Toothache

While tooth decay is often the primary cause of a toothache, it's important for you to have a complete oral examination to determine the cause. Other causes of a toothache can include the following:

• Infection
• Gum disease
• Grinding teeth (bruxism)
• Tooth trauma
• An abnormal bite
• Tooth eruption (in babies and school-age children)

TMJ/TMD (Temporomandibular Joint Disorder), sinus or ear infections, and tension in the facial muscles can cause discomfort that resembles a toothache, but often these health problems are accompanied by a headache.

Pain around the teeth and the jaws can be symptoms of heart disease such as angina. If your dentist suspects a medical illness could be the cause of your toothache, he or she may refer you to a physician.

If you have a toothache, you may have a cavity or advanced gum disease. The first sign of decay may be the pain you feel when you eat something sweet, very cold or very hot. If the pulp – the inside of the tooth that has tissue and nerves – has become irritated, this can cause pain in your tooth.

What symptoms accompany a toothache?

Because the symptoms of a toothache may resemble other medical conditions or dental problems, it can be difficult to diagnose the cause without a complete evaluation by your dentist. If you notice pus near the source of the pain, your tooth may have become abscessed, causing the surrounding bone to become infected. Or the pus could indicate gum disease, which is usually characterized by inflammation of the soft tissue, bleeding gums and abnormal loss of bone surrounding the teeth.

Contact your dentist immediately if you have any of the following symptoms:

• Fever
• Difficulty breathing or swallowing
• Swelling around the tooth area
• Pain when you bite
• A foul-tasting discharge
• Continuous lasting pain

How do I alleviate the pain if I cannot see my dentist right away?

Anyone with a toothache should see a dentist at once for diagnosis and treatment. If left untreated, a toothache and the condition that is causing it can worsen. However, if you are unable to schedule an emergency appointment, the following self-care treatment can temporarily alleviate pain and inflammation from a toothache:

• Rinse with warm salt water
• Gently floss teeth to dislodge any food particles trapped between teeth.
• Take an over-the-counter pain reliever such as ibuprofen (Advil) or acetaminophen (Tylenol) to relieve pain.
• Never put aspirin or any other painkiller against the gums near the aching tooth, as it may burn the gum tissue.
• Apply an over-the-counter antiseptic containing benzocaine directly to the irritated tooth and gum to temporarily relieve pain. Direct application of oil of cloves (eugenol) may also help to numb the gums. The oil may be rubbed directly on the sore area, or soak a small piece of cotton and apply it to the sore tooth.
• If there has been some trauma to the tooth, a cold compress may be applied on the outside cheek to relieve pain or swelling.

How can my dentist help?

Your dentist will conduct a complete oral examination to determine the location and cause of the toothache, looking for signs of swelling, redness and obvious tooth damage. He or she may also take x-rays to look for evidence of tooth decay between teeth, a cracked or impacted tooth or a disorder of the underlying bone.

Your dentist also may prescribe pain medication or antibiotics to speed the healing of your toothache. If by the time you see your dentist your tooth has become infected, then treatment could require removal of the tooth or a root canal procedure, which involves removing the damaged nerve tissue from the middle of a tooth.

Is there a way to prevent a toothache?

The key to preventing toothaches is establishing a regular oral hygiene routine and sticking to it. For example, failure to brush and floss regularly after meals can significantly increase your risk of developing cavities, which can cause toothaches.

Here are a few tips to help reduce your risk for developing a toothache:

• Brush at least twice a day, preferably after meals and snacks.
• Floss at least once a day to prevent gum disease.
• Visit your dentist regularly for oral examinations and a professional cleaning.

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Leg pain its treatment

The structure of the leg begins with the skeleton. The large bones of the leg are the femur (thigh bone) and the tibia and fibula of the shin. The patella (kneecap) is located in front of the knee joint where the femur and tibia meet. Smaller bones are found in the feet and toes. Major joints of the leg include the hip, knee, and ankle, but the small joints in the feet and toes also are important since they help support the body and cushion the force that is generated by walking and running.


The joints are stabilized by thick bands of tissue called ligaments. The ends of a bone that make up part of a joint are covered with cartilage to help them glide through their range of motion and decrease the friction of bone rubbing on bone.

Muscles attach to bone and have tendons that stretch across a joint. When a muscle contracts, the joint moves. Major muscle groups that affect leg movement include the buttocks, the quadriceps (in the front of the thigh), the hamstrings (in the back of the thigh), and the gastrocnemius (in the back of the calf). There are other smaller muscles, including those in the foot, that help stabilize the multiple joints in the feet.

There are two sets of blood vessels in the leg. The arterial system delivers blood, rich with oxygen, from the heart. The aorta leaves the heart and descends into the abdomen, divides into the iliac arteries, and further splits into the femoral arteries at the level of the groin. The femoral artery runs along the back of the femur, and at the back of the knee (the popliteal fossa) it begins branching into smaller and smaller arteries to supply the lower leg, feet, and toes with blood.

The venous system drains blood from the leg and returns it to the heart, allowing tissue-like muscle to get rid of carbon dioxide and other waste products of metabolism. There are two sets of veins in the leg, the superficial and deep venous systems. The superficial system runs along the skin while the deep system is located deep within the muscles and along the bones. Blood drains from the superficial system to the deep system through connecting veins called perforators that prevent blood clots that occur in the superficial veins from entering the deep vein system and embolizing or traveling to the heart and lungs. The superficial and deep systems come together in the groin to form the femoral vein.

Nerves from the spinal cord supply information to the leg, transmitting signals from the brain that allow purposeful movement. They also return information or sensations to the brain. These include the sensations of pain, light touch, pressure, vibration, temperature, and position. As well, nerve impulses can flow from the legs to the spinal cord and back without going up into the brain. These nerve loops allow the health-care professional to test deep tendon reflexes (when the knee or ankle are tapped with a hammer) to assess spinal cord function.

Illness and injury can affect any of these structures, causing inflammation, discomfort, and pain. More than one mechanism may occur at the same time to cause leg pain. Some examples include the following:

People with poorly controlled diabetes may develop diabetic neuropathy, in which the nerves to the legs and feet malfunction. Symptoms may include pain and loss of sensation in the feet as well as a pins-and-needles or tingling sensation. Diabetes is also one of the risk factors for peripheral vascular disease, which may cause narrowing of arteries in the legs, decreasing blood flow to muscles. Lack of blood supply may cause exercise-induced pain or claudication, in which muscles start to ache with activity because not enough oxygen rich blood can be delivered. Intermittent claudication is the term used to refer to pain in the legs that occurs while walking due to peripheral artery disease (peripheral vascular disease). This pain usually gets better with rest. As arteries narrow over time, decreased activity will bring on increased pain.
An injured muscle will cause pain because of inflammation and swelling, but it may also affect the balance of muscles surrounding a joint. If this imbalance persists, the joint may start to hurt because of chronic stress placed upon it.
People with back problems due to arthritis or a ruptured disc may develop sciatica, or pain from the sciatic nerve that radiates down the leg. Sciatica may also be associated with numbness and/or tingling in the leg.

Treatment

Care at home depends upon the reason for the leg pain.

For sprains and strains, RICE is the initial recommendation: rest, ice, compression, and elevation. Acetaminophen (Tylenol) and ibuprofen (Advil) may be used for pain control. Over-the-counter medicines are usually safe to take but may interact with other prescription medications. Health-care providers or pharmacists are usually available for questions and advice.
Hamstring and calf injuries generally heal with the body's production of collagen fibers to build scar tissue in the area of muscle damage. Depending upon the severity of damage, it may take days to weeks to completely heal. The treatment of a strain is RICE (rest, ice, compression, and elevation). Once the initial phase of recovery begins, it is important that the muscle regain its length. Often, stretching exercises are used to help restore the hamstring muscles to their full length to allow full range of motion of the knee and leg. The decision as to when to start these exercises or to use other types of physical therapy is individualized for every patient and is often made by the health-care provider.

Crutches may be used in the first few days after injury to rest the leg. Elastic bandages (Ace wraps) may be applied to the thigh, beginning at the knee and moving upward to the hip joint to provide compression.

Ibuprofen may be suggested as an anti-inflammatory medication and for pain control. As with any over-the-counter medication, it is important to check with a pharmacist or health-care provider to make certain that it is safe to take ibuprofen in each specific case.
People with sciatic pain should consider a short period of bed rest (usually less than 24 hours) followed by activity as tolerated. Patients tend to return to normal activity more quickly if the amount of bed rest is minimized. Alternating ice and heat may be helpful; acetaminophen and ibuprofen may also be used. Chiropractic or physical therapy treatments may be of help. If the pain is associated with a change in bowel or bladder function, this may indicate cauda equina syndrome, in which the spinal cord is at risk of permanent damage, and emergency care should be accessed immediately.
For patients with chronic medical conditions, prevention is often the best treatment. The pain of neuropathy in people with diabetes is very hard to control; a lifetime of blood-sugar control minimizes the risk of this and other complications in later life.
Similarly, lifetime control of high blood pressure, high cholesterol, and diabetes along with smoking avoidance will minimize the risk of peripheral vascular disease, as well as heart attack and stroke.
Most conditions that cause leg pain arise slowly, and home care should be individualized for each patient. One's health-care provider is an important resource for diagnosis, prevention, and treatment.
If acute pain with leg swelling or loss of feeling associated with a cold leg occurs, medical care should be accessed immediately

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