A hole in the tooth

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The topic about a hole in the tooth is one we have previously dealt with under the title of dental caries. This topic must be seen as a part of that being that carious dentition involves a lot more than just having a hole in a tooth or more. When the hole in the tooth is not taken note of and properly treated, it can form something bigger. It can form an abscess even as tooth decay continues, and this can ultimately develop into the seeding of live bacteria into the bloodstream to cause blood poisoning or less threateningly, into the heart to form vegetations and progressively reduce the overall quality of life the individual enjoys until the heart succumbs to failure and the person dies. Most of the time, though, this entire range of effects is not seen but it is important to our overall health to be aware of the consequences of a failure to act when a hole is first seen in the tooth. It is, therefore, a chronic disease of an unappreciated magnitude seen in some countries of the Western democracies. It is the most common chronic disease in children and adults.

The health of our mouth and teeth has a fundamental impact on the quality of life we live. The health of a person’s oral cavity has a bearing on the way a person eats, what they eat, the way they talk, and even the way they smile or laugh. Besides, even the kinds of fluids the person can drink are affected by the kind of dentition they have and we shall be able to appreciate the reasons for this soon. A hole in the tooth is a cavity. Neglecting to have it attended to and treated early by a qualified healthcare professional causes it to grow progressively in size and become deeper. In the beginning, dental cavities do not cause pain which is also the period in which it is easiest for dentists to offer reliable treatment. Over time, as they grow bigger and deeper, they become progressively more difficult to treat. The symptoms of a tooth cavity will, therefore, vary depending on the dimensions of the cavity. In most cases, the person who suffers the problem may not even notice that there is a hole in the tooth. This factor alone is one of the most common reasons why many people end up presenting late for treatment.

The second reason, of course, is that many people do not appreciate that their mouths deserve special care at the hands of a trained expert and simply would not care about exploring treatment options even for the ones they have identified. It is a crass reflection of ignorance and poverty both of which would undoubtedly lead to disease in the graphic ways in which they have been described in the first paragraph. In the main, what people would most often observe about their teeth is some discolouration at the initial stages. The affected tooth may show a dark or gray area of change which will be obvious on naked-eye inspection. Sometimes, the area affected may be whiter than the surrounding tooth and as time goes on, the tooth would become more sensitive to hot food or drinks; cold food or drinks; sweet foods, and sugary snacks. The tooth would also become more sensitive than what is usual and pain could then begin. At the onset of pain, it is typically mild but this is set to increase over time just as the tooth also becomes increasingly sensitive to pressure.

In the later stages of the disease, because that is what it is, the tooth can become extremely painful and a visible cavity with features of decay can be seen in the tooth when an X-ray is done. The tooth can later form an abscess around itself or near the gum and the taste of food in the mouth can change for the worse such that it may be persistently bad. All these features can cause swelling to occur in the face on the affected side and the breath can become so bad that a permanent mouth odour is present. Beyond this point, the person can develop a fever either as part of the features of an abscess or more ominously, as part of a more extensive infection. At this point, most people will tend to want hospital care which they can get on an emergency basis or by appointment with a dentist depending on how bad they feel. Proper treatment can no longer be avoided at this point and the person will need antibiotics, pain relief, and diligent examination by a qualified dentist to determine what else needs to be done.

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A usual dental check-up will involve the taking of a proper history of the condition, and a visual examination of the mouth and the teeth. At this stage, some of the things which we mentioned above will already be evident to the dental surgeon but they are likely to probe further by carrying out a physical examination during which checks are conducted for soft areas of the tooth or teeth depending on their number. The examination is also performed for light spots, dark spots, and holes. Frequently, X-rays are requested to further examine the affected teeth so that the scale of the problem can be determined. Once this is done, usually, the treatment options become clear and the patient can get the full benefit of expert care. Further examination for gum disease and even mouth cancer screening can also be carried out to complete the examination. Routine scaling and polishing can usually be done to further clean up the teeth. This is necessary for people to understand because tooth decay affects more than 95 per cent of the people of the world so that most people are actually at risk for developing the condition.

In sub-Saharan Africa which is already at the mercy of many different problems in addition to ignorance, poverty, and other disease conditions that rate may be closer to 98 per cent of the population. The frequent intake of sugary drinks, especially in the urban areas where this may be seen as a sign of affluence or civilization, fast foods, and sweets all play a role as they interact with bacteria inside the mouth to form acids that act on the enamel layer of the teeth to cause erosion. In adults, the gums could recede with advancing age such that a lower gum line exposes more of the teeth to the deleterious action of mouth acids to cause erosion. These problems are preventable by brushing the teeth two times a day with vertical strokes of the brush rather than horizontal and using toothpaste that contains fluoride. Reducing the intake between meals of surgery snacks and beverages also helps as does the habit of drinking water improved with fluoride. Even mouthwash should not be used unless it contains fluoride. Finally, avoid tobacco smoking and make it a point of duty to see a dentist at least two times a year to have your teeth checked.

A tooth cavity is often not painful but that is not an excuse to not seek treatment once you have become aware that it is there. That is because sooner rather than later, the pain will come. When early treatment is sought and obtained, the prospect of dental abscess and even the higher risk of spreading infection can be obviated. Sadly, many people even in advanced countries do not pay particular attention to their dental hygiene as many grow into adulthood with cavities developed in childhood. This is all too evident in their streets when you get to interact with random people. In our native land, it is so much worse. There is hope that with increasing understanding, these sights will become less frequent.

Questions and answers

Dear doctor, good day to you. I appreciate the good work you are doing through your column in Sunday PUNCH. This gives comfort to your readers! I am 75 years old and attending treatment for a chest infection in one of the private university teaching hospitals.  The cardiologist is giving me one of the best treatments including referring me to other consultants and laboratories for more tests!  However, I did an abdominopelvic ultrasound test. One of the conclusions is “multicystic left kidney disease.” He did not give me any medicine or referral for this. He told me not to worry. My request is what is your advice on this? I will be grateful if I can know when the answer will be published to enable me to book for Sunday PUNCH in advance because the paper is not easy to come by in my area. God bless you. xxx@xxx.com

Thank you very much for your kind words. I will join your doctor in not recommending any medication for your condition. That is because you do not need any. Multicystic kidneys develop when a cluster of sac-like things grow around the kidneys and cause the kidney to lose function slowly over time. This is an abnormality of development that begins while someone is still in the womb. So that the logic behind not giving you any treatment is that if you have lived until this age with little or no ill-effects arising from it, there is no need to disturb your system over it at this time. In severe conditions when it must be treated, an operation is the preferred method for doing so and you do not need that. So remain calm and happy and carry on with your life as if there is nothing because this finding was by accident meaning that it has had no adverse effect on your health through the years.

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Dear doctor, I suddenly fell on a slippery floor in 2016 which has caused an injury to my lower back, and probably affected my joint. I have been to the hospital for a medical check-up and I was given some drugs such as Neurovit Forte, Cataflam and Tumol-500 to take but still there’s no difference. Last December, I went for X-ray scanning and the doctor prescribed some drugs such as Pregabalin capsules (for a month), Arthrotec 75 (for 2 weeks), Dehydrocodeine Tablets BP (for 3 weeks) and Sirdalud Tizanidine (for a month). After taking the above drugs, there is no sign of change. Doctor, please I need your advice. Should I consider taking an herb or is there any type of drug that could heal the pain? Thank you, sir. xxx@xxx

Well, it is possible that the injury you sustained as a result of that fall has not yet been diagnosed. You ought to see an orthopaedic surgeon for a more extensive examination which will determine whether the tests you have already done are sufficient. I doubt that enough has been done. You will have X-rays and scans done as well, and a definitive diagnosis will then afford you the treatment for your condition. Because the relevant diagnosis has yet to be made, the drugs you have been taking have not appeared to work. As for herbs, I am no expert in that aspect of treatment and cannot give you any advice regarding that.

Dear doctor, thank you for what you are doing through your column in Sunday PUNCH. Thank you sir for your time on my matter. I saw the response you posted last week and I am grateful for it. I will contact the surgeon. Thank you once again.   xxx@xxx.com

Thank you very much for your prayers. I appreciate you, and I wish you God’s speed.

Dear doctor, can groundnuts and date palms cause weight gain? I eat them together and seem to be ballooning. Christ’s speed xxxx@xxxx

That is a likely consequence of eating them together. As innocent as dates look, they are rich in plant sugars while groundnuts are rich in oils. Taken together frequently and in large quantities would cause weight gain.

Dear doctor, thank you very much for the scope of the work you do for the populace. Over the last 15 days, I developed pain in my shoulders and the pain is disturbing because it does not allow me to sleep well. I have complained to my doctor who gave me Paracetamol and Ibuprofen tablets but there has been no improvement. Now, the pain has spread to my right ankle too and I was told not to wear high-heeled shoes for some time. I did not believe that could be responsible for such pain and so I wore them to the office two days later only to find that my feet were swollen. About three months ago during a visit to Yola, Adamawa State, I fell down in the bathroom and twisted that same ankle. But I had an X-ray done then and there was no broken bone. What do you think I should do sir? 0803xxxxxxx

Thank you very much for your comments. It appears as though your ankle might have sustained a sprain during that fall in Yola. In that case, although three months seems like a long time and some healing must have taken place to the injured tendons or ligaments, it is still considered wise for you to rest the foot properly by wearing flat shoes for a period of between four and six months because that joint carries all of your weight. So the avoidance of high-heeled shoes should be seen as part of your treatment because they abnormally distribute the forces on your feet. But it is temporary and you will be able to wear them later. At the same time, you probably need fresh X-rays that would also examine your shoulders so that a more effective pain-killer can be prescribed for you.

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Dear doctor, may God continue to bless and guide you. I am a 21-year-old lady and when I was 13 years, I checked my genotype at a general hospital and the result showed I was SS but my parents were not convinced because I hardly fell sick. We later went to a private hospital where the result indicated I was AA. I tried another private hospital and the result there showed that I was AS. Could it be the hospitals’ fault or why is it difficult to get my exact genotype? Sir, my elder sister who is 25 old and set to marry went for hers and it came out as AC. Kindly educate me on this type of genotype sir. Thank you very much. 0803xxxxxxx

Thank you very much for your question and also, thanks a lot for your prayers. I would say that those hospitals have probably not done enough to determine what your true genotype is. Therefore, your elder sister has reasons to worry. The AC genotype is also a sickle cell disorder with a carrier status just like AS. It is merely a different type of genotype as you can have a White man and a Black man. However, I would advise that you both go to the teaching hospital or a federal medical centre near you and have proper haemoglobin electrophoresis done. This will inform both of you of what your respective genotypes are.

Dear doctor, how is the weather at your end? You wrote that anything hot/cold could harm one’s dentition. What happens in the case of ice-cream always taken cold-frozen and hot tea/coffee? What happens to one’s teeth in those cases? I use sachet ginger instead of sugar for my tea daily and also buy bottled ginger drinks which I keep and take at a gulp twice a day. How healthy is this? Is ginger intake too much? I am a male and 37-year-old. God be with you, sir. 0802xxxxxxx

The damage to your teeth occurs a little at a time over a period of years. It is worse when a cold substance is taken and soon afterwards something really hot is taken as well or vice-versa. You need to guard against this kind of feeding. As for ginger, it is a natural product that is essentially a condiment. I am unable to say whether your intake is too much or too little. But as in all things, moderation is the key to maintaining good health. At any rate, today’s essay should help educate you further about what effects your drinks can have on your teeth and also advise you about what to do.

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