Oral fixation

Your root canal may not be the only thing to worry about. Kareena N Gianani looks at other disorders of the teeth that lie low but need equal attention

It’s a tooth at the root of your problems
Lavanya Sharma was left gaping at the dental X ray. She saw five unerrupted teeth below her gums — two wisdom teeth, two canines and a premolar — embedded in her bone. 

Bad breath and a sudden pain behind her jaw prompted her to visit the dentist who diagnosed a gum infection and suggested she get an X ray. The radiogram showed Sharma had a condition called multiple impacted teeth.

An impacted tooth is prevented from growing normally due to pressure from the bone or other teeth. Experts believe that the problem of impacted teeth is genetic.

Dr Ashok Dabir, consultant oral and maxillofacial surgeon at Breach Candy Hospital, explains that impacted teeth are not always dangerous.

“Wisdom teeth are the most common forms of impacted teeth. I’ve seen many cases when these impacted teeth don’t affect the patient’s daily activities at all. The problem arises when these exert pressure on other teeth, or get infected.”

He adds that in rare cases, impacted teeth may also trigger the growth of a keratocyst (explained below).

Sharma had her wisdom teeth removed surgically, but the canines and premolar tooth were left untouched as they posed no threat. Dr Dabir warns that impacted teeth are asymptomatic, but mustn’t be treated lightly.

“There are chances that you can develop gum diseases, cardiovascular disorders, or even cancer.”

Stress can also cause your jaw to ‘click’
Abhijeet Roy didn’t need a dentist to tell him that his stress levels as an audit manager were dangerously high. The 30-year-old had to rush to one because of a strange ‘click’ sound every time he opened and closed his mouth.

He felt a pain around his jaw, neck and back, that spread to his arm. “My dentist said that I was suffering from myofascial pain dysfunction syndrome (MPD) caused, in my case, due to bruxism (grinding of teeth).”

Stress had given rise to Roy’s habit. Ligaments around the joint formed by the jaw and the skull had stretched beyond capacity, causing his jaw to ‘click’.

Dr Dinesh Jain, consultant oral and maxillofacial surgeon, is far from surprised. “Earlier, people suffered from it because of tobacco chewing. But it’s almost become a psychosomatic disorder now. I see 2-3 patients a week with MPD due to psychological problems.”

Other causes of MPD are misaligned teeth, jaw-injury, fractured teeth, weight-lifting (it makes one clench his jaw) and severe nailbiting. MPD is likely to strike at middle age and affects more women than men.

Roy was advised to wear a dental guard at night that reduced his tooth-grinding. “I’m trying to cut out stress and not exert my jaw muscles,” says Roy. Dr Suchetan Pradhan, cosmetic, laser and implant dentist, feels low-power laser treatment is the only long-term therapy. In severe cases of MPD, surgery is considered the last resort.

A ‘harmless’ cyst that eats away your bone

 As Kavya Kashyap headed to her dentist’s, she thought it was just one of those days when her wisdom tooth was erupting painfully.

However, the area got infected so severely, that Kashyap couldn’t open her mouth and her left cheek had swollen alarmingly.

With no respite even after four sittings to drain the abscess, the dentist advised Kashyap get an ortho-pantomogram (a dental radiography).

Kashyap’s lower jaw bone had an odontogenic keratocyst. It is an uncommon condition where a benign cyst erodes the jaw over years without any symptoms of pain or swelling.

Kashyap and her doctor were unaware of the cyst for five years, and by the time they realised there was something amiss, the cyst had reduced her bone to less than half.

“The diagnosis was by pure chance. I had only gone to get my wisdom tooth checked.”
The cause of an odontogenic keratocyst is unknown. However, most doctors believe that embedded teeth which do not erupt fully, are likely to cause this condition most common in people between 20 and 30.

Kashyap underwent a surgery to remove the cyst in June 2006. Her bone will grow naturally over time. Dr Shalini Pradhan, dental surgeon, says: “In 20 years, I have diagnosed only four cases. But there is up to 60 per cent chance that a keratocyst will reappear, because it produces daughter cysts around the area that may grow after surgery.”

g_kareena@dnaindia.net