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Why do they hurt when I bite with it or put pressure on them?

There are times in our life that all out of the blue, a tooth starts to bother you whenever you place some pressure on it – either putting your upper and lower teeth together or chewing certain foods with it.

Some end up with a painful tooth having a chip or a crack, some people have swelling and pain in the supporting gums, but some people see their symptoms subside after a few days or weeks with no apparent consequences.
So, what are the reasons for the pain when pressure is placed on it?

The first potential reason is the tooth is cracked or has small fracture(s) in the enamel (enamel is a very hard layer covering the surface of a tooth). Tooth enamel is like the porcelain in your china, it cracks, chips or develops fractures when there are strong or repeated impacts on it from grinding, clenching, biting on hard foods or receiving a direct impact. The fractures or cracks weaken the tooth structure. This means that whenever there is some pressure exerted on the tooth, the fracture or crack microscopically widens – separating the tooth across the crack. The separation triggers the pain fibres in the pulp inside the tooth to fire up, resulting in pain. If left untreated, fractures or cracks will become more extensive with hypersensitivity to cold and hot.

If you have a cracked or chipped tooth, seek dental care as soon as possible because it will lead to more serious infection and tooth loss. The most appropriate treatment for extensively cracked tooth is a crown. The crowns are recommended because a crown covers the entire tooth like a helmet and because of the coverage, it can hold the structures of the tooth tight together, despite pressure exertion. The crown can be made of different materials like gold alloy, zirconia, or lithium disilicate. For the less serious cracks, composite resin fillings could be sufficient for most cases. In those cases when the cracks were not treated early on and have propagated deep into the pulpal spaces, root canal treatment is then needed before or after the crown is placed on the tooth. However, if the crack has gone deeper and wider, extraction of the tooth would be needed.

The second reason could be due to excessive wear of the enamel, resulting in the exposure of the underlying structure of a tooth called dentine. Dentine is a weaker structure than enamel and it has thousands of microscopic tubules that lead into the pulpal structure of a tooth. Because of the microscopic communication between the nerve fibres in the pulp and the environment, the tooth can be very sensitive to touch, pressure, temperature changes, PH (acidity) of the liquid and foods that are in contact with the exposed dentine.

What causes the excessive wear? It could be from teeth grinding, chipping, erosion, chronic exposure to acidic foods and liquid, having highly abrasive foods or materials in the mouths, gastroesophageal reflux disease (GERD), toothbrush abrasion and cavities.

The treatments could be a review of the diet and elimination of possible constant exposure of abrasive materials (job related hazard like cement factory workers), or provision of a mouth guard to reduce teeth grinding. Alternatively filling the cavities and chipped teeth, medical consultations for GERD and possibly a crown coverage for the sensitive teeth.

The third reason could be premature contact or interference with the normal jaw movements during chewing. In a premature contact situation, a tooth is longer and it suffers constant contact and excessive force on it over time. Because of the heavy pounding on that particular tooth, the supporting bone started to break down and the supporting structure became inflamed. That leads to further breakdown of the supporting gums and bone with infection ensues. Because of the inflammation, the tooth becomes mobile tooth and tender during chewing and biting.

The treatment of choice for the over-erupted (premature contact) tooth is to reduce the spots on the tooth (occlusal adjustment and equilibration) that are high so that the tooth would not be hit and moved during chewing and clenching. Then the inflammation and infection should be addressed by scaling and root planning, antibiotics, local growth factor application and gum surgery. Sometimes bone regeneration (to a small extend) can be achieved once the high spots have been removed and therapies been initiated.

The fourth reason for painful teeth whenever pressure is put on it is simply gum disease. Inflammation of the supporting gum tissues can cause weakening of the bone and sensitization of the nerve tissues in the gums and bone. The tooth will simply be feeling tender when pressure is placed on it. The treatment is to get rid of the gum infection by scaling, and cleaning. The other approach is to improve the oral hygiene technique and habit. Sometimes gum disease happens to a particular area is simply due to open contact between two teeth that allows compact packing of food in between – a simple treatment is to close up the gap by a filling or a crown.

The last potential reason for sensitive teeth is abscess in the bone. Abscess tooth is normally caused by cavities that have entered into the pulpal spaces. The infection and inflammation eventually affected the jaw bone at the tip of the roots. Those abscess teeth can be very sensitive to touch. Situations like this typically requires endodontic therapy of the abscess/infected pulp or extraction of the tooth.

Call Affinity Dental Care in Burlington for an examination if you have sensitive teeth. If it is not treated early on, you may lose the it in time. We love to be your dentist to help you with your dental care. Keep smiling…

Our Dental Office Is Open

If you would like to book an appointment or have questions about your teeth, please call Dr Wong at Affinity Dental Care by giving us a call at (289)-861-5111.

     

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