(The author is a final-year student of dentistry in Nizamabad’s Meghna Institute of Dental Sciences)

Studying and staying in rural areas is a real-time experience to learn and share. Rural people tend to have more faith in themselves than others. They look at every (or most? ) outsider with some suspicion.

I encountered one such patient who had visited our college with a swollen face due to a decayed tooth. Like thousands others in the village, she too believed that her tooth decay was caused by worms! I tried making her understand that it was not worms but germs that did the damage to her tooth.

We are taught and trained to be polite to the patients, however much they test our patience.

Excerpts from my conversation with Raziya – a stubborn 45-year old lady, who had more faith in the village baba masquerading as a doctor than a qualified doctor.

Raziya: You are a student, right? In which case you may not know much about this disease I’m suffering from.
Me: Since you know your problem, what is it that you seek here?
Raziya: No, no… I don’t know the exact problem… the baba in our colony told insects are eating away my tooth. I came here to get rid of them.
(I understood her concern. It was now time for me to make her place her belief in me, a doctor, than a village quack – not an easy task!)
Me: Insects? now where did you see insects from in your mouth? and who is that baba?
Raziya: He cures any diseases.. we villagers go to him for any health issues. For just Rs 10, he treats us well.
Me: Rs 10!! That’s a meagre amount. So what does he do to get rid of those ‘insects’? And why do you visit us if you are being treated by him?
Raziya: I knew you know nothing! Isn’t there any other doctors whom I can my problem? You are wasting my time and yours as well.
Me: there are a few doctors, but they would never check patients like you who come to us with a question mark for everything.
Raziya: what can this be, if not insects?
Me: its germs, not insects. micro-organisms which you can never see with your naked eyes. If they were insects, you would have been on the hospital bed already with many diseases. now I can treat this and help you if you stop visiting that baba and listen to me.
Raziya: do you charge for the treatment? (I went totally blank, not knowing how to handle such people)
Me: First tell me, would you help me treat you?
Raziya: Depends on how much you charge. I come from a poor family and we cannot afford expensive treatment.
Me: Don’t worry, there is a free dental camp running these days and its going to cost you nothing for the treatment. But I want to tell you that it’s not insects that caused the tooth decay.
Raziya: But that baba showed me an insect coming out of my mouth when I rinsed my mouth after he placed a small toothpick in my mouth and removed it.
Me: That’s a trick to make you people believe him… they are happy with whatever you pay.
Raziya: Everyone in this village visits him… many say that his treatment works well for many days and they feel relieved after he treats them.
Me: Not everyone has the same problem as yours…
Raziya: Ok Sir (This was the first time she called me as Sir! Obviously, sense was dawning on her!) Can you tell me how to get rid of the pain and the swelling?
Me: Yes I will give you some medication for a few days so that the pain and swelling subsides. Then we can decide what to do with the decayed tooth. But before that, you need to get an x-ray of that tooth.
Raziya: Will that cost too? How much?
Me: Come, I will get it done under my name and you will be charged nothing then.

(The X-ray was taken and medication was prescribed, both free)

Raziya: Sir, if the pain and swelling doesn’t get reduced after all this?
Me: Just follow my instructions. I will handle it if it doesn’t reduce. But if you still visit that baba, don’t expect these medicines to work on you.
Raziya: I won’t, Sir. But please help me get rid of the pain.
Me: I’m sure these medicines would work well. Come back in six days and then we will see what the situation is.

(After a week, she visits the hospital with a smile)

Raziya: The pain has been less and the swelling is totally gone. But when I eat something, the tooth pains a lot. What can be done about it?

(I knew it was again a hard situation, as the tooth was severely decayed and needed to be extracted, but she would look at me with a big suspicion if I told her that..)

Me: What do you think caused the tooth decay – insects or germs?
Raziya: There are no insects. I, too, checked it myself with a few other people. They say the baba is trickster and uses the toothpick to place an insect inside the tooth which comes out when we rinse the mouth.
(I heaved a sigh of relief… it was now easy for me to tell her everything about the line of treatment)

Me: So, finally you agree! The tooth, as you can see in the x-ray, has been damaged totally. It needs to be removed as the infection from tooth has caused your face to swell. If the tooth is removed, most of the future problems can be avoided and the pain too will vanish.
Raziya: Please do what ever you feel is better for me. I won’t question you more.

And then it was a good time for me explaining everything and going with the correct line of treatment, later she went to explain everything to her friends and family. Couple days later she came with 3 other ladies to me, explaining their problems.

Seeing all this I could easily see how backward the people in villages still are, and how hard it would be for people to spread awareness among them if they have a biased mind against people from urban areas trying to guide their betterment.

—

The baba which the lady was talking about, takes a toothpick with a hole and tiny worm near its tip. And after inserting the toothpick into the tooth, he waits for a couple minutes till the worm moves into the tooth. When it does, the baba asks the person to rinse the mouth and the worm falls out. This is not a big trick, but still these foul tricks are blindly believed by people in villages who develop a feeling of suspicion on the doctors.

—

This story is also a part of my participation of this dental contest and you can also see a few free dental care reports at their site.

When an individual visits the dentist with complaints like tooth sensitivity, pain etc. then his teeth are checked by the dentist for cavities. Once, a dentist spots cavities in one or more tooth, he takes the decision about removing the weakened area and filling it. The weak part of the tooth can be removed with hand piece or laser. After this, the tooth is cleaned for the removal of bacteria. Tooth isolation is the first step which is done while filling the tooth. It is important for preventing the interference of moisture with the bonding process. Different types of adhesives are applied on the tooth and after that the filling mixture is put on the tooth. With the help of a special light, the filling is fixed in to the teeth.

The cost of dental fillings depends largely on the material which is used for filling. Some studies suggest that amalgam fillings are not good for the health of people. However, amalgam fillings are cheaper than fillings done with composite material. The procedure of filling the tooth with amalgam is quite simple. While the process of filling teeth with composite mixture is sophisticated. Though composite fillings are expensive, they are far better than amalgam fillings in terms of durability and health. Apart from this, the cost of dental fillings also depends upon the dentist which is chosen by you. The location where the dental filling is done also affects the cost of dental fillings.

The main cause of this disease is the exposure of teeth of children to sugars present in milk, juice and other sweet liquids; for a long period of time. When sugar stays on the tooth for a long time then it combine with the bacteria present in the mouth. It results in the formation of acids which destroy tooth enamel. Teeth present in upper front are at the maximum risk of baby bottle tooth decay.

Tooth decay is also called by the name of caries. You may find no symptoms of caries in the initial stages. A small scrap of demineralised enamel appears on the surface of the tooth at first. Only a dentist can figure out such a patch on the tooth surface. Teeth become sensitive to cold or hot in the advanced stages of tooth decay. Dentists use an instrument called explorer to spot this. When the cavity reaches the pulp stage, pain and swelling may appear. It suggests that a regular check up by the dentist is best for spotting this disease.

If we talk about the treatment of this disease then a lot of processes are there. In some of the cases, the cavities may be so extreme that the teeth of the children need to be pulled out. It is best to try those methods which are effective for the prevention of this disease. Parents should take care that the baby does not sleep while sucking milk or juice from the bottle. Water should be mixed with milk for weaning a baby between the ages of 12 to 18 months.

Navigate through the contents -
Causes of toothache
How to prevent toothache?
What is the treatment for toothache?

Causes of toothache -

1. Temperature Sensitivity – This is one of the most common causes, in which any contact to very hot or very cold temperature suddenly causes sensitivity to the tooth and causes pain. This is more prominent when the tooth surface has been worn out earlier and the dentin part of the tooth is exposed directly to the extreme temperatures and the dentinal tubules show the maximum sensitivity.
2. Dental decay or caries – Caused due to plaque formation consisting of microorganisms which slowly decays the tooth and cause pain.
3. Fracture of the tooth – This may be caused due to any accident, or improper contact of teeth within food in between and the masticatory forces being higher.
4. Cracked tooth – As the color directly hit to tooth is reflected, identifying a crack on the tooth is not easy but still this is one of the reasons for tooth pain.
5. Pulpal irritation – This can happen after any dental treatment. This can happen only if the tooth does not accept the material used for the treatment or for the filling. During this, there is some inflammatory response produced by the pulp and this leads to dental pain.
6. Improper Diet – The salivary production, the gastric production are all controlled by a biological cycle in our body and the saliva with maximum enzymes is secreted in a timely manner. So proper diet and time should be maintained, or else the infection of microorganisms become more evolved and can cause tooth pain.
7. Sugary diet – Diet containing sugary food is full of carbohydrates which are always regarded as the house for microorganisms. In a sugary environment, the bacteria grow rapidly and cause the decay and pain of the tooth.
8. Gum disease – Gum diseases like Gingivitis are one of the factors that cause the tooth pain.
9. Other than mouth – Rarely, some conditions like sinusitis, or an ear infection can also indirectly lead to tooth pain.

How to prevent toothache?

You never know what the reason for your toothache is. So your best adviser is the dentist. Visit a dentist as soon as you experience pain in the mouth as it can be some infection or injury and should be needed to treat it before it spreads. Here are some of the precautions and remedies you can follow to prevent toothache -

1. No extreme conditions – You should avoid hot or cold things that can increase the pain. The pain caused due to inflammation of pulp i.e. pulpitis can be prevented by having food of normal temperature conditions.
2. Vitamin-C rich diet – Vitamin-C or ascorbic acid is well known for helping in absorption of calcium and phosphorus, and deposition on the tooth to strengthen and growth of the calcified tissues of the tooth i.e. the enamel layer. And this vitamin also helps in restricting the growth of microorganisms.
3. Brushing habits – You should brush twice daily, i.e. before breakfast and after dinner. Here are a few tips on how to brush your teeth(Read comments there). If you have untimely and improper brushing habits, lot of small food particles accumulate between the teeth in the embrasures and this can lead to formation of dental plaque and tooth decay later. Flossing also helps in emptying the spaces and keeping them clean.
4. Use fluoride-based toothpaste – Fluorine is well known to prevent infections, and helps in strengthening of the enamel layer which can prevent the rotting of the layer due to microorganisms.
5. Lessen sugary food intake – Sugary food as said, helps in growth of microorganisms. This is why the young kids are told to eat lesser chocolates as this helps in protection of the tooth surfaces and so tooth pain does not occur.

Treatment of toothache?

When suffering from toothache, as said above, you have to visit a dentist for the best cure. But before approaching a dentist, you can follow these steps to subside the pain -

1. Use toothpaste for sensitive teeth, which are specially made to reduce the pain due to hypersensitivity on the tooth.
2. In pain due to tooth eruption, a teaspoon of salt taken in a cup of water is used to rinse the painful region thoroughly and this salt content helps in reducing the pain for sometime.
3. Ulcer near the tooth can also cause tooth pain. This can be reduced by normal rinsing of that region with salt water.
4. Painkillers like NSAIDs(Non-Steroidal Anti-inflammatory drugs) i.e. Ibuprofen available as Nurofen and other tablets like Nicip plus can help in relieving pain as they are the analgesics which act on reducing pain.
5. Clove oil or powder – Clove is one of the best natural remedies as it has antiseptic properties and when clove oil is used on any painful tooth, the pain is relieved immediately giving relaxing effects. In absence of clove oil, grinding clove and using its clove powder is also helpful.
6. Bacterial removal by wheat – It is believed that wheat juice or wheat grass when chewed helps in reducing tooth pain, and sometimes also helps in curing any decaying of the tooth as it is known to helpfully remove the attacking the bacteria from the region of infection.
7. Salt water – Salt water either cold or in warm temperature when rinsed in the painful region would help in reducing the pain caused due to either any infection or any tooth eruption.
8. Bacterial kill with onions – Bacterial growth can also be ceased by chewing onion for 3 minutes, this can be burning to mouth but it rapidly kills the bacteria and prevents the further growth and reduces the dental pain.
9. Using Asafoetida – It is believed that using Asafoetida helps in relieving pain and is advised to use along with lemon juice and heated slightly before usage. It should not be directly applied, but a cotton swab is soaked into this solution and used over the painful region of the tooth.
10. Pepper as a dentrifice – Pepper when mixed with a bit higher quantity of salt is used for various purposes like curing of toothache, prevention of dental caries, reducing foul breath, reducing bleeding of gums.

But it is still advised that these are the temporary remedies and you should give a visit to the dentist for the final conclusion.