Dr. Manju Abraham

The tooth is made of 3 layers, each with unique characteristics and specific function, the enamel, dentin, and pulp. The enamel is the outermost layer of the tooth and gives the tooth it's hard and lustrous appearance. The enamel is thicker on the crown than the root and is the first one to be affected by tooth decay. The only symptom when the enamel is decayed is food lodgment and discoloration.

The dentin is the next layer, which is composed of minute fine tubules leading from the enamel to the living portion of the tooth, which is the pulp. Once decay progresses from the enamel, the dentin is affected, and this leads to sensitivity in the teeth. When the root portion is exposed to the oral environment, because the root is covered by a more delicate substance called cementum, more severe dental sensitivity ensues.

There is a sharp, shooting discomfort through the tooth to specific foods, such as sweet, acidic, or hot or cold foods.  The main reasons for tooth sensitivity include:

• Tooth decay, both crown and root caries
• Periodontal disease and gum recession
• Tooth erosion 
• Aggressive tooth brushing
• Mouth breathing
• Bruxism or night grinding 

However, there are some simple ways to manage sensitivity, which can be done regularly at home.

1. Toothpaste made for sensitive teeth: Potassium nitrate has been shown to block the tubules and has been included as an active ingredient in toothpastes. These are very effective, and if you are brushing twice, this can be used instead of the regular paste once.
2. Brushing: Both the type of toothbrush and the brushing technique can have an impact on sensitivity.  Change to softer brushes and learn the ideal way to brush your teeth. A lot of times, rough brushing can lead to erosion and subsequent sensitivity
3. Rinsing: Fluoride containing rinses have been proven to reduce sensitivity 
4. Food habits: Even before sensitivity sets in, being cautious to avoid acidic fruits and juices can help prolong the onset of sensitivity. If possible, consuming these food stuffs should be followed by brushing or at the least a thorough rinsing
5. Sealants: If a person is prone to caries (deep pits and fissures, for instance), then it is advisable to get sealants applied on the teeth. This can reduce the instance of wearing of the enamel which then leads to sensitivity
6. Mouth guard: If you are a night grinder, then a mouth guard can help curtail this habit and thereby reduce sensitivity.

There you go with how to reduce sensitivity. Try these simple, easy measures and go on to enjoy the sweets or hot or cold foods that you have always craved for.

Removal of teeth is gradually not the first option for a lot of dental issues. However, a large number of dental infections and other causes end in extraction. The front teeth, because of their visibility, are more likely to be replaced. The back teeth often go un-replaced, though they play a higher role in terms of food digestion and function. In many patients, reasons for impaired bite and crooked tooth are traced back to failure to replace a removed tooth. (Learn more to maintain healthy teeth)

Let us look at the some of the issues as a result of not replacing a missing tooth:

1. Reduced chewing/digestive efficiency: The back teeth play a significant role in chewing the food and contributing to the initial stage of digestion. The salivary enzymes play a significant role in digestion when the food is chewed and removal of back teeth tends to make people swallow food faster than if good amount of chewing were to happen. Studies show that loss of each posterior tooth (molars especially) reduces tooth efficiency by 10%.
2. Malocclusion: A malocclusion happens due to the empty space created, into which 3 teeth are trying to move. The tooth before and after the empty space tend to slowly tilt towards the empty space in between. Also, the opposing upper or lower tooth supra erupts into this space.  Each tooth plays a critical role in maintaining the adjacent and opposing tooth in place, which is lost when a tooth is not replaced after removal.
3. Bone loss: The tooth also is essential for maintaining healthy bone, and if not replaced, it can lead to accelerated loss of alveolar bone.  Good bone support is very essential for construction of dentures, especially in old age, when complete dentures which are almost always removable need to be done. This is true especially in the lower teeth, where denture retention is a big challenge.
4. Extra pressure on other teeth: Not replacing a tooth puts additional pressure on the remaining teeth, leading to accelerated bone loss and wearing off of the enamel.
5. Esthetics: There will be a sinking in of the face when back teeth are not replaced, leading to a puckering.

So, the next time, tooth loss is inevitable, ensure you plan how to replace it in the earliest possible time period. The more it is delayed, the more difficult it is to replace it and the more expensive it will turn out for the patient. Fixed dentures or removable dentures can be the options, depending on age, food habits, finances, etc. Implants also could be another option, which is the new-age solution for replacing teeth.  A detailed discussion with your dentist, ahead of removal will help you plan better. (know more for Nutrition and Dental Health)