Dental Pain Explained

Often people experience dental pain due to different reasons, however the most common reason for any tooth ache or dental pain is caused by inflamed gums or irritated nerves in your teeth. Inflamed tissues in the mouth can also contribute to toothache and sore gums. Dental pain can be caused by many different reasons such as, cavities, broken teeth, infected tooth pulp, and bacteria infections.

Because diseases like cavities, gingivitis and periodontitis involve a bacterial infection, that bacteria can be spread to others during kissing, from sharing straws, or when sharing a toothbrush.

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Dental pain is a symptom that something is wrong and should be checked by a dentist. The only way to stop the pain permanently is to have the problem corrected. A sever abscess is not only very painful but can also lead to death if left untreated.

One of the most common reasons for a toothache is caused by cavities. When bacteria builds up in the mouth plaque forms around the teeth. The bacteria in the plaque convert the sugars in food to acids that eat away at the protective enamel layer of the tooth If the cavity is left untreated, it will continue to grow and eventually reach the nerve of the tooth causing, in most cases, severe pain.

Infections of the gum, or periodontal disease, are also another common cause of dental pain. The same plaque that contributes to cavities can irritate the gums, making them inflame then recede to expose the cementum. Periodontal disease can lead to chronic inflammation of the tissues in the mouth.

Gingivitis and periodontitis are two basic types of periodontal disease. Gingivitis is the most common gum disease and is characterized by an inflammation of the gums, or gingiva. When plaque forms on teeth, the adjacent gums become swollen and red and can become extremely painful. Their are several types of Gingivitis and all must be treated to relive pain.

Ordinary Gingivitis - swollen red gums that bleed easily and bad breath. If left untreated the condition can progress.Drug-induced Gingivitis - a side effect of many drugs.Acute Necrotizing Ulcerative Gingivitis - an acute infection characterized by tissue death, spontaneous bleeding, rapid pain onset and a bad mouth odor.Hormone-Influenced Gingivitis - Affects pregnant women, children, and women using oral contraceptives.Desquamative gingivitis - Typically a result of an allergic reaction or of skin diseases. Peeling gum tissue with a red and painful surface.

Until one can seek dental care, over-the-counter ibuprofen will help relieve dental pain. Motrin Ibuprofen is effective for dental pain because ibuprofen reduces pain caused by inflammation. You may also find that rinsing your mouth with warm salty water may also help..

If your mouth is sensitive to warm or cold in the mouth, try using ice packs on your face for 24 hours and after that warm heat. Typically 20 minutes on and 20 minutes off will also help reduce dental pain. Avoid sugary or crunchy foods when you are experiencing dental pain, as both can cause additional pain.

DO NOT listen to old wives tails and put aspirin on your hurting tooth! It may burn your dental tissue and can cause even more pain.

Seek dental care as soon as possible. Untreated dental issues can lead into even more problems and pain if they are left untreated.

Dental Pain Explained

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Celiac Disease Biopsy Explained: Part I Villous Atrophy

The diagnosis of celiac disease is confirmed by a characteristic abnormal appearance of the small intestine under the microscope. Flattening of the normal finger like projections called villi accompanied by signs of inflammation is taken to indicate damage or injury from the storage protein gluten in wheat and similar proteins in barley and rye. The small intestine biopsy has became the gold standard for establishing the diagnosis of Celiac disease or gluten sensitive enteropathy. Before 1960 gluten withdrawal followed by improvement and subsequent worsening upon rechallenge was the diagnostic criteria.

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Early in the 1960's through the 1970's the small intestine was biopsied by having people swallow a small metal capsule that was attached to a suction tube. This was used to suction up tissue into the capsule before guillotining off some tissue once the capsule was confirmed to be in the small intestine by x-ray. Now the tissue is obtained by upper endoscopy, the passage of a lighted video scope through the mouth under sedation to the small intestine, where biopsies are obtained with cupped forceps.

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Celiac disease biopsy: What does the pathologist look for under the microscope?

The small intestine normally has finger like projections called villi that give it a large surface area or contact area for absorption. The villi result in a shag carpet or terry cloth towel type appearance. Lining the outside surface of each villous are intestinal cells or enterocytes that secrete mucus and absorb fluids, nutrients, minerals like iron, and vitamins like B12. On the surface of the enterocytes are digestive enzymes like lactase that digest lactose or milk sugar. At the base of the villi are crypts or circular like collections of intestinal cells.

Celiac disease biopsy: What is villous atrophy?

Normally, villi are 3-5 times longer than the crypts are tall. However, intestinal injury can result in blunting, shortening (partial villous atrophy) or complete loss of the villi and flattening (villous atrophy) of the intestinal surface. The shag carpet will have bare spots or the terry cloth towel becomes like a tee shirt. The result is lack of absorption of nutrients and water resulting in weight loss, malnutrition, and diarrhea.

Celiac disease biopsy: What if the biopsy does not show atrophy or partial atrophy?

If the villi are at least 3 times as long as the crypts are tall then no flattening or blunting of the villi is present and celiac disease becomes more difficult for the pathologist to diagnose without the history or blood test results. However, an increased number of IEL's (intra-epitheliel lymphocytes) in the setting of a positive specific blood test for celiac, symptoms and especially if supported by presence of DQ2 and/or DQ8 gene pattern, is highly suggestive of celiac disease. The difficulty comes when the blood tests for the specific tests are negative or not elevated but only the "non-specific" blood tests (anti-gliadin or AGA and anti-reticulin antibodies) are elevated. Also, some people with milder forms of celiac have no blood tests abnormal but have classic biopsy findings of celiac and are termed seronegative (blood test negative) celiacs.

Celiac disease biopsy: Can the biopsy be normal in celiac disease?

By definition, the biopsy has been considered the gold standard for diagnosing celiac. However, recent studies have shown that the biopsy can be normal in some people with celiac. How can this be? The pathologist reading the biopsy may interpret the biopsy as normal based on his or her bias about celiac disease, a failure to appreciate the significance of the presence of IEL's, or misuse of the older standard of >40 IEL's per 100. However, more importantly is the recent recognition that normal appearing biopsies may not be normal. Electron microscopy has revealed ultra-structural abnormalities in apparent normal biopsies of people confirmed to have celiac disease. Special stains, that include immune labeling of lymphocytes, have also confirmed increased numbers of certain types of specific lymphocytes in the villi of intestinal biopsies of people confirmed to have celiac. The bottom line is that a normal biopsy does not definitively exclude celiac disease or gluten sensitivity.

Celiac diasease biopsy: What are other possible causes of biopsy changes that mimic celiac disease?

Cow's milk protein sensitive enteropathy (CMSE), viral or bacterial infections, medications (especially aspirin like arthritis medications e.g. ibuprofen etc), autoimmune enteropathy, Helicobacter pylori infection (the stomach ulcer bacteria), AIDs, common variable immunodeficiency, and lymphoma of the intestine are all possible causes of small intestine changes that may mimic celiac. However, if you have classic celiac type symptoms, a positive celiac specific antibody (anti-endomysial antibody or tissue transglutaminase antibody) and a positive response to a gluten free diet then celiac is the likely cause. The likelihood is further increased if you carry one or both of the two major genes associated with celiac disease, DQ2 and/or DQ8. Normalization of celiac specific blood tests and the biopsy after a gluten free diet confirms the diagnosis of celiac disease.

Celiac Disease Biopsy Explained: Part I Villous Atrophy

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