Most common dental conditions

Even though the mouth is a relatively small area of the body, there are a surprising number of conditions and symptoms that can arise.

If you ever have a concern with your mouth, no matter how small, visit your dentist. They will be able to offer advice and suggest treatment options, whether it be a chipped tooth, toothache or an ulcer that does not heal.

We have looked at a wide variety of dental and oral conditions and treatment available.

We hope this will prove useful for reference and reassurance.

Bad breath (halitosis)

What is it? Bad breath is a common problem that can affect anyone at any time and age. It’s caused by a number of things but it’s usually caused by poor oral hygiene. Build up of bacteria can cause halitosis as can food trapped in the teeth. Bacteria break down food pieces in the mouth which release unpleasant smelling gases. Brushing twice a day and flossing will help minimise this. Persistent bad breath can sometimes be a sign of gum disease. Hygienists and dentists will be able to assist with oral hygiene, techniques and products available.

Occasionally, bad breath can occur following illness or infection. This should resolve when feeling better. Medication can also contribute to the causes of bad breath, as some medications cause dry mouth, which limits the production of saliva. Talking to a doctor about medicines and their side affects may help.

How would I know I have it? It’s not always easy to tell if you have bad breath. Others may notice it first but feel uncomfortable telling you. A simple test to find out whether you have bad breath is to lick the inside of your wrist or back of your hand. Wait for the saliva to dry. If your wrist or hand smells unpleasant, it’s likely your breath does too.

Can it be treated? Yes. Good oral hygiene keeps the mouth well maintained and reduces bacteria. Brushing twice a day, flossing and using mouth rinses all contributes to good oral hygiene. Regular check-ups with your dentist will ensure your mouth is in the best shape.

Seeing a hygienist will help to maintain the gums and reduce bacteria build up. If your dentist suggests seeing a hygienist, it doesn’t mean they think you have poor hygiene, so try not to feel offended. A hygienist’s job is maintaining the gums and seeing a hygienist regularly helps keep our mouths healthy.

They’ll clean out any debris between the teeth and under the gums that may be caught - which is difficult to remove with brushing and flossing at home - plus they’ll polish your teeth to remove any surface staining caused by eating, drinking and any habits such as smoking. We service our cars to keep them up and running, why not our mouths?

Burning mouth syndrome

What is it? Burning mouth syndrome is a condition characterized by a burning pain or hot sensation which can be localised to the lips or tongue or more widespread in the mouth. It’s a common condition often affecting women, particularly after the menopause due to hormonal changes, but men can get it too. The sensation can be continuous or intermittent. The sensation of burning in the mouth can occasionally be the result of medical or dental problems such as thrush infections or vitamin deficiencies.

Another cause for burning mouth is stress and anxiety. This can turn into a vicious circle at times, as living with burning mouth can have its stressful moments, such as concern that the problem is mouth cancer, being in pain and feeling uncomfortable.

How would I know I have it? The causes of burning mouth syndrome are poorly understood, however studies suggest that changes occur in the way the tongue transmits temperature and taste to the brain. This results in pain, discomfort or burning. It’s called a ‘neuropathic pain’ as it’s caused by the malfunction of nerves.

The effect of these symptoms can cause further problems such as altered sleep habits, fatigue and even depression. Burning mouth syndrome, along with the hot sensation can be accompanied by other symptoms such as dryness in the mouth, an unpleasant taste and even feelings of numbness. This can increase with talking, eating hot or spicy foods and even stress.

Can it be treated? Burning mouth syndrome symptoms can be reduced by some foods and drinks, sleep, rest and even distraction, but there’s no known cure. Hormone replacement therapy hasn’t been shown to improve symptoms; neither have vitamin supplements following ‘normal’ blood test results.

Symptoms often improve following reassurance there’s no serious disease present in the mouth. The burning sensation can be worse at times of stress and go away when life’s running more smoothly. In some cases, prescribing low doses of antidepressants can relieve the symptoms of burning mouth syndrome. Your doctor will be able to advise you should such treatment be an option.

Burning mouth syndrome isn’t the same as a burnt mouth, which occurs when eating very hot foods or drinking hot drinks (pizza is a good example). Burns can occur anywhere in the mouth, such as the tongue, cheeks and gums which leaves the mouth feeling sore and tender. It’s common for the mouth to peel in the burnt area.

There’s little that can be done to heal the burn quicker, but there are ways to manage the symptoms such as avoiding acidic foods such as citrus fruits and vinegar as this will irritate the burn and may lead to a longer recovery. Soothing foods such as yogurt and ice cream can help to cool the area. After a couple of days the mouth begins to heal and all symptoms will disappear. However, should the pain from the burn be too much to handle, or you’re concerned the burn is taking a while to heal, you may wish to see your dentist or doctor to check the area and advise of any other remedies.

Caries / tooth decay

What is it? Tooth decay is when tooth structure becomes compromised and a hole appears or begins to appear in the tooth. This can happen on a baby or adult tooth. When decay has entered the enamel on our teeth (the surface of teeth we can see), unless we can see the decay, we wouldn’t know it was there as enamel has no sensation. Once the decay has gone through the enamel into the dentine (which is softer than enamel and can carry sensation) sensitivity begins. If decay is left untreated, it will continue to travel through the dentine and then head to the nerve. This then leads to toothache and possible abscess.

How would I know I have it? If caught early, you may not even be aware you have tooth decay! Decay can appear as a ‘new’ hole (on a tooth that has not been treated before) and decay can occur under an existing filling or crown. Decay can usually be detected on x-rays. Your dentist may take x-rays every couple of years or so when you attend for your check up appointments. This is to detect any decay that may be occurring under existing fillings or between the teeth, as this is difficult to spot in the mouth.

Another sign of decay is sensitivity to hot, cold and occasionally sweet foods and drinks. If left, this sensitivity can increase, which can in turn progress to toothache and even an abscess.

Can it be treated? Yes. If decay is caught at an early stage, a simple filling can be done. Your dentist can advise you on the different materials available to you, such as a metal filling or a white composite filling. However, if left, the decay will become deeper and may interfere with the nerve. Once there is nerve involvement it is likely root canal treatment will be required. It is advised to crown a tooth following root canal treatment to protect the remaining tooth structure. Decay can usually be treated, but catching it sooner makes for easier treatment.

Cold sore

What is it? Cold sores are small blisters that develop on the lips or around the mouth. They are caused by the herpes simplex virus and usually clear up without treatment within 7 to 10 days.

How would I know I have it? There are no symptoms when a person first becomes infected with the herpes simplex virus. Cold sore outbreaks occur some time later. Cold sores often start with a tingling, burning or itching sensation around the mouth. This is then followed by the appearance of small fluid-filled sores a few days later.

The herpes simplex virus is contagious when a cold sore is present and can be passed from one person to another by close direct contact, such as kissing. After the virus has been contracted, the virus remains inactive, with occasional flare ups. How often these flare ups occur vary from person to person. The virus can be activated by certain things; again this varies from person to person but examples are fatigue, injury to the lip and even hormonal changes, especially for women.

Can it be treated? Cold sores usually clear up themselves after 7 to 10 days without treatment. However, there are antiviral creams and patches available over the counter without needing a prescription. When correctly used, symptoms can be reduced and healing times quickened. To be effective, these treatments should be applied as soon as the first signs of a cold sore appear, which is usually a tingling, itching or burning sensation. Using antiviral cream after this won’t have much effect.

Dental implant

What is it? A dental implant is a more permanent treatment option offered to replace a missing tooth, whether that’s one tooth or numerous teeth. Just like a tooth root, an implant is placed into the jawbone. When a tooth is removed or not present (a tooth may not have formed), the option to have an implant may be available. An implant is a titanium post which looks a little like a screw and is fixed into the jaw bone.

Who can do it? An implant specialist (implantologist) or dentist who has trained in implantology will carefully, precisely and slowly drill into the jaw bone. This is carried out under surgical conditions and patients are usually awake and made numb using local anaesthetic. Even if you have some of your own teeth, implants can be done to replace gaps, from one single tooth to a whole set.

Can I have an implant? Implants are a safe, tried and tested treatment, and with care will probably last longer than your natural teeth! Implants aren’t always suitable - good oral hygiene is required, as are reasonable bone levels to support the implant and treatment is much more favourable for patients who don’t smoke. Your dentist will be able to advise you on treatment options best suited.

However an implant is the second best alternative to a natural tooth and an implant is designed to be permanent. Implants aren’t available on the NHS by a general dentist. Implants are only covered under the NHS following oral cancers, trauma (such as a road traffic accident) and hypodontia (when adult teeth do not form and only baby teeth remain); however there are very strict criteria that need to be met. Many appointments are required and treatment is time consuming.

Your dentist can look to refer you to an NHS hospital who can offer implants should these criteria be met for review.

Dry mouth

What is it? Normally, feeling thirsty is your brain’s way of letting you know you’re becoming dehydrated as it doesn’t have the amount of fluid it needs. By having a drink the fluid levels are restored.

If you’re feeling thirsty all the time and for no good reason, it should be investigated by your GP as it could be a sign of an underlying health condition such as diabetes, sickle cell anaemia (an inherited blood disorder), diabetic ketoacidosis (a dangerous complication of diabetes caused by a lack of insulin in the body) or sjogrens syndrome (where the body’s immune system attacks glands that secrete fluid, such as the tear and saliva glands).

A dry mouth or excessive thirst can sometimes be a side effect of certain types of medication, such as antidepressants, antihistamines or even diuretics (water tablets). These medicines can affect the salivary glands, leading to a reduction in the amount of saliva they produce.

How would I know I have it? Common symptoms of dry mouth include:

• a sticky, dry feeling in the mouth and throat
• frequently feeling thirsty
• sores in the mouth, corners of the mouth and cracked lips
• burning and tingling sensation in the mouth and throat
• dry and red raw tongue
• problems speaking or difficulty tasting, chewing and swallowing
• hoarseness and bad breath.

Can it be treated? If dry mouth is thought to be caused by medication, talk to your doctor. They may be able to adjust the dose being taken or change to a different medication.

In addition, an oral rinse to restore mouth moisture may be prescribed. If this doesn’t help, a medicine to stimulate saliva production may be prescribed.

Other steps that can be taken to help improve saliva flow include sucking on sugar-free sweets or chewing sugar-free gum, drinking plenty of water to help keep the mouth moist, protecting teeth by using fluoride toothpaste and rinses plus visiting a dentist regularly.

Breathing through your nose rather than mouth can also help as can using a room vapouriser to add moisture to the air, especially at night. It’s also possible to purchase an artificial saliva substitute over the counter. For dry, cracked lips the use of lip balm will help.

Inflamed gums (gingivitis) and periodontal disease

What is it? Gum disease is a very common condition where the gums become swollen, inflamed, sore or infected.

How would I know I have it? Your gums may appear red and puffy and may be sensitive. You may also notice your gums bleed when you brush and floss.

If left untreated, gingivitis can worsen into periodontal disease. This can lead to bone loss where teeth appear longer, sensitivity as roots become exposed and possible even loss of teeth. In the UK, more people lose their teeth due to gum disease than decay.

Can it be treated? Yes. Good oral hygiene (twice daily brushing and regular flossing) will help remove trapped bacteria on your teeth. If your dentist recommends seeing a hygienist they aren’t saying you’re a bad brusher-it’s maintenance for your gums. We service our cars, why not our gums? A hygienist will spend time cleaning each tooth, removing trapped plaque and debris followed usually by a polish to remove any surface staining.

Periodontal disease can differ in severity. It may not be curable but it can be managed. This may be dealt with by your dentist or a gum specialist- a periodontist.

Mouth cancer

What is it? Mouth cancer, also known as oral cancer, is where a tumour develops on the surface of the tongue, mouth, lips or gums. It’s also possible, but less common, for tumours to grow in the salivary glands and tonsils.

According to the NHS around 8,300 people are diagnosed with mouth cancer each year in the UK, which is about 1 in every 50 cancers diagnosed. More than 2 in 3 cases of mouth cancer develop in adults over the age of 55 and men are more likely to get mouth cancer than women. People with periodontal (gum) disease are 2.5 times more at risk.

The two leading causes of mouth cancer in the UK are drinking too much alcohol and smoking. Both alcohol and tobacco are carcinogenic - this means they contain chemicals that can damage DNA in cells and lead to cancer.

More than 90% of mouth cancers in men and 85% in women are linked to lifestyle (smoking and drinking alcohol) and environment (for example socialising, working or living with others who smoke).

A common cause for mouth cancer, although not seen much in the UK, is chewing betel nut. Betel nut is a vine leaf, popular in Asian countries, which is chewed normally with areca nut, and/or tobacco. Areca nut is also considered carcinogenic when consumed with tobacco.

Exactly what triggers these DNA changes that lead to mouth cancer is still uncertain, but the risk of mouth cancer increases significantly in someone who’s both a heavy drinker and heavy smoker. However it’s not just alcohol and smoking which increases the risk of mouth cancer - other risk factors include chewing tobacco or other smokeless tobacco products, poor diet, poor oral hygiene and the human papilloma virus (HPV).

The human papilloma virus (HPV) is a family of viruses that affect the skin and moist membranes that line your body such as the cervix, anus, mouth and throat. Although very uncommon, there’s evidence that certain types of HPV can cause abnormal tissue growth inside the mouth which can trigger mouth cancer. This can be picked up thorough oral sex with a person infected with HPV. Most infections don't cause any serious harm and are cleared by your immune system within two years.

How would I know I have it? The most common symptoms of mouth cancer include red or white patches in the mouth or throat, unusual lumps and ulcers that don’t heal or reoccur. These can be painless too, making it more difficult to detect. Other symptoms may include persistent pain in the mouth, pain or problems when swallowing, changes in voice or speech difficulties, swollen glands in the neck, unexplained weight loss, bleeding or numbness in the mouth, teeth loosening for no obvious reason or difficulty moving the jaw.

Mouth cancer is often spotted by a dentist during routine check ups. Using the mouth mirror, a dentist will examine the inside of your mouth and tongue - they can see parts of the mouth that can’t be easily seen ourselves. If the dentist does find something unusual, a referral to a consultant at hospital will be made. A small sample of cells may be gathered from the area (a biopsy) and these cells will be examined under a microscope for investigation. If the cells are cancerous, more tests will be carried out, in which the results will determine what course of treatment is required. 

Can it be treated? As with any form of cancer, treatment is more successful when caught early. Despite the increase of mouth cancer cases over the last 10 years, more people are being treated successfully and living for longer.

Early detection results in a survival outcome of 90%, however, delayed diagnosis means survival rates fall to as little as 50%. It’s strongly advised you see your GP or dentist if any of the symptoms mentioned above have lasted for more than three weeks.

Mouth cancer, during the initial/early stages of the disease, tends not to cause any noticeable symptoms. This is one reason why regular dental check ups are so important, particularly if you’re a smoker, a heavy drinker or chew betel.

When brushing your teeth, look out for any changes, lumps, bumps and colour changes. If there are any changes noted, that don’t improve after three weeks, see your dentist or doctor.

Toothache / Abscess

What is it? Toothache is pain in and around the teeth and jaws. It’s most often caused by tooth decay.

How would I know I have it? The pain usually starts suddenly and it can vary from mild discomfort to a severe throbbing, which is often worse at night. The area of your jaw close to the infected tooth may also be sore and tender to the touch. Toothache can either come and go or be constant. Eating or drinking can make the pain worse, particularly if the food or drink is hot or cold.

Can it be treated? Yes. It’s best to see a dentist sooner than later, as toothache will only intensify. Your dentist will assess you to see why you have toothache (decay, broken tooth, gum recession) and treat accordingly. Treatment could include a filling (a metal filling or a white ‘composite’ filling may be an option), root canal treatment (where the infected nerve tissue is cleaned out and the tooth internally disinfected) or extraction (tooth removal) depending on how the troublesome tooth presents to the dentist. They will inform you of all your available options.

Trauma / Broken tooth

What is it? Dental trauma is often the result of an accident. This could be a trip, fall, sporting accident or car accident- there are many possibilities. The damage caused can vary significantly; the tooth/teeth may have no symptoms, may feel bruised, the nerve in the tooth could die and form an abscess, the teeth could break or could even be knocked out completely. Whatever the circumstances, it’s always best to have your teeth checked by a dentist following a trauma.

Teeth can break for other reasons, not just trauma. A tooth can break if it bites something hard, if a large filling breaks or if it’s significantly decayed, among other reasons. It’s always best to see a dentist following a tooth has broken to allow them to offer treatment options and protect the tooth, if necessary, with a dressing.

How would I know I have it? Most people are aware there’s something wrong straight after a dental trauma, whether that’s a broken tooth, a tooth that’s come out, or pain.

However, occasionally it’s over a period of time symptoms may arise. This is usually the case when a tooth has had a knock and the nerve has died. Gradually the tooth will begin to cause pain, followed by hot and cold sensitivity, tenderness and normally the formation of an abscess. In this instance, a root canal treatment is required to clean out the infected nerve tissue causing the pain and abscess, thus making the tooth dead as it has no nerve supply. If a tooth breaks, pain and sharp edges are common symptoms.

Can it be treated? Most traumas and tooth breakage are repairable but how this is carried out depends on the circumstances. Repair can be immediate (such as a replacement filling) or may take months to give back function and aesthetics to a patient (such as implants and crowns following a car accident).

If a tooth breaks, how the tooth is repaired depends on how the tooth presents to the dentist. If the tooth can be filled with a filling, your dentist will discuss different material options with you.

This can include an amalgam (metal) filling. This type of filling needs a certain amount of tooth structure to be present to support the filling. A composite (white) filling may be an option, as a white filling chemically bonds to tooth structure; this can prove cost effective when there’s less tooth structure to hold a metal filling, and is cheaper than a crown.

A crown is often suggested when original tooth structure is lacking, therefore not providing a stable foundation or support for a filling. As a treatment option it’s advised to protect what tooth structure remains, as a crown covers a tooth, as a hat covers our head. The tooth in question will be drilled to minimize its shape and make it a smaller version of itself. Your dentist will take an impression of the tooth to be crowned. It’s common for the dentist to take impressions of all the teeth, upper and lower, which will be sent away to a laboratory where a crown will be made. The crown is completely bespoke and is manufactured to ensure a perfect fit. Once made, a crown is cemented in place. 

It’s important to see a dentist as soon as possible to assess the situation, provide relief from pain and offer a treatment plan. If a trauma is serious and requires hospitalisation (such as a road accident) the consultants from the oral department will be involved.

If a whole tooth is knocked out (roots as well), place the tooth in milk. If milk isn’t available, place it in the mouth; the best place is in the lower lip if this can be tolerated, however extreme care is needed to ensure tooth isn’t swallowed. This keeps the tooth in its natural environment. Try not to touch the root of the tooth and if the tooth is dirty, rinse with milk or tap water. Don’t scrub the tooth or use disinfectant.

If there’s bleeding from the area, don’t panic. Get a clean handkerchief or clean cotton material, fold it up to fit the area of the socket and bite down to apply pressure. Don’t use cotton wool or tissue. If painkillers are required, avoid medication containing aspirin; this thins the blood slightly which will make the area continue to bleed.

It’s possible to try to put the tooth back in yourself. Hold the tooth by the crown and put it back into the socket firmly, root first. Bite on a clean handkerchief for about 15-20 minutes. However, if it isn’t possible to do this, place in milk or the mouth as above.

Ideally a tooth needs to be reinserted within 24 hours of the accident for best results; the sooner the better for successful re-insertion, preferably within the first hour. Either a trip to a dentist or A&E will be required.

The tooth, if successfully reinserted will then need to be splinted to hold it in place while it heals and stabilizes in the jawbone. This is done by placing a piece of wire or fibreglass (which looks like a thin white strip of plastic) on to the teeth, which is long enough to reach the teeth either side of the loose tooth.

These teeth are now splinted together. The splint will need to stay on between 2 and 6 weeks, with the dentist checking the progress of the tooth regularly. Unfortunately this usually has to be done on the front surface of the teeth to hold it in place properly, so may be visible. Once the tooth is no longer loose, the dentist can remove the splint with the dental drill, leaving the teeth looking as they did before being splinted together.

Sometimes teeth that have been reinserted can die and need root canal treatment. This can normally be carried out by your dentist.

Where there’s a known risk of damage to your teeth, such as sports (rugby, hockey, boxing) it’s strongly advised an investment is made on a gum shield. Your dentist takes an impression of your upper teeth; this will only take 10 to 15 minutes. From this impression, a model of your teeth is made and a mouthguard is created on the model to ensure a snug, comfortable fit. Mouthguards range in price (£70 to £150 but call your dental practice for their fees) but are worth every penny as are certainly cheaper than a dental implant.

Ulcer

What is it? An ulcer is a painful round or oval sore that appears in the mouth. They can appear anywhere in the mouth but are most common on the tongue or cheeks. There’s no exact cause for an ulcer, but they most often appear following trauma such as biting the cheek or tongue, tooth brushing a bit too vigorously or a rough tooth or filling.

How would I know I have it? Ulcers can be quite sore and last a week or two. They often appear as a white coloured sore with a red inflamed border.

Can it be treated? Ulcers can be managed with topical gels (available from pharmacies and supermarkets) but normally it’s a case of waiting for them to heal. Avoiding acidic foods can help reduce soreness.

If a mouth ulcer doesn’t go after three weeks, it’s best to get it checked by your dentist. Usually, an ulcer in the mouth is nothing to be concerned about and will heal over. However, if you’re aware of having had an ulcer for three weeks or more, do get it checked as this could be a sign of mouth cancer. Your dentist will refer you to hospital to have the ulcer or lesion investigated if they feel it’s necessary.

Wisdom teeth eruption

What is it? On average between the ages of 18-25 wisdom teeth come through. Occasionally they erupt at an angle and can cause infection, pain, swelling and even decay in adjacent teeth.

How would I know I have it? Wisdom teeth can erupt without too much fuss. Gums can feel sore and tender but this soon settles and can be managed with over the counter pain remedies. Sometimes, wisdom teeth do not erupt and sit quietly in the jaw bone.

Occasionally though, wisdom teeth form at an angle, and try to erupt. Impacted wisdom teeth can sometimes be seen on x-ray and can often look as though a tooth has fallen over, depending on the angle of the tooth. An impacted wisdom tooth may begin to erupt, before physically becoming stuck. This can cause potential problems such as decay on the wisdom tooth and even the adjacent teeth, gum infections as the tooth becomes difficult to clean and food can trap under the gum, or even damage to the roots of the adjacent teeth where the wisdom tooth tries to find a way to erupt, which could lead to the loss of further teeth.

Can it be treated? Yes. If the gums become inflamed, sore and infected where a tooth is erupting, a dentist may prescribe antibiotics to help clear infection. They may also recommend warm salt water mouth rinses. Once a tooth has broken through the gum symptoms tend to settle and the tooth erupts with no further problems.

If flare ups continue, it’s found the wisdom teeth are impacted, decay is present on the wisdom or adjacent teeth, or if damage is occurring to adjacent teeth due to the position of the wisdom teeth, extraction may be advised. This may take place at your dental practice but it’s common for a referral to be made to a hospital for this to be done. Your dentist would arrange this for you.