Dental Pathology

Why Are Toothaches So Painful? Understanding the Agony

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Toothaches, though common, are often underestimated in their capacity to cause excruciating pain. For those who have experienced the agony, it’s clear that toothaches can be more than just a minor inconvenience. In this blog, we will delve into the intricate world of toothaches, exploring why they can be so painful. Understanding the underlying mechanisms can not only provide insight but also underscore the importance of proper oral care. 

Anatomy of a Tooth:

When it comes to comprehending toothaches, it’s vital to start with the basics: the anatomy of a tooth. Your teeth may seem like hard, inert structures, but beneath the surface lies a delicate network of tissues and nerves that make them surprisingly sensitive. 

Each tooth consists of several layers: 

  • Enamel: The hard, outermost layer that protects the tooth from external forces and substances. 
  • Dentin: A layer beneath the enamel that forms the bulk of the tooth’s structure. 
  • Pulp: The innermost layer, housing the tooth’s blood vessels and nerves. 

It’s the pulp, with its intricate nerve endings, that plays a pivotal role in sensing and transmitting pain signals. When this layer becomes irritated or compromised, it can result in the intense pain commonly associated with toothaches.  

Causes of Toothaches:

Toothaches can arise from various dental issues, all of which share the common trait of causing discomfort. Some of the most prevalent culprits include: 

  • Cavities: Tooth decay, or dental caries, if left untreated, can penetrate the enamel and dentin, reaching the sensitive pulp. 
  • Gum Disease: Periodontitis, or periodontal disease, can lead to gum recession and exposure of the tooth’s roots, causing pain. If the disease is severe enough, the pulp can be infected from the root tip. 
  • Dental Abscess: An abscess is a painful pocket of pus that forms at the tooth’s root, often due to an infection or trauma. 
  • Tooth Fractures: Cracked or fractured teeth can expose the pulp, leading to pulpal infection, and causing severe pain. 

The severity of the pain experienced can vary depending on the underlying cause and its extent. Dental issues left unattended can exacerbate the pain over time. 

Inflammation and Irritation:

In the realm of toothaches, inflammation and irritation are formidable adversaries. When the pulp becomes inflamed or irritated, it triggers a cascade of events that amplify the pain sensation. 

The body’s natural response to injury or infection involves increasing blood flow to the affected area. This influx of blood brings immune cells to combat the issue but also heightens the sensitivity of the nerves. As a result, the pain intensifies, often becoming relentless and unbearable. 

Normally, when there is inflammation and increased blood flow, tissues swell. However, because the pulp is such a small and narrow space, and the walls of the tooth are so hard and stiff, the inflammation and swelling cannot easily leave the tooth. In the case of an infected or traumatised pulp, this results in the nerves being intensely compressed and eliciting a severe pain response. 

Inflamed tissues can also press against neighbouring structures, causing discomfort in surrounding areas of the mouth, face and sinuses. The nerves inside teeth do not have a sense of location, meaning that pain can be difficult to pin-point and may also refer to these nearby structures. 

Nerve Sensitivity:

Dental nerves are among the most sensitive in the body. They are finely tuned to respond to even the slightest changes in temperature, pressure, or chemical composition. This heightened sensitivity serves a protective function, alerting us to potential threats to our teeth. 

However, it also means that when dental nerves are exposed due to issues like cavities or fractures, they can react intensely to external stimuli. For instance, sipping on a hot beverage or biting into something cold can send shockwaves of pain through the affected tooth. This heightened nerve sensitivity is a key contributor to the pain experienced during a toothache. 

Understanding this sensitivity underscores the importance of protecting and caring for our dental nerves through diligent oral hygiene practices. 

Referred Pain:

One peculiar aspect of toothaches is referred pain. This phenomenon occurs when a problem in one tooth causes pain in other teeth or even in distant parts of the face or head. This can make pinpointing the exact source of the pain challenging. 

For example, an issue in a lower molar may cause pain that seems to radiate to the ear or jaw. This occurs because the nerves in the affected tooth share pathways with nearby nerves, leading to the sensation of pain in multiple locations. Understanding referred pain is crucial for dental professionals to accurately diagnose and treat the root cause of toothaches. 

Pain Management and Relief:

Relief from the torment of a toothache is understandably a top priority for anyone enduring this discomfort. While it’s crucial to seek professional dental care for a long-term solution, there are some steps you can take at home to alleviate the pain temporarily. 

  • Over-the-Counter Pain Relievers: Non-prescription pain relievers such as ibuprofen or paracetamol can help reduce inflammation and provide some relief from toothache pain. Ensure you follow the recommended dosage and consult with a healthcare professional if you have any concerns or underlying health conditions. 
  • Topical Anaesthetics: Some over-the-counter gels or ointments contain topical anaesthetics that can temporarily numb the affected area, providing relief from pain. Be sure to follow the product’s instructions carefully. These are more likely to be of benefit for pain arising in the gums than within the teeth themselves, however. 
  • Rinsing with Warm Saltwater: Gargling with a warm saltwater solution can help reduce inflammation and ease discomfort. Dissolve half a teaspoon of salt in eight ounces of warm water and use it as a mouthwash. 
  • Sensitive toothpastes: Some toothpastes that are aimed at reducing sensitivity have ingredients in them that help to block off the tubules, or pores, within exposed dentine, and reducing sensitivity to cold stimuli. Once you stop using these products however your initial sensitivity is likely to return. 
  • Antibiotics: Teeth that are infected in the nerves, or pulps, of the teeth, usually responds well to systemic antibiotics however, when the course of antibiotics is completed the bacteria within the pulps of teeth are allowed to repopulate again and you can expect your toothache to return soon after. 

It’s important to remember that these measures are temporary solutions. Toothaches are typically indicative of an underlying dental problem that requires professional attention. Delaying a visit to the dentist can lead to more severe issues down the road, so it’s wise to seek expert care as soon as possible. 

Preventing Toothaches:

Prevention is often the best approach when it comes to toothaches. Thankfully, there are several steps you can take to minimise the risk of developing dental issues that lead to pain: 

  • Regular Dental Check-ups: Scheduling routine check-ups with your dentist is essential for early detection and treatment of dental problems. In Australia, the Australian Dental Association (ADA) recommends regular dental visits to maintain optimal oral health. We recommend every 6 months. For low risk individuals, 12 monthly is fine. For those with a history of gum disease, 3 monthly is best. 
  • Oral Hygiene: Proper oral hygiene practices, including brushing and flossing daily, can help prevent tooth decay and gum disease. Use fluoride toothpaste and replace your toothbrush every 3-4 months. 
  • Balanced Diet: A diet rich in nutrients, especially calcium and vitamin D, can help maintain strong teeth. Limit sugary and acidic foods and beverages, which can contribute to tooth decay. Also drink plenty of water. 
  • Avoid Tobacco and Excessive Alcohol: Smoking and excessive alcohol consumption can increase the risk of gum disease and other dental issues. Quitting smoking and moderating alcohol intake can benefit both your dental and overall health. 
  • Mouthguards: If you engage in contact sports or grind your teeth at night, consider wearing a mouthguard to protect your teeth from injury or damage. 

Dental Health and Overall Well-being:

The link between oral health and overall well-being is an area of growing interest in the field of dentistry. Maintaining good oral health is not just about avoiding toothaches; it’s also about promoting your overall health and quality of life. 

Several studies have shown that poor oral health can be associated with various systemic conditions, including diabetes, heart disease, respiratory infections, and Alzheimer’s disease. This underscores the importance of oral health in maintaining your general health and well-being. 

In Australia, the National Oral Health Plan 2025 highlights the significance of oral health as an integral part of overall health. It emphasises the need for a collaborative approach between healthcare professionals to ensure the well-being of individuals. 

In conclusion, toothaches are painful for several reasons, from the intricate anatomy of our teeth to the heightened sensitivity of dental nerves. While temporary relief measures can provide respite, seeking professional dental care is crucial to address the underlying issues. 

Prevention, through regular dental check-ups and good oral hygiene, remains the most effective strategy to avoid the agony of toothaches. Remember that your oral health is not isolated; it is closely intertwined with your overall well-being. 

If you’re experiencing a toothache, don’t hesitate to reach out to a trusted dental professional. They can diagnose the problem, provide appropriate treatment, and guide you in maintaining optimal oral health. 

For residents of Brisbane, Smile Design Dental in Kangaroo Point, is a reputable dental practice ready to address your dental concerns and ensure your smile remains healthy and pain-free. 

Cost of Tooth Extraction in Brisbane, Australia

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Toothaches can ruin your smile. Getting them treated is important. Tooth extractions can relieve pain and prevent future problems. The cost of tooth extraction is a common concern for many. It varies by country and depends on factors like the tooth’s condition and position. Your dentist will assess your teeth to determine the procedure’s cost.

Factors Affecting the Cost of Procedure

The cost depends upon the variety of factors which we will discuss here.

Complexity of Procedure

The cost depends on how complicated the procedure is. Experienced surgeons charge more, which raises the overall cost. Complex procedures are more expensive than simpler ones.

Variation Based on Individuals

It varies from individual to individual to individual. Sometimes, the tooth is stuck between the soft tissues and requires much attention. It makes the procedure more complex,  and the price gets high automatically.

Number of Removed Teeth

The cost of removing teeth depends on how many you’re taking out. Removal of multiple teeth costs higher costs than less or single teeth removal. If you’re removing multiple teeth, it’s more expensive than taking out just one. Removing a single tooth is usually cheaper.

Used Anesthesia

The cost of sedation is connected to the method used. Basic methods like IV sedation or general anaesthesia are affordable. More advanced methods are expensive. The choice depends on the patient’s needs, medical history, and how complicated the procedure is.

Geographical Locations

The geographical locations are also associated with the procedure fee. Dental care is usually cheaper in rural and suburban areas compared to cities. In cities, there’s more competition and demand, which makes teeth extractions more expensive.

Additional Procedures

While going to the dentist, you should expect additional procedures. The original procedure is sometimes associated with X-rays and follow-up appointments. A single sitting is usually cost-effective. Other procedures add to the actual cost of the process.


Insurance can be helpful, but it doesn’t always cover everything. It depends on the insurance plan you have. Depending on your coverage, the cost can be a big deal or not much of a problem.


Dental care is too expensive for many people, and some insurance companies don’t help much. You must trust the dentist’s advice, but it is tough to know if they’re looking out for you or just trying to make money.

Average Cost of Tooth Extraction

The average cost ranges from $1200 to $3000 depending on the mentioned factors. The locality where you belong and the complexity of the procedure plays a major role in the cost.

Private health insurance does help with rebating your money. You need to check the policy before you get it. Also, there’s usually a waiting period of 12 to 18 months before you can use it for dental services. You can also use payment plans to cover tooth extraction costs. 

Hence, teeth removal depends on various factors and is linked to the costs of the whole procedure. You should understand the average available payment options.

How Much Tooth Implant Costs in Brisbane, Australia

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A beautiful smile requires attention to your oral health. It enhances the personality and boosts confidence in a person. Certain factors, like natural aging, accidents, or gum diseases, can affect the smile. Fortunately, technological advancement allows the person to revive the smile they own.

A single-tooth implant is one of the most efficient treatments for tooth loss. Especially in Australia, it is the most common treatment for tooth loss. The costs vary for certain reasons. A single-tooth implant can cost approximately $5500. The value increases depending on various factors, i.e., if a sinus is involved, the cost can rise even up to $11000.

What is a dental implant?

A tooth implant is a new-age treatment for tooth loss. Traditional methods to treat tooth loss were dentures or bridges.

Several factors cause the success of tooth implants. One of which is the usage of biocompatible material. These materials adjust easily and have no side effects on the body. Titanium is a biocompatible material and is surgically inserted into the jawbone. It serves as the stable foundation for artificial teeth. It also supports the artificial crown. Unlike dentures and bridges, these implants are adjustable and comfortable in your mouth. Over time, they become a part of your bone, giving strength and adding beauty to your smile. It boosts your self-confidence. It also improves other abilities like chewing and your facial structure.

Implants function like natural teeth. It makes them a preferable choice for most Australians for tooth loss treatment.

Factors Influencing Tooth Implant Cost in Australia

Let us talk about the factors which impact the cost of an implant.

Number of Implants:

Cost can vary depending on the number of tooth implants. If you do a single tooth implant, it will cost less. There is an increase in price with the number of implants. For multiple implants, the cost will increase.


The location of the dental clinic is the biggest factor affecting the cost of tooth implants. It plays a very significant role. The dental implant cost in an urban dental clinic is higher than in a rural dental clinic.


“The more expert, the more expensive” can be a phrase applicable to famous and expert dentists. Experienced professionals may charge more for the services they provide.


The choice of anesthesia also affects the cost of the treatment. General anesthesia is costly as compared to the local anesthesia.


The usage of premium materials costs more as compared to the lower quality materials. Generally, dentists use Titanium as the implant material. Others include zirconium because of its excellent bending capability with teeth.

Type of implant:

There are many types of implants. Standard implants, mini-implants, and all-on-four implants are some types. The cost of each type of implant varies from the other.

Single Dental Implant:

The typical cost of a single tooth implant in Australia ranges from $3000-$6000. It can vary based on location and the material used. Multiple Dental Implants cover the implant of more than one tooth and are also called MDA.

All-on-four dental implants:

These include only four implants on the upper and lower sets of jaws. These serve as the support mechanism for the new fixed teeth. A typical all-on-four dental implant ranges between $23000-$27000 in Australia.

Implant-Supported Dentures:

Replacing several teeth at once. This type of implant is an overdenture that can be very helpful if a person has lost most of his teeth. This treatment costs from $15000 to $30000 in Australia.

Managing Dental Implant Cost

There are lots of tips for managing the cost of tooth implants. Some are listed here.


Always opt for insurance while visiting your dentists. Insurance policies are very rigid. Try to explain the importance of implants in your case. Most plans do not cover the treatment, but some partially cover it.

Choice of dentist:

Consult multiple dentists. Compare the treatments and plans offered by them. Try choosing the most experienced dentist who is also cheap.

Tax Deductions:

Depending on your situation, you may be eligible for tax deductions. Consult with a tax professional for guidance.

Payment Plans:

Enquire about payment plans or financing options dental clinics offer. It will make the cost more manageable over time.


Some dentists also offer saving plans like 10% off and 20% off. All you need to do is to find one such dentist.

FSA and HSA:

Both of these pay funds for the medical and dental expenses of the people. Consult with your Flexible Spending Accounts (FSA) administrators and Health Saving Accounts (HSA). They will check for a plan that can cover the expenses.

Are Bad Teeth Genetic?

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It is quite common for tooth decay and crooked teeth to occur more in families. Many people will despairingly state that they have, “chalky teeth” or “soft teeth”, like their parents. But does that really have to be the case and how much is genetic and environmental?

There are some genetic factors that lead to weaker teeth. Amelogenesis Imperfecta, Dentinogenesis Imperfecta, Enamel Hypoplasia, Dentine Hypoplasia, are conditions where the teeth do not develop correctly and can be softer, more prone to decay, and fall out much sooner. These conditions are quite rare however, and typically occur with other genetic conditions and will be more clearly diagnosed in people that possess them. There are other conditions where teeth may be absent, smaller, or fused to other teeth. In otherwise healthy people these conditions do not usually affect the whole dentition and can be managed with your dentist.

Some people are also more susceptible to gum diease: gingivitis and periodontitis, which can also lead to early tooth loss. Most cases are of a chronic nature and tooth loss/recession does not usually present until people start to age. More aggressive cases can occur younger and can be much more destructive. Fortunately aggressive cases are rare and both can be well managed with professional dental care before too much damage occurs.

There are a number of genetic conditions that can lead to poorer tooth quality though generally, the more destructive they are the rarer they are, and the more likely there are other genetic conditions being managed. For the vast majority of the population the genetic structure of their teeth are actually quite sound. So, if genetically bad teeth are so rare then why is it so common to see bad teeth in families?

Environmental Factors

For most families that see more tooth decay environmental factors play a large role and that starts before bub’s first tooth even erupts.

Oral bacteria runs in families. Studies show that a parent with tooth decay, will carry more cariogenic (hole-causing) bacteria in their mouths and will more likely lead to early colonisation of this same bad bacteria into the infant’s mouth. This association is even more directly linked to the mother. So all those loving kisses could be spreading worse germs for young bub. Of course, we don’t recommend stopping the kissing but rather, that parents get onto their oral health before the delivery of their children and seek a dentist’s advice as soon as teeth start erupting. It may be that fluoridated toothpaste is recommended from an earlier age to help counteract this bacteria.

Parents Set The Stage

Parents have a hard time raising kids whether it be fifty years ago with less access to information and health care, or now where two parents are typically expected to work and are critically time-poor, as well as facing today’s financial pressures. However, it is in the formative years that sets the stage for the health of your teeth as an adult. The biggest predictor of tooth decay in adult teeth is the presence of decay in baby teeth. In addition, space issues and dental anxiety can develop if there’s decay in baby teeth and these are lost early.

Then you’ll likely learn off your parents’ habits. However your parents have learnt to clean their teeth and mouths they’ve passed onto you. Unfortunately, if they didn’t have the best knowledge or motivation at the time, they may not have brushed their teeth for two minutes, twice a day with fluoridated toothpaste, and once daily flossing. And then they may have been less likely to force their uncompliant child to do the same.

Dietary habits are formed here as well and any diet that has frequent exposure to sugars will lead to weakening of the tooth structure. Chalky teeth may develop from here, or only become a little bit weaker, but this could lead to damage and wear not obvious for years down the track.

If your family lives off tank water, or use more advanced filtration for your drinking water, you may also be missing out on fluoride. Some regions in Australia and places overseas also do not add fluoride to the water. Without fluoride in the water, your teeth will just be a little less acid resistant and will be a little more susceptible to tooth decay. Understanding this, teeth can still remain strong with good oral hygiene care.

Some people are also opting for fluoride-free toothpaste and refraining from giving their children any as well. Of a particular note, baby teeth are a little less acid resistant than adult teeth, so holding back fluoride content here can be even more hazardous to children’s oral health. It is best to speak to your dentist about what toothpaste you and your kids are using and together you should be able to accommodate a plan that is right for your family.

It’s hard being a parent, but it is so important to get onto your child’s oral health from the time their first tooth appears. Even before the first tooth you can wipe their gums with a moist cloth to help disturb the bacteria in the mouth and allow your child to get used to the action. At this time, have a simple consult with your local dentist to ensure you’re doing the right things for your child’s teeth and to help guide their care into the future. Aside from early holes, these teeth cleaning habits are carried into adulthood and will have long-term ramnifications.

What to do about chalky teeth

So unfortunately you didn’t have the best factors affecting your teeth as a child or they’ve softened over time and find yourself with “chalky teeth” or “bad teeth”. Now what to do about it.

Firstly, you can always strengthen your teeth.

When teeth are soft, or chalky, the enamel (the stronger outer layer or your teeth) is demineralised. It is weakened by acid and the structure can be worn off easily just with a fingernail in some cases. But this can harden up again.

First step is to reduce acid. Reduce acidic beverages and best to just drink water. Then, if your really want something with a bit of flavour, drink it at mealtimes and drink it quickly. Try not to graze on snacks all day. Increasing your water intake will improve your saliva flow which will help to return your mouth to a more neutral pH. Use an extra soft toothbrush with soft pressure, a high fluoride toothpaste and potentially a home remineralising agent, like Tooth Mousse. Discuss a plan to strengthen your teeth with your dentist and once they’re a bit harder, then start any restorative work that needs to done.

The enamel is the strongest layer of the tooth. It can be demineralised by acid and become soft or chalky, and flake away easily. This can be reversed by gentle brushing with high fluoride toothpaste and remineralising agents.
Dentine is a softer inner layer of the tooth that gets exposed when enamel is lost. This layer is more susceptible to tooth decay. Like enamel however, dentine can also harden up with good oral hygiene. If there is a lot of exposed dentine/structure loss then restorations or crowns may be indicated.

With good oral care chalky teeth can become hard strong teeth.

Prevention is certainly better than a cure. The cycle of bad teeth running through families can end simply by ensuring good oral hygiene practices. And it all starts with the parents, so make sure you’re onto your children’s teeth from the time they’re in the womb. Improving your own oral health will have a downstream effect on your child. Teach them the right habits from the time the first tooth erupts. As an adult, you can always harden your teeth by brushing and flossing, so go gently at first so as to not wear off the softer structure. In time, you should find your teeth will become firmer and decay progresses slower and is less likely to develop.

You’re not destined to have chalky teeth like your parents!

Medical Conditions and Your Dental Health

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The mouth and body are intricately linked and unsurprisingly, any medical conditions you have or medications you take can affect your dental health. A few diseases of note for oral health are: diabetes mellitus; heart disease or recent/unresolved heart surgeries; high blood pressure; osteoporosis; pregnancy; auto-immune conditions. Your medications can also affect conditions and treatment we give you, particularly: blood thinners; osteoporosis medications; chemotherapy; recreational drug use; among others.

Below are some of the typical associations of dental health and medical conditions and medications/drugs though this is by no means an exhaustive list.

Gum disease and medical conditions

Gum disease starts off as gingivitis, bleeding of the gums where the damage is usually reversible. However, if this has been long standing this can progress to periodontal disease where the bone holding onto your teeth starts to break down. Recession occurs and teeth can become mobile and even fall out.

Gum disease, or periodontal disease, can show more aggressive deterioration in conditions where the immune system is compromised. Periodontal disease is a very common auto-immune disease where the body’s reaction to the bacteria beneath the gums is over-responsive, leading to deterioration in the area. If you already have one auto-immune condition like osteo-arthritis or irritable bowel disease, you are at a higher risk of developing periodontal disease.

Diabetes mellitus also shows a link with periodontal disease. When blood sugars are not well controlled, an aggressive form of periodontal disease presents more frequently. Whilst the normal progression of periodontal disease is chronic and slow, deterioration here can occur much more rapidly. Once blood sugars are well managed however, your periodontal health should be much simpler to manage.

Bleeding and peeling gums may occur with more complicated medical conditions. From vitamin C deficiencies (scurvy) to chemotherapy to other auto-immune conditions, these can all thin the tissues and lead to tearing. Some conditions require consulting with specialists to improve or mitigate these effects. The use of specialised ultra-soft toothbrushes can help reduce trauma to the gums in such cases.

High Blood Pressure, Blood Thinners and Dental Work

It is important to have your blood pressure controlled when undergoing any medical procedure and that includes dentistry. In particular, any procedures that put the body under more stress, like extractions, could elevate your blood and put it at risk of developing a hypertensive crisis. Most dental anaesthetics also contain adrenaline in them to allow them to function better. This can at times enter nearby blood vessels and raise your heart rate for a few minutes. It is therefore very important to let your dentist know if your blood pressure is not well controlled.

Medications used to thin the blood can also mean additional bleeding with dental procedures. Complicated procedures like tooth extractions will cause a fair amount of bleeding but even simple treatments, like a clean or fillings, can disrupt the gums and cause bleeding.

There are multiple medications available now as blood thinners, but the one that will have the most impact with dentistry is warfarin. This can thin your blood so much that in the event of a tooth extraction you will not be able to form a blood clot and will potentially keep bleeding without further treatment. In such case we will require an INR test to be performed within 24 hours of your procedure, this will tell us the risk level of your bleeding and what further protocols will need to be taken. Other medications can have a similar effect to this but are generally more dose dependant, make sure to communicate to your dentist all the details of these.

Aspirin usually does not require any special protocols, as long as your blood typically clots within 10 minutes, but may require a dressing after any extractions.

Fish oil and other vitamins/extracts can also thin your blood, so relate any of these types of medications also.

Antibiotic Prophylaxis and Dental Treatment

Antibiotic prophylaxis is usually only required in conditions that may lead to bacterial endocarditis.  This is where irritation from the mouth leads to bacteria entering the vascular system and may attach to the heart, primarily the valves. This is a rare infection that has shown an association in individuals that faulty/unrepaired heart valves, recent valvular surgery, unrepaired heart defects, in those who have previously had bacterial endocarditis, and those who have had rheumatic fever in Indigenous/Torres Strait Islander heritage. If you have any conditions with your heart/valves it is always best to check with your dentist whether you will require this antibiotic prophylaxis prior to your dental treatment.

Prosthetic joints/ prosthetic hip replacements were previously managed with antibiotic prophylaxis however this is no longer required. The data now shows that there is no convincing connection of bacterial infection to these locations.

Tooth Infection and Bacteraemia

A tooth infection is where bacteria enters the tooth, first through the enamel layer, further to the softer dentine, then finally into the nutrient-rich pulp. Once bacteria reaches the pulp it multiples almost instantly and becomes a source of infection that can enter the rest of the body via the apex of the tooth roots. Usually the body is able to fight off the bacteria that exits the tooth but is unable to reach inside the tooth itself. This means the bacteria can never be entirely eliminated without either a root canal treatment of tooth extraction.

Occasionally the bacterial load will become too great for the immune response to fight off and the infection can move to the tissues and spaces near the tooth causing cellulitis. This will result in swelling and a great deal of pain in the area. If the swelling occurs further back in the mouth there is the potential for a life-threatening condition to be caused, called Ludwig’s Angina, where the airways become blocked off. Bacteria could also enter the blood vessels and lead to bacteraemia. There have been correlations of long standing teeth  and gum infections and chronic health conditions. Though more research needs to be conducted to make any direct causative links, poor oral health does seem to have a part to play in heart disease, Alzheimer’s, and potentially other auto-immune conditions.

It is incredibly rare in developed nations though it is possible for bacteraemia from a tooth infection to become so severe that septic shock can occur. There would be many warning signs, like intense pain and fever, that should have you seeking treatment long before such an extreme event takes place.

Medications and Dental Health

Pretty much any medication you take can lead to reduced saliva flow and dry mouth. If any medications you take dry your mouth out considerably, consider consulting your GP to try switching to another one. A dry mouth can be uncomfortable, leads to a higher chance of tooth decay, can impact speech and denture wearing so it’s worthwhile trying to improve these side effects. Artificial saliva gels/mouthwashes/toothpastes can help when medication cannot be switched out for another one.

Some medications, like Dilantin (an anti-convulsant), can cause gingival hyperplasia – where the gums swell and can obscure and even displace teeth. The effects of these drugs may not reverse once stopped and may require the excess tissue to become cut away. This can also lead to gum disease, the teeth becoming wobbly and may even fall out. It is best to switch your prescription to another drug if you see this starting to occur at all.

Osteoporosis and Bisphosphonates

Bisphosphonates are commonly used to treat osteoporosis. They are incredibly effective at preventing the bone from breaking down but they are a bit of a double edged sword – they also prevent the bone from rebuilding as effectively. You may have taken this in either tablet or as injection many months apart. Bisphosphonates, once taken, stays in the bone forever.

In cases of teeth extractions if you’ve had bisphosphonates in the past this puts you at increased risk of bisphosphonate-induced osteonecrosis of the jaws. What this entails is that the extraction site may never properly fill in with bone and may potentially be exposed and always be a little bit sore and tender. The risk of this is fairly low though because the condition can be permanent it is important to consider when these drugs have been taken in the past. If you are thinking of taking bisphosphonates make sure your dental health is thoroughly checked and managed beforehand. Once you have taken bisphosphonates it is important to avoid tooth extractions wherever possible, therefore maintaining good dental health is critical.

Osteonecrosis can also be caused by a newer alternative to bisphosphonates, denosumabs (Prolia). This drug is administered via tablet or injection also, months apart, stays in the bone, but levels may decrease a little more over time than bisphonates. It is important to treat denosumabs in the same ways as bisphosphonates: avoiding extractions and becoming dentally fit prior to starting.

Chemotherapy and Dental Health

Chemotherapy is a great tool for fighting cancer but unfortunately it commonly comes with some poor oral health side effects. It can lead to dry mouth, weakened gums and tissues in the mouth as well as the rest of the digestive tract. It can also lead to progression of tooth decay very rapidly.

Your specialist will have some great tips in helping to manage the side effects you face with chemotherapy but for dentistry we suggest a few things.

  1. If there’s time before you start chemotherapy, see your dentist and complete and necessary dental treatment.
  2. Use a specialised ultra soft toothbrush.
  3. Use Tooth Mousse Plus and a high fluoride toothpaste.
  4. Use saliva gels/mouthwashes, such as Biotene products
  5. See your dentist regularly between courses of chemotherapy.

Pregnancy and Dental Health

Pregnancy puts a large toll on a woman’s body. It disrupts her immune system as well as redirects many nutrients from her body to that of the foetus’s.

Pregnancy gingivitis is a common presentation with pregnancy where the gums will be more prone to bleeding and have increased inflammation. Don’t be scared of the bleeding. Bleeding occurs because of the presence of bacteria, it is just with pregnancy the body is having a larger than normal reaction to the bacteria. Once bacteria, ie: plaque, is removed and the teeth are kept clean this bleeding will settle down. You may bleed a little more with flossing too, but this should reduce after a few days. If bleeding persists see your dentist, you may require a clean to remove calculus and check the integrity of your fillings.

You can still have dental work performed when you are pregnant, but best to leave elective and non-urgent treatment to the second trimester. This is the safest time during your pregnancy where the stress of the dental procedure is the least likely to affect your baby. If you have pain or an untreated tooth infection it is usually best to have this addressed sooner to prevent possible cellulitis and bacteraemia. Dental anaesthetics are all localised within the tissues in your mouth, so rest assured that these are completely safe to use during pregnancy. Treatments such as teeth whitening and injectables are best to wait until after the baby is born and weened.

Pregnancy will not cause your teeth to deteriorate, but a lack of oral hygiene and an acidic mouth might. Brushing and flossing diligently should keep your teeth decay-free. The baby will not steal calcium from your teeth. Your teeth have been formed long before you fell pregnant and will only breakdown from external factors. Morning sickness however can lead to greater acid stress on your teeth. The acid can soften the outer surfaces of your teeth leading to greater wear, particularly if you grind, and allow for faster tooth decay. Counteract the acid by drinking water every time you are sick or suffering reflux. Consider a high fluoride toothpaste, use tooth mousse plus, and avoid nocturnal snacking.

Recreational Drugs and Dental Health

Recreational drugs can affect your dental health in a number of ways depending on the type of drug you are using. Certain drugs, like ecstasy and methamphetamines, can lead to a parafunctional grinding habit. It is common these drugs can cause you to chew your lips, wear into your teeth and can even lead to tooth cracks. These drugs also dry out your mouth reducing the protective action of your saliva, worsening the grinding effects. “Meth mouth” is a typical presentation of someone who has abused methamphetamines where considerable damage has occurred to the teeth and gums. Damage can occur quite rapidly and lead to tooth loss.

Marijuana will typically increase more “snacking” behaviour. Each time we eat the oral environment becomes acidic but this improves over time and the teeth are able to harden up again during periods where there has been no food or drinks consumed for a while. A habit of consuming marijuana may reduce times where this beneficial remineralisation takes place and extends demineralisation from acidic periods. If marijuana is smoked this can also lead to increased incidence of oral cancer as with tobacco smoking.

Recreational drugs also tend to decrease the user’s oral hygiene, where teeth may go unbrushed for long periods of time. It is recommended to brush teeth twice a day and floss at least once, if this hygiene is carried out plaque can mature into more dangerous colonies that are more likely to lead to tooth decay.


Your oral health is inexorably linked with the rest of your body where conditions from the mouth can be affected by other health condition and medications, and vice versa. When oral health and medical conditions are well managed they do not typically affect each other negatively, though medications can lead to some poor oral health side effects. It is always important to report all medical conditions and medications, both current and used in the past, to your dentist.

If you have any questions about how medical conditions and your dental health may affect one another just leave a comment below.

What causes bad breath (halitosis) and ways to fix it!

By | Dental Pathology | 6 Comments

Oral Thrush

Halitosis, or bad breath, can have a number of causes. One of the biggest and most common of these is oral thrush as a result of a fungal infection. Candida Albicans can cause a large white, yellow, or brownish patch on the tongue. This typically forms when saliva flow is low, there is increased mouth breathing, insufficient oral hygiene, smoking, or in cases of reduced immunity.

Saliva is not only important to flush away bacteria from the teeth and gums, but also fungal pathogens from the tongue. Low saliva flow is called Xerostomia. When this occurs pathogens are allowed to accumulate and settle in on the tongue resulting in oral thrush.

Xerostomia can be caused by dehydration, most medications, caffeine and alcohol consumption, smoking, advancing age, and Sjogren’s syndrome (an auto-immune condition of the salivary glands that commonly presents with other auto-immune conditions.)

To improve xerostomia drink plenty of water, switch medications (where possible), reduce caffeine and alcohol intake, and quit smoking. There are also certain aides you can purchase that can stimulate saliva flow delivered in mouthwashes, toothpastes, and gels.

Mouth breathing may be due to sinus congestion, so if there are issues here it is advisable to investigate these with your GP or an Ear Nose and Throat Surgeon. Nasal sprays can be useful for periods of heavier congestion.

In addition to improving your saliva, brushing your tongue every time you brush your teeth will help clear this fungal accumulation. Using your toothbrush is fine, however, since a soft or ultrasoft toothbrush is the preferred brush for your teeth, it is best to use a tongue scraper. You can also use fungal lozenges and gels that your dentist can prescribe for you, though these tend to have a somewhat limited effect.

Whenever you notice any abnormal patches on your tongue or elsewhere in your mouth, ensure you see your dentist to investigate. Though oral thrush is the most common cause, this could be due to other conditions which will need further treatment.

Gum Disease

When halitosis is particularly mentionable by your peers, it could be due to gum disease, either severe gingivitis or periodontitis. Both will present with red, bleeding gums, particularly when brushing and flossing. Without intervention, gum disease is likely to worsen over time and can lead to wobbly teeth and early tooth loss.

To prevent gum disease ensure you are brushing for two minutes, twice a day, brushing your gums gently but thoroughly. Floss at least once a day. Don’t be scared if you see any bleeding. Bleeding means there is bacteria and it’s the bacteria inflaming your gums. Remove the bacteria and the gums should improve.

Ensure any issues with the gums are assessed by a dentist. Once severe periodontitis sets in the damage is often irreversible. Bad breath from gum disease generally responds very quickly to treatment.


Reflux can occur with a weak oesophageal sphincter (GORD), related to your diet and quantity of food eaten, stomach ulcers, or from other issues from the stomach or gastrointestinal tract. When halitosis is caused by reflux you’ll likely experience multiple periods of an acidic taste occurring in your mouth. You may also present with a higher amount of tooth wear. Drinking plenty of water and eating smaller portions may help. Also avoid acidic and carbonated beverages. If simple changes to your diet doesn’t improve your reflux it is best to investigate with your GP.

Tonsil Stones

Small white/yellow calcifications may develop within your tonsils which are generally shed from time to time. Tonsil stones are more likely to occur with dehydration and regular alcohol and caffeine intake. Most of the time these will be shed and swallowed without you realising, though someone smelling your breath at the time may detect something a bit stale. Unless you suffer any symptoms tonsil stones aren’t usually too much of a concern. Simply drink plenty of water and few, if any, tonsil stones will develop. If you notice a fair number of these shedding, or have sore, enlarged tonsils without signs of an infection, have your tonsils examined by your dentist or GP.

Tooth Decay and Abscesses

When bad breath is a result of tooth decay or abscesses within the mouth, you’ll likely be aware of the issues. For tooth decay to be severe enough to cause halitosis you’ll be able to feel the size of the holes easily with your tongue. Abscesses will usually be quite painful. There may be pus leaking giving a foul taste and cellulitis, swelling around the cheeks and jaws. See your dentist immediately if you show any of these conditions. Cellulitis is of particular concern, as swellings arising from infected teeth could also block airways in severe cases.

Lesions Within the Mouth

Sores, cuts and ulcers could also lead to bad breath. In cases of extracted teeth, food can occasionally get caught here and will cause a smell. Keep any lesions clean with salt water rinses and ensure you do not pick at the area. Picking at sores will remove the healing factors in place and delay healing. If any sore persist after two weeks without improvement or worsening smells see you dentist immediately as this could indicate an infection or some other chronic condition.

Lesions that do not resolve in time or come and go, that are painful or bleed, should always be assessed by your dentist. Some of these could be auto-immune related or, in rare cases, carry carcinogenic properties. Early identification and management is vital in these cases.

Severe toothache. Tooth pain from pulpal infection.

By | Dental Pathology | No Comments

Toothaches are a major source of dental pain. Tooth pain can originate from a number of sources. From exposed dentine to leaky fillings, traumatic pressure, hypersensitivity from grinding or abrasive brushing, or referred pain from gums or nearby sinuses. Generally the most severe toothaches arise within the pulps, or “nerves”, of the teeth. This is commonly called pulpal pain or “nerve pain”.

How does pulpal pain, or “nerve pain”, occur in a tooth?

A toothache that can be described as an 8 to an 11 out of 10 would usually be caused by pulpal pain. It will likely be hot and cold sensitive, worsened with pressure, and give a severe ache. The primary source of this tooth pain is pulpal infection.

The first stage of tooth infection is when bacteria breaks down the outer layer of the tooth. To achieve this, bacteria needs to be well established on the tooth surface and given access to carbohydrates to metabolise. Bacteria quickly forms into a soft white layer called plaque. The longer it is left undisturbed, the greater the decay potential. If one little spot of plaque is left for more than 24 hours and given access to carbohydrates, particularly sugars, then tooth decay can occur. Once decay reaches inside the tooth it is unlikely to stop without intervention.

Enamel forms the outermost layer of the tooth. This is the strongest part of the tooth and most resistant to the decaying effects of bacteria. The longer bacteria has to work on this area the more likely decay may penetrate this layer and cause a cavity.
The yellow layer of the tooth is dentine. This structure is less dense and bacteria and decay can break this area down much quicker. To stop this process a filling is needed. If nothing is done the decay will keep extending.
The dental pulp or “nerve” of the tooth. This layer is a nutrient rich area filled with blood vessels and small nerves. When bacteria reaches here it spreads quickly. Inflammation results, crushing the nerves inside. This is how severe toothaches arise.
Bacteria quickly moves through the pulp to the base of the tooth roots and into the bloodstream. An abscess may form in this area and bacteria can spread into nearby tissues causing cellulitis.

Early tooth decay, or tooth infection, can be treated with fillings. The decay is removed by a dentist and the lost tooth structure is restored using composite resin, a white tooth coloured material, in most cases. If left untreated this decay will usually extend until it reaches the interior of the tooth – the pulp. The pulp is a nutrient rich area that feeds the tooth blood and nerves, it is what makes the tooth alive. Imagine bone marrow but for teeth. Unfortunately, it is so nutrient rich that as soon as bacteria reaches here it spreads and multiplies almost instantly. The infected tooth becomes an infected pulp and severe tooth pain, or pulpal pain, results.

Why is pulpal pain so bad?

The nutrient-rich, lush area of the pulp becomes the perfect breeding ground for bacteria. It spreads quickly, releasing nasty toxins into the bloodstream. The body detects the bacteria has invaded areas it shouldn’t be and mounts a defence to try to destroy the bacteria. When there is an immune response, inflammation occurs. However the pulp is encased by hard tooth walls and doesn’t allow for swelling. So pressure builds up within the pulp, full of tiny nerves which essentially become crushed. That’s when we experience severe toothaches.

Does pulpal pain go away on its own?

Treating a toothache can seem scary, expensive, and possibly even more painful, so you may be tempted just to let things play out. This is not a good idea.

The type of bacteria that invades the pulp is bacteria our body is usually good at destroying, however that tight area inside the tooth is very hard to reach. Larger white blood cells can’t access the pulp very well and the immune system isn’t capable of clearing out the bacteria on its own. This means the infection cannot be cleared without professional intervention.

If you’re lucky, an equilibrium could be achieved where bacteria is cleaned from the body as it leaks from the tooth and the pain may lessen. These states are usually only temporary however and a large bacterial load is likely to resurface in the future. You’ll also always have a source of bacteria entering your bloodstream potentially causing other health effects. If the bacterial load becomes more severe then you could also develop cellulitis, swelling within the nearby tissues. The swollen areas become very tender and may even extend further back to your airways, restricting airflow.

Treatments for pulpal pain



If you’re in a lot of pain, there’s a fair amount of swelling, or you’re just too scared to see the dentist right away, a course of antibiotics can help to clear the infection from the nearby tissues. This is only a very temporary solution however. Antibiotics, like the immune system, is not able to properly access the pulps of teeth and cannot remove the bacteria inside. It will reduce the amount of bacteria just around the tooth and reduce inflammation, so it will help with the pain. But soon after the antibiotics are finished the bacteria will spread again and the pain is likely to return.

The best way to permanently remove the bacteria is to remove the source, which is the tooth pulp. This can be achieved either through a root canal treatment or tooth extraction.

Root canal treatment

In most cases your dentist will recommend root canal treatment when they determine you have an infected pulp. This process involves removing all the decay and cleaning inside the tooth. The pulp is completely removed, and the area is shaped and then filled to prevent any bacteria from returning. It usually consists of three sessions which needs to be performed with high care. Any left-over bacteria could lead to long term failure. It has a success rate of 90% over a ten year period. Once completed the tooth will be essentially “dead”, but the bacteria will be removed and the tooth can be kept. Healing will be able to occur and the tooth will not be a source of bacteria to the body anymore.

Tooth extraction

If the cost of root canal treatment is too high, or the tooth is too compromised to have a successful outcome, the tooth can be extracted instead. With the tooth removed the source of the bacteria will be too and the bacteria that entered the nearby tissues can usually be cleared by the immune system quickly. The obvious down-side to this option is that a space is left where the tooth was. Sometimes this can be tolerated if it is a back tooth, though there will be less area to chew with. A front tooth can be unsightly and tooth replacement options will usually be recommended. Dentures, implants or bridges can provide options to replace missing teeth.

For more information on root canal treatments, dental extractions, or tooth replacement options, click on the link below.

How to prevent bleeding gums

By | Preventative, Dental Pathology | No Comments

At times when brushing or flossing you may notice some bleeding, it could be a little bit, or it could be a lot. The gums can get swollen, tender and red, a condition called gingivitis.

The cause all comes back to bacteria.

Bacteria releases chemicals that are detected by your body where your immune system tries to fight it off. But the more that builds up, the harder it is for your body to clear it away. Your first line of defense is your saliva, then immune complexes are released from the blood stream in an attempt to reach the bacteria on your teeth. However, once bacteria builds up a thick layer called plaque, it is protected from our body’s defenses. The immune system keeps trying to penetrate into that thicker plaque and as more chemicals are released from bacteria, so too are more chemicals released by the immune system. The result is inflammation: red and bleeding gums.

The solution? Remove the bacteria, aka: plaque.

Plaque is a thick layer of bacteria that has its own defenses from being removed so things like mouthwashes and antibiotics are not that effective at targeting deep into it. That means physical removal is the most effective method. This involves brushing two minutes twice a day and flossing at least once a day. Don’t be scared of the bleeding, go gently but thoroughly. Once you’re consistently removing that plaque the bleeding will subside shortly after.

Still bleeding even with thorough brushing and flossing?

Other factors such as calculus (a hard substance that builds up on teeth over time), or poor margins on restorations can lead to areas not properly cleaned. A visit to the dentist to perform a thorough and at times, deep clean, may be warranted. They can also check to see if any of your fillings are defective which may need to be replaced. Other health conditions can also lead to bleeding gums, such as pregnancy (pregnancy gingivitis), uncontrolled Diabetes, certain medications, or other oral pathology. Looking after your health and removal of the bacteria should still resolve your gums. If your gum disease is more severe it may have progressed to periodontitis, which occurs when gingivitis has been untreated for a long time. Periodontitis requires further intervention with a dental professional.

It is recommended to have regular check ups and cleans every 6-12 months. Most health funds will cover two a year so it’s good to be vigilant and take full advantage of this.

End message:

Don’t be afraid of bleeding gums, it just means you need to brush and floss more thoroughly (but gently). And don’t forget your dental maintenance appointments!

What is TMD (Temporomandibular Joint Disorder)?

By | Dental Pathology | One Comment

Temporomandibular disorder, or TMD, describes a range of issues arising from in and around the temporomandibular joint (TMJ). These involve: night-time grinding or clenching; tooth wear and cracks in teeth; clicking or pain when opening and closing the lower jaw; pain resulting from long periods of mouth opening; or limited capacity for mouth opening. The causes of these symptoms usually have many factors involved.

So where do we start? Firstly, your general dentist will assess your symptoms and possible causes of TMD, then will tailor your treatment accordingly.

The temporomandibular joints (TMJ) provide the pivot points for the lower jaw’s range of movement. This joint can suffer damage over time from disc displacement (clicking or locking), arthritic wear, or other pathological issues.
The masseters are the main muscles of mastication involved in chewing. If these become overworked they can become hypertrophic (enlarged), may become tender, and lead to further grinding and clenching.
Wear tends to occur on the chewing surfaces of teeth over time due to excessive grinding. The small lower incisors shows the most wear but wear will also be occurring on all the teeth. In severe cases, the wear can be quite significant and lead to shorter teeth and reducing the vertical dimension of your bite.
The necks of teeth can also suffer abfraction, which is wear that leads to concavities here and exposes dentine. The exposed dentine can be quite sensitive and since this part of the tooth is less dense, further wear or decay is likely to develop here.
A major muscle of mastication that stretches out laterally here is called the temporalis. If increased tension is experienced here, headaches are commonly experienced.
Those who suffer TMD may find that their jaws fatigue quickly after holding there mouths open for a short period of time. This is generally because of the overworked muscles of mastication that work in the opposite direction to close the jaw.
Congestion in the nasal sinuses may lead to increased mouth breathing and this can increase the likelihood of congestive sleep apnoea. It is important to search for any issues that be contributing to TMD when selecting a treatment protocol.

Causes of TMD

Congestive sleep apnoea: occurs as a result of your tongue rolling back in your mouth at night, blocking your airways. Grinding and clenching may occur as an attempt to wake yourself up at night. Specialised splints or C-PAP machines can be useful in treating this condition.

Crooked teeth have been occasionally associated with TMD, though usually when there are more significant bite problems. Teeth straightening, at times with jaw repositioning surgery, may help to reset your bite into a more harmonious position.

Anxiety, stress, and personality quirks may just lead some people to grind without any other clearly defined cause.

What are the treatment options?


If sleep apnoea and bite discrepancies don’t seem to play a large role we usually start with a splint. This is a clear plastic mouthguard you wear on your top teeth at night. These are specially fitted for your teeth so they don’t fall out easily and provide an even bite with a free range of movement. These will not stop your grinding or clenching, but it will help to reduce it and ease forces. The plastic material acts as a buffer between your teeth and protects them from wear and cracks. The splint can look bulky at first, but after a couple of weeks most people adapt fairly well. For our splints, we use a hard firm material on the outside and a gel layer on the inside fitting surface. These are generally reported as far more comfortable than the standard plain hard splint design.

See General and Cosmetic Dentistry - Splints
Splints are specially moulded to your teeth to ensure they will stay on all night snugly.
At Smile Design Dental we use a gel internal layer to ensure comfort.
Hard plastic outer layer will keep the splint’s stability and absorb the wear from nocturnal grinding. The bite will be fairly even to ensure forces are well distributed and avoiding any locking from the joints.

Muscle Relaxant Injectables

Muscle relaxant injectables provide an alternative to those who find a splint still too bulky. These can be injected into the overworked, enlarged chewing muscles. The masseters, bands of thick muscle at the back of your jaws, are usually injected first and reviewed 4-6 weeks later. The muscles will lose some strength so that they will naturally release when clenched, easing tightness. The temporalis, a band over the temple and stretching laterally across the skull, may also require injecting. The injectables typically last 4-6 months and can be seen to slim the jawline giving a nice aesthetic side effect.

Injectables into the masseter muscles will reduce strength and bulk. Allowing the jaw to open with less resistance and will reduce capacity to clench tightly for long periods. Reducing the bulk can help to slim the jawline.
A thin wide band of muscle over the temples is the temporalis. When these muscles are overworked there is an increased tendency for headaches. Muscle relaxant injectables may be added here along with the masseters.

Other treatments

Physiotherapy can also be used as an adjunct to the prior treatment methods. This will focus on improving range of motion and decreasing tension. If your TMD is a little more complicated you may require a more specialised splint, anti-inflammatory or anti-anxiety medications. If there are physiological changes to the joints then surgery may be required. Arthritis or other changes can occur when TMD has been present for a long time without adequate intervention. These can be difficult to treat and may only provide a small improvement, therefore early management of TMD is critical.

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