The best insurance against painful teeth or losing a tooth is regular dental check up once every six months. The reason is not difficult to understand. Any problem is tackled best when it is identified in its earliest stage. The simpler the problem, easier it is to solve.

The outermost layer of the tooth is called enamel. This is the hardest tissue in the body and is made of calcium and hydroxyapatite crystals. Enamel is also a dead tissue containing no nerves or blood vessels and so cannot feel pain.  Then what is the cause of a painful tooth? When a cavity develops in a tooth, the person is usually not aware of it in the initial stages. This is because the cavity develops from enamel towards the center of the tooth. The second layer is called dentin, which contains millions of open-ended tubules connected to enamel on one side and to the deepest layer called the pulp, which contains blood vessels and nerves, on the other side. When the decay reaches beyond the middle of the second layer, the patient may feel some sort of sensitivity to cold, hot, sweet or sour foods. Or he may even feel mild pain occasionally. Even at this stage a simple filling either of silver amalgam or a suitable composite resin can save the tooth. Once the decay breaches dentin and enters the pulp the patient feels continuous and throbbing pain because the bacteria release their toxins directly into the pulp leading to the formation of an abscess and the ‘death’ of the tooth.

At this stage, a normal filling cannot be done. The tooth has to be either extracted or an attempt to save it by Root Canal Treatment should be made.

If the tooth is removed, then an artificial tooth should be provided – either a removable denture made of plastic or metal; or when feasible, a fixed bridge made of ceramic or any other suitable metal or best of all, an implant should be placed to replace a missing tooth. This is done for the following reasons:

1.      to maintain the space occupied previously by the tooth,

2.      to prevent the neighboring teeth from tilting into the empty space and becoming loose,

3.      to prevent the opposing tooth from becoming non-functional,

4.      to maintain the health and integrity of the underlying bone (only implants can help in this),

5.      to maintain proper occlusion (bite) so that the person can eat without difficulty and

6.      in the case of a front tooth to maintain esthetics (beauty) and to help in proper speech, in addition to the reasons mentioned above.

All these are time consuming and expensive and could easily be avoided if a person gets a dental check up done regularly at least once every six months instead of waiting until the pain occurs.

There could be another reason why toothache may occur: gum disease in the form of severe periodontitis, which is the advanced stage of gingivitis. In periodontitis, toxins produced by the bacteria in plaque destroy the structures attaching a tooth to the underlying bony socket. This results in spontaneous bleeding from the gums, pain and swelling in the gums due to pus accumulation and ultimately loosening of the tooth in its socket. In advanced cases (when the patient feels pain and when the tooth has become very loose) the dentist may try to stabilize the tooth by a surgical procedure – commonly called a ‘flap surgery’, followed by splinting the adjacent teeth together either by wiring them or by using a composite resin material. This may save the tooth. Some times, unfortunately, the tooth has to be removed.

Periodontitis could be avoided by getting scaling done regularly every six months. Here again, timely visits to the dentist, before you feel pain can save you from losing the tooth or from long and expensive dental procedures.

Diabetics in particular are extremely susceptible to periodontitis (because of their lowered immune status, among other reasons) and resultant loss of teeth. So they should definitely get scaling done regularly.