)

- Irreversible Treatments:

  • Adjustment of the bite by grinding the teeth

  • Extensive dental work

  • Mandibular repositioning splints

  • Orthodontics

  • Surgical procedures including replacement of all or parts of the jaw joint

Are treatments covered by insurance?

Many medical and dental insurance plans do not pay for the treatment of jaw joint and muscle disorders, or, they only pay for some procedures. Contact your insurance company to see which treatments are covered for you.

What is geographic tongue?

Many factors can cause infections in the mouth, but one of the oddest-looking oral conditions is not connected to an infection, nor is it a sign of oral cancer. In fact, most people with geographic tongue are otherwise healthy.

Geographic tongue occurs when the papillae (the small bumps that cover the tongue) disappear from random areas of the tongue, leaving smooth, red patches of different sizes that create a map-like appearance. These patches may change in size and shape from day to day. The condition is not always painful, but some people report tongue discomfort and burning that may be worse when they eat hot or spicy foods.

The reason for the loss of papillae remains uncertain, although studies have shown that the condition does run in families. Other possible causes include stress, allergies and hormone changes. And smoking and alcohol consumption may make any irritation worse.

If your symptoms persist for more than 10 days, see your dentist to rule out any potentially serious oral health condition. Geographic tongue usually resolves without treatment after a few months and the tongue returns to a normal appearance. If you are suffering from geographic tongue, you can reduce your discomfort by avoiding spicy foods, alcohol and tobacco.

Causes of black hairy tongue and treatment

Black hairy tongue causes

  • A black hairy tongue is a temporary and harmless condition that is often caused by an overgrowth of bacteria in your mouth.

  • Certain types of bacteria accumulate on the papillae (the small projections that cover the tongue) and create red blood cell pigments, which can make the tongue look black. And if the normal shedding of the outer layer of cells on the tongue is inhibited, the papillae are larger and the tongue can appear "hairy".

  • No one knows for sure what causes a black hairy tongue. But some research suggests that it can be caused by a change in the normal bacteria in the mouth due to antibiotic use for a medical condition, or by using products that contain bismuth, such as Pepto-Bismol.

  • Other possible causes of a black hairy tongue include smoking or using other tobacco products, drinking excessive amounts of coffee or tea, and failing to follow a regular routine of daily oral hygiene.

  • Ironically, chronic bad breath has not been associated with a black hairy tongue, but using certain mouthwashes may increase your risk. Mouthwashes containing astringents (such as menthol or witch hazel), or full-strength oxidizing agents such as peroxide, may increase your risk of developing a black hairy tongue if you use them excessively.

How to treat a black hairy tongue?

  • Brush - Gently brush your tongue with a toothbrush twice a day as part of your daily dental care routine. Once the problem is resolved, it is still a good idea to brush your tongue-you can help prevent the black tongue from coming back.

  • If the discoloration persists, see your dentist.

Diabetes and oral health

Be aware

Several types of health conditions contribute to poor healing of oral tissues. But people with diabetes should always be aware that they are at risk for poor healing from any type of dental problem.

According to the Mayo clinic, studies have shown that people with type 2 diabetes are three times more likely to develop gingivitis than people who don’t have diabetes. People with diabetes can be more susceptible to infections and they may take longer to heal. And poor oral hygiene can make your diabetes more difficult to control, too. If you develop an infection due to gum disease, it can affect your insulin needs.

Diabetes discussed

Diabetes is one of the most common endocrine disorders. People with diabetes are at greater risk for infections and often suffer from dry mouth, which can promote tooth decay and gingivitis. And because people with diabetes are also prone to poor healing of oral tissues, gingivitis can be more difficult to treat if it does occur. This is why a regular oral care routine is especially important. If you have sensitive teeth or gums, choose a toothbrush with soft bristles and a soft floss to minimize discomfort.

Tell your dentist

If you have diabetes, be sure to tell your dentist. He or she may want results from a blood test to show how well you control your condition. A hemoglobin A1C level less than seven percent is considered well-controlled diabetes, while levels of eight percent or higher indicate poor control. Most people with diabetes don't require any special dental care but it is a good idea to ask your dentist and doctor to talk to make sure there are no special recommendations for you and schedule regular check-ups for thorough dental cleanings.

Also, if you have orthodontic work done and have diabetes, be sure to check with your dentist immediately if any wires or brackets are damaged so they can be repaired before a sore forms.

How fluoride rinses can help diabetic patients

Cleaning teeth regularly is especially important for people with diabetes because they often suffer from dry mouth, or xerostomia.

Chronic dry mouth can lead to tooth decay because there's not enough saliva to wash away food particles and bacteria, and to buffer the acid that causes decay. If you have diabetes and you often suffer from dry mouth, your dentist or dental hygienist might recommend a fluoride rinse. Most fluoride rinses have artificial sweeteners that won't impact blood sugar, but be aware that there may be fluoride rinses that contain sugars that could affect glucose control in people with diabetes. Overall, fluoride rinses are safe, but be sure to follow the instructions and avoid swallowing the rinses.

Alternatively, professional fluoride treatments may be recommended for patients with diabetes to help protect against tooth decay. The best way for those with diabetes to prevent decay and gum disease is to follow a consistent oral health routine of twice-daily tooth brushing with a toothpaste with fluoride and daily interdental cleaning.

If you have diabetes and you are prone to a dry mouth, you may want to brush and floss your teeth more frequently to help get rid of food particles and bacteria. And consider using a medium to soft bristled toothbrush to avoid gum irritation.

Oral care side effects associated with cancer

Approximately one-third of people who undergo treatment for cancer will develop some type of oral complications, according to the public health statistics. These complications can range from mild gingivitis to severe oral infections, and they can interfere with cancer treatment and with the patient’s overall quality of life.

  • Ideally, schedule any invasive dental procedures, such as a root canal, before you star chemotherapy because an untreated dental infection could become more severe as a side effect of the cancer drugs.

  • Once you begin chemotherapy, check your mouth each day for sores or other problems. Everyone responds differently to chemotherapy, and you may have some oral side effects for only a short time or for the duration of your cancer treatment.

  • Be sure to keep your oncologist informed about any changes in your oral health, and make sure that your dentist and oncologist talk to each other to coordinate your care if dental problems arise during chemotherapy.

Oral side effects associated with chemotherapy also include:

  • Dry mouth

  • Painful mouth and gums

  • Oral infection

  • Changes in taste

  • Burning or swelling of the tongue

You can relieve these side effects by following a consistent oral care routine of twice-daily tooth brushing and interdental cleaning. In addition, an at-home fluoride treatment can help prevent cavities and is often recommended for radiation therapy patients.

Affordable dental care options

What you should know

For people with severe financial limitations, taking care of a dental problem or going to a dentist for preventive care may be low on their list of priorities.

But the truth is, taking consistently good care of your teeth is more cost-effective than waiting until a serious dental problem occurs. Plus, oral hygiene is important for overall health. So if you or someone you know has been avoiding going to the dentist because they don't have insurance or don't think they can afford it, consider these options:

Options to consider

  • Dental schools. Many dental schools sponsor patient clinics and offer quality dental care at reduced cost. Check with a local university if it includes a dental school clinic, or ask at a local community health centre.

  • Shop around. You can evaluate the overall cost of dental care by figuring out the cost of getting to the dentist and the convenience of the office hours.

  • Do comparison. If you want to compare fees for services, call different offices and ask for the cost of a standard service, such as a preventive visit that includes a professional cleaning, or the cost of full-mouth x-rays. If you choose a dentist who participates in your workplace's insurance plan, you may be covered for free check-ups and cleanings twice a year.