Even amongst good friends I sometimes get mistaken for a dentist. Don’t get me wrong, I would be very proud to be a dentist. If only I could stomach the sight of blood, saliva etc then maybe I would have trained to be one.
But being a layman and being asked dental questions can be tricky. I have to admit on occasions I’ve been a bit naughty and given outrageous advice, before quickly retracting it once the joke was complete (calm down – no GDC referral necessary).
But I did want to understand both personally and professionally just why toothache is so bad. Why does it reduce tough, grown men (and women) to tears, unable to do the simplest things?
So I asked a friend (who has all the right letters after his name) to give me a simple explanation, and help me understand why we see some of the complications that are common when a toothache isn’t treated in time.
So, with apologies for the graphic photo, here is what he sent me.
The structure of a tooth has hard outer layers, which act to protect and insulate the pulp in the centre of the tooth. This pulp space contains a nerve, so that as the outer hard layers of enamel and dentine are lost, this nerve becomes more vulnerable. With a diet high in sugar, bacteria produce acid that attacks and dissolves the outer hard layers of the tooth, creating a cavity.
As this gets worse, it causes inflammation of the pulp (pulpitis), which gives symptoms of sensitivity progressing to pain. The problem is now, the outer hard layer of the tooth acts as a rigid case, preventing swelling of the pulp – which is part inflammatory process. This leads to the exquisite pain of severe toothache, where an inflamed nerve can be felt throbbing against the hard case of the tooth and it is hard to find any relief from this pain even with pain medication.
Eventually the inflammation acts to strangulate the nerve, and the pulp dies and loses its nerve supply and blood supply. The painful symptoms of toothache cease.
So that’s what a toothache is. What I didn’t fully understand, was what happens once the pain stops. Because although the pain might be gone, things are going to go downhill, especially if you are on a poor diet:
But bacteria present inside the tooth invade deeper and cause an infection around the root of the tooth. This infection creates an abscess at the end of the root. This abscess causes the tooth to be pushed out of the socket of bone, so it feels high on the bite and is painful every time the patient bites together or closes their mouth.
Often the abscess drains pus into the mouth causing a bad taste and bad breath. This process is no longer driven by sugar but depends on the state of the immune system. In a healthy patient this infection may become ‘walled off’ and create a cyst. But in malnourished or immunosuppressed patients, chronic cases develop and it may cause further destruction to the bone, and pus may drain through the skin of the face causing a pointing sinus.
And that is what this lady has. It had taken just 3 months to develop, and as you can see, it’s extremely unpleasant. Not just for her, but the likelihood is she will be ostracised from her community because of it. But this isn’t the end, we have seen many cases of what happens next. In just one of the 24 districts we work in, they see one death a month caused by untreated dental infection:
If the infection remains untreated and does not drain in this way, osteomyelitis (a deep infection of the bone) may develop. This serious infection causes whole pieces of dead bone to break through into the mouth and predisposes to pathological fractures. In patients who have weakened immune systems, the bacteria that invade the root canal system seed a virulent infection, deep into the bone, which may spread rapidly. This type of rapidly progressing infection spreads along tissue planes and can cause a dangerous swelling which occludes the throat causing asphyxiation (Ludwig’s Angina), can spread to the brain or overwhelm the whole body with a massive infection which can lead to death.
This is the reality of toothache when there’s no access to help. This is what happened in the UK a couple of hundred years ago before dentists and antibiotics, and sepsis due to tooth infection was a leading cause of death.
It’s what happens now in the rural areas we work in.
When you understand what’s going on, and how it’s actually quite simple to prevent the nasty consequences described above, it makes you want to do something.
We need to train more rural Health Professionals next year to treat these problems quickly and effectively when they occur.
Please help us to do more to prevent this kind of suffering – click here to join us and our ‘What if..?’ campaign.