MOUTH PAIN FROM GUM DISEASE ( GINGIVITIS )

Do you have mouth pain confined to your gums, with bleeding or swollen gums? Can you see a 1mm. wide, deeper pink line of gum along its' edge up against your teeth?

Bleeding is likely to be obvious if you use floss between your teeth.

Flossing is useful to get out bits of meat caught between teeth, but may not adequately clean away plaque.

You will be able to cure mouth pain from gingivitis. Gum disease responds well to careful cleaning. This is also true if the apparent cause is drugs for epilepsy.

Severe lack of vitamin C causes scurvy, with bleeding gums from gingivitis. One's food should include raw items, as vitamin C is destroyed by cooking.


Peridontal disease isn'tjust a mouth pain problem. It's a strong risk factor for later developement of cardiovascular disease. It increases silent systemic inflammation believed to underlie many chronic degenerative diseases.

If someone has valvular heart disease, it increases the risk of bacterial endocarditis. This is infection on the heart valves, a very nasty thing to get.

It's definitely not just a matter of sweet breath.




Brushing teeth

Soft bristles are better as they can bend to get into crevices and do less damage to gums and teeth than hard bristles.

Some toothpastes are more abrasive than others, so it's worth checking about your brand.

The head of the toothbrush should be small so you can get it into all parts of your mouth, particularly the inner surfaces of the lower teeth, which are easy to miss.

One brushing technique is to hold the brush where tooth and gum meet, at a 45 degree angle towards the gum and move it back and forwards across the tooth.

Powered brushes with a rotation oscillation action do a better job than hand brushing. They are held against the teeth, just moved around enough to cover all the tooth. They are pushed firmly enough for the bristles to splay out and into the crevice between the tooth and gum, but not firmly enough to slow down or restrict the oscillations.


Oil pulling for mouth pain

Oil pulling is a funny name. I for one certainly find it easier to use my tongue to push the oil emulsion between my upper teeth, at any rate.

Clean your teeth, leave any dentures out, and put one teaspoon of edible oil in your mouth.

Swish this around your mouth and force it between your teeth with your tongue.

For 20 minutes!!

I'm not kidding. It seems like forever. The reason for this time is that the oil has to seep into any pockets left between teeth and receding gums.

(When a dentist checks teeth, a fine blunt probe is gently inserted into this "gingival sulcus" or "peridontal pocket" alongside the tooth, to see if it is more than 3-4mm deep. If it is, or bleeding results from the probing, gum disease may be present.)

Water soluble materials will have been washed out by your saliva. The material left will be oil soluble.

Do not swallow this oil, now an emulsion. Spit it out and clean your teeth again to remove residual oil.

This is worth the effort. Your mouth pain may be helped within a few days.


Amosan

My instructions for the use of amosan, are "off label." The packet tells you how to use it as a mouth wash. These instructions are courtesy of a naturopath Malcolm Cooper, to whom I owe a lot of valuable insights.

Having cleaned your teeth, leave the toothpaste on your toothbrush and lay it on its' side.

With dry hands, tear the top off a sachet of amosan and tip a small pile of the powder onto the side of the toothbrush.

Fold the torn edge of the sachet and secure with a paper clip. It won't keep long, probably a day or so (best in a plastic bag.)

Now go through the motions of cleaning your teeth again, to apply the amosan to the gums.

This may sting the first few times if your gums are inflamed. Mouth pain to fix mouth pain!

This treatment releases oxygen to kill germs in the crevices cleaned out by the oil pulling.


Hydrogen peroxide and sodium bicarbonate

For baking soda tooth care, I just have some in a small bowl and dip my wet toothbrush in this. It really doesn't taste bad.

If you're into making homemade toothpaste, there are some recipes at the ultimate cosmetics site7.

Peroxide has to be appropriately dilute, and does the same job amosan as well as helping whiten your teeth.


Xylitol and molybdenum

Xylitol is very useful, even for helping prevent dental decay. It is available as peppermints and chewing gum. It is a sugar produced from birch tree bark, which is not fermented in our mouth.

The RestoreUnity blog writer swears by a Xylitol oral rinse called Spry. This blog has good info. Most mouth washes are bad news5, but one with chlorhexidine could be used briefly at the start of treatment.

Molybdenum supplements may be useful.


Miniature pipe cleaners

Interdental brushes come in multiple sizes, straight and tapering. These do a much better job at mechanical cleansing between teeth, than floss.
Twist and move them in and out at the same time.


Flossing

This is best for removing bits of meat caught between teeth.

Take a bit more than a foot of floss and tie the ends together with a double throw on the knot. I think this is much easier to use than just a straight length.

Wind it around various fingers and insert the taut floss between adjacent teeth, then move ones fingers sideways a little so the floss "hugs" one of the teeth. Then rub it repeatedly up and down the tooth, moving right down as far against the gum as possible without discomfort. Then move over to the tooth on the other side and do the same.

I prefer unwaxed floss as it is easier to tell when the tooth is clean.

If you go to this much trouble, I certainly wouldn't throw it away after one use. Wash and keep - easy. Mouth pain prevented economically!

There are special floss threaders and floss with a firm tip at one end, if one can't get floss down past the contact point of the teeth (or if one has bridges or joined crowns.)




Cloth squares ( "non-woven sponges" )

If you have multiple teeth missing and wear a partial plate, this is a useful method.

Mydent International is one supplier (item number NW-0300.)

These are stretched out and used as floss, except that they are pulled back and forth instead of up and down on the tooth.
This is quite effective at polishing off plaque from the sides of teeth.


Water pick (dental irrigator)

This is a device delivering a pulsing high pressure spray of warm water. It is a good investment if you have gum problems.

Shirley MacLaine had a Russian (I think) friend who always brought his when visiting, from memory. I don't remember which of her books that was in, but they are all very good reads.

At any rate, this may be the ants' pants in cleaning between your teeth. Mouth pain prevention that actually doesn't cost an arm and a leg!

You do have to be careful where you point it when it is working. It is a good water pistol.

I use an electric toothbrush, then interdental brush and floss, and still get out more food fragments with the dental irrigator.


Herbal remedies for gingivitis

Bloodroot is apparently useful for gingivitis and a lot of other things as well.

Cathy Wong4 lists vitamins C and D, stress reduction, tea tree oil, CoEnzyme Q10, green tea and cranberry, as possible remedies for gingivitis mouth pain.

Essential oils of thymol, eucalyptol, menthol and methy salicylate have been formulated as a mouthwash for reducing plaque, gingivitis and halitosis. This formulation apparently has enough alcohol and is acid enough, to be a problem in dry mouth or existing decay.



Your dentist - ideally not the last resort

Toothache may be from tooth decay or internal resorption rather than gum disease.
Bleeding is a pretty good pointer to gum disease. Tenderness between teeth on flossing can be due to any of them.

These can diagnosed easily by your dentist, if necessary using x-rays.


I am convinced that once decay has exposed your tooth root canal, the tooth is better out. If you do decide to have endodontic treatment to conserve a dead tooth, be prepared to have it removed if mouth pain persists.

A proportion of teeth removed for this reason, have been found to have very toxic substances from bacteria living in the dentine. These would have been continually leaching out into one's system.

Extraction techniques may include sectioning the teeth to minimize the risk of damaging your jaw bone or TMJ, and curettage or cleaning the socket to prevent the occurrence of residual osteitis (chronic infection of the jaw bone).

It has been estimated that when a abscessed tooth is removed, one has otherwise only removed about half of the infected tissue. The rest is in your jaw bone.

NICO lesions can then persist as foci of infection and nerve irritation.

In chronic mouth pain from this, surgical clearance of the damage can have a very good effect8, whether the diagnosis was trigeminal neuralgia or atypical facial pain.




Here I'll put in a plug for an Australian development.. GC Tooth Mousse Plus, a cream one applies to teeth with small holes, in the attempt to avoid drilling. It can be applied with a cotton bud, interdental brush or your finger.

It contains casein phosphopeptide - amorphous calcium phosphate (CPP-ACP), which encourages remineralization of the enamel.

This may save expensive mouth pain treatment!




Peridontitis - gingivitis has spread into the bony tooth socket

Here teeth are slowly detached from their supporting tissues due to infection. The bone in which the teeth are rooted, is resorbed.
There is loosening of teeth, and dental pockets going in between the tooth and the jaw bone. The gum edge has retreated towards the tooth root.

X-ray will show loss of alveolar (tooth bearing) bone.



Dental erosion sensitivity.

Hot, cold or sugary drinks or food can cause pain if the enamel on your teeth has been eroded by acid, exposing the sensitive dentine.

This used to be a big problem in small children given acid fruit juice in a bottle.

Gastric acid reflux can also cause generalized dentine sensitivity.

Receding gums expose dentine and make one prone to it.


Single painful tooth

Apart from decay, if it already has a filling, this may be cracked (as can be the tooth itself.)

If someone taps the individual teeth with a small metal object, the culprit should be the most tender one.


Gum pain from trigeminal neuralgia

This pain can be stabbing, shooting, cutting or like red hot needles or electric shocks. Mild bouts can be tingling, pins and needles or aching.

Spasms begin very suddenly, last seconds and recur over days or weeks. Bouts like this can return every few months or years even, with nothing in between.

Half of people report the pain was first felt in their upper gum. It can also be in lip, in front of the ear, around and behind the eyeball, nearly always on one side only.

Excruciating mouth pain!

trigeminal nerve dermatomes The three parts of our trigeminal nerve, supply sensation for the skin of our face and supply the muscles we use to chew with.

The skin areas supplied are shown as brown, gray and puce on the face.

Only one of the three divisions is involved, mostly.

Trigeminal neuralgia starts of its own accord, and is probably due mostly to damage to the nerve inside our skull.

It is called neuralgia because the pain comes from damage to the nerve itself - neuropathic pain.

Nociceptive pain is when our nerves are perfectly healthy, and are telling us that something else is wrong.

Post traumatic neuropathic trigeminal pain from dental treatment may be a different condition, or the same but initially thought to be due to a dental cause.



When medical treatment is unsatisfactory, surgical treatment can be useful...

"Microvascular decompression (MVD) is an effective and safe treatment for patients with trigeminal neuralgia refractory to medications. All of our patients responded to surgery with 71% of complete symptom relief. MRI scan is not sensitive in detecting vascular culprit but it is essential to rule out other compressive causes."

(See reference 3) - where there is also one to a good 2010 review of treatments.





Dry socket following tooth extraction

Here the hole from removal of a lower tooth, has delayed healing. You will probably be able to feel the hard edge of the jaw bone, in the hole.

Packing the hole with crushed up chewable vitamin E tablet, is really good here. This is worth doing immediately after the extraction, if your dentist has not sewn the hole up.


ORAL (MOUTH PAIN) FROM STOMATITIS

Antibiotic treatment complications - antibiotic sore mouth

If you recently had broad spectrum antibiotics and you have mouth pain, the two are probably cause and effect.

Is your tongue clean or slightly red? Even if you have no tongue pain, scrape it against your teeth and see if it is tender.

This condition may respond overnight to an injection of high potency B complex vitamins, but not to oral supplements. The problem appears to be caused by disturbance in the bowel.

Throat pain treatment as a cause of mouth pain!


Oral thrush following antibiotics

Candida is present in about half of all people at any one time.

This yeast organism is not killed by ordinary antibiotics - these are substances produced by yeasts in nature to kill bacteria!

Antibiotic treatment simply clears away the competition and gives yeasts a clear run.

White coating on your tongue is a strong clue to this complication.

It takes 3-4 months after a course of antibiotic, before your gut flora normalizes, and anything which speeds this up is likely to be useful for you.

My naturopath mentor always wanted me to prescribe nystatin whenever one of our mutual patients required antibiotics. Yogurt containing lactobacilli is also likely to be useful now.


Denture sore mouth

Candida is often present here.

Scrub them with salt and soak overnight in dilute hydrogen peroxide.

Inexpensive mouth pain prevention.

Sensitivity to materials dentures are made of, was found in 12 of 53 people with dentures and burning mouth syndrome, in one study12.

This may need skin patch testing to sort out.




Angular cheilitis or angular stomatitis

This is inflammation, with maceration, exudation and cracking at the corners of one's mouth - the labial commissures.

We are more likely to get this if it is many years since we had our natural teeth out. The jaw bones gradually narrow, and our mouth closes more, folding in the skin at the corners of our mouth. This crease provides good conditions for germs and Candida to grow.

You may need to get your existing full dentures relined (more bulky,) to make up for the bone loss and widen your bite.

This condition may also be an indication of poor nutrition.

Xylitol can help avoid this corners of mouth pain. It can also help oral thrush.


Primary herpes simplex stomatitis

Totally miserable toddlers mostly. The first time one meets the cold sore virus, with no prior immunity, it's very nasty. They may have ulcers all over their mouth and lips.

They are feverish and refuse even fluids because of the mouth pain. Sometimes they need admission to hospital, where local anesthetic gel is used as well as paracetamol (acetaminophen.)




Recurrent herpes simplex - cold sores on lips, or gums or inside nostril

After the first attack, it is not as severe but still causes pain for over a week.

Laser applied directly to the area early in an attack, can shorten this time considerably.

Antiviral drugs such as acyclovir, applied to the area hourly when you first feel tingling, are useful. This is the day before the blisters appear.


Applying an ice block to the area works too. Looking at info on the net, people are using it for up to 30 minutes. The patient who told me about it originally, said 2 hours!

People are writing to wrap the ice in cloth rather than have it directly on your lip, but I've used it directly on the lip with no problems - it doesn't stick, as the ice is melting all the time. Hold the ice in a folded tissue.

This is also best before the rash appears.


Melaleuca alternifolia (Australian tea tree) essential oil has broad-spectrum antimicrobial activity, including against HSV.
One trial9 using 6% TTO in an aqueous gel base, was encouraging.


Lysine 1-3 gm per day and appropriate homeopathics by mouth can be useful. Homeopathics need to be chosen by looking at the person overall, not just "for cold sores."

Other surface treatments include lemon balm, sage, aloe vera and rhubarb.






STREP THROAT AND VIRAL SORE THROAT

Virus sore throats outnumber Streptococcal 3 to 1, if there are no white spots on your tonsils.

If you have not had your tonsils removed, obvious off white spots on them, about 2mm (1/10th inch) size, are a reasonable indication of Streptococcal infection. The back of the throat is likely to be deep red all over. Fever and tender glands under your jaw on both sides, also suggest this.

Tender palpable glands in the posterior triangles of your neck , with these spots on your tonsils, would favor glandular fever due to Ebstein barr virus.

If there are are no white spots, an ordinary virus infection is most likely. The whole back of your throat may be mildly red. This is likely to turn into an obvious cold in the nose, in a day or so. A tender gland under the jaw may be found, but only on one side usually.

If you are already hoarse, with a touch of laryngitis, this is against Strep infection in favor of an ordinary virus, such as adenovirus, echo or coxsackie virus.



Penicillin treatment of Strep throats has probably been responsible for the vastly reduced risk of chronic rheumatic heart disease in developed countries.

The last two times I saw someone with florid acute rheumatic fever , were about 1970 and quite recently in 2011.

These were due to autoimmune reaction following Streptococcal sore throats.

Dangerous mouth pain.

This is one condition where the length of antibiotic treatment is important. Less than one week of penicillin and you have 40% chance of still having the germ in your throat. Ten days is good.

Since writing this, I've read medical papers saying that short courses of penicillin are just as effective. The older literature was very definite on this point, so I'll stick to the longer course.

Note September 2012: The latest guidelines10 from the Infectious Diseases Society of America, have said 10 days too.

Septic throat due to the GABHS is another example where use of potent anti-inflammatory treatment may be combined with the antibiotic.
Here 8mg of dexamethasone is used sometimes, in adults. This is a very large dose of cortisone.



Some of the remedies from before the antibiotic era, may still be useful.

Mandl's paint (Pigmentum iodi co.) is one example. I am told that painting this on a really swollen infected throat could reduce the edema within minutes.

The formula was iodine 5 grains
potassium iodide 10 grains
oil of peppermint 3 minims
glycerine to 1 fluid ounce


See more on next page, on tonsillitis and tonsillectomy.





APHTHOUS ULCERS - CANKER SORES

Aphthous ulcers (canker sores) are anywhere on the throat, and are an off white spot about the same size surrounded by a red area to twice the size. The rest of the throat will have normal color.

aphthous ulcers

These are a cause of recurrent mouth pain, and may be allergy related. You may be interested in looking for unsuspected allergies.
Germs which have been implicated include Helicobactor pylori and cell wall deficient (L) forms of Streptococci.
Iron, B12 and folate deficiencies may need correcting.
Dr. Monir Maurice found lower Ph and protein in saliva in recurrent aphthous ulcer (RAU) patients, so zinc deficiency may also be a factor. Dr. Julian Whitaker certainly finds this.

Corlan pellets may help for ulcers in parts where you can hold it against the ulcer for some hours, at the bottom of your mouth or beside your lower gums.

Kenolog in orobase may stick well enough to ulcers in other spots.

Cautery with a silver nitrate pencil definitely helps, but has to be carefully touched only on the center of the ulcer.

A mouth wash of tetracycline can be made with 1 capsule opened into 1/4 cup of water as hot as you can stand, held in the mouth for at least 3 minutes, four times a day until you feel relief starting.

Sea Buckthorn oil, cold pressed extra virgin pine nut oil and Sucralfate suspension, are claimed o be useful.

A tea tree oil gel reduced healing time from 12.5 to 9 days, in one trial.

Aphthasol paste (Amlexanox) has been well researched, and is apparently effective and well tolerated. It is an old drug, which is usually reassuring re unusual side effects.

Another old drug used is colchicine





There are many other possible causes of mouth pain, for your professional to consider

Mouth cancer is not rare and should be considered when something isn't healing, particularly (if you can feel it with your finger) there is a lump.
Prevention is better than cure. If you don't want to give up smoking, consider getting your nicotine shot from electronic smokeless cigarettes.

E-cigarettes aren't good for your lungs11. They still contain a number of toxins and carcinogens, including nitrosamines, diethylene glycol, and other components suspected of being harmful to humans (Medscape.)



Lesions indistinguishable from aphthous stomatitis can be seen in Behcet's syndrome, Reiter's syndrome, Crohn's disease and celiac disease.

Periadenitis mucosa nectrotica recurrens (PMnR) - Sutton's ulcer, is similar, more prolongued and heals with scarring.

Mouth ulcers due to coxsackie A16 virus are easily recognized as there are little blisters (vesicles) with bright red edges on palms and soles as well. This hand foot and mouth disease is different from the cattle disease of the same name.

Oral lichen planus (OLP) presents as white reticular striations or plaques which cause no symptoms, or erosive lesions causing anything from sensitivity to bad pain.

oral lichen planus

Skin lesions elsewhere in lichen planus are flat-topped purplish little bumps, predominantly on the fronts of the wrists or ankles, backs of the lower legs, low back and natal cleft.

Flareups of OLP can be caused by stress, NSAID, ACE inhibitor and beta blocker drugs. The cause of OLP is unknown, but the mechanism is inflammation involving CD8+ T lymphocytes.

Prescription of alternative drugs, replacement of dental restorations and prostheses and stopping cinnamate-flavored toothpaste can be tried.

Traumatic ulceration can happen because of poorly fitting dentures, broken teeth with sharp edges, etc. The cause should be obvious.

There will often be a flap of skin on either side of traumatic ulcers which have been present for some time. This will be the most obvious feature.

Drug induced oral ulceration can be very severe, as in Stevens-Johnson syndrome or lack of white blood cells. Always suspect drug reactions with any symptom starting soon after first taking anything new, but always contact a doctor immediately, before stopping medications.

Mucositis from radiotherapy for head and neck cancers. This was reduced by zinc supplements in one trial6, provided the people weren't also on chemotherapy. 75mg of beta carotene per day and glutamine mouth washes have also been found useful here.

Acute leukemia causes multiple ulcers with grey coating and a lot of mouth pain.

Burning mouth syndrome is another thing I've not personally seen, has alteration in taste and dry mouth as well, believed to involve nerve damage, cause not known.

Mouth breathing may contribute. People with a lot to say in a short time often gulp air through their mouth as it is quicker than through the nose.

My Buteyko teacher put a nice spin on it. He said breathing through ones nose during a conversation allows one more time to listen properly to what is being said to one and more time to think carefully about what one wishes to say in reply.

Mouth breathing at night may be easily controlled by putting on a bit of adhesive tape from upper to lower lip.





From mouth pain to ear pain page.

From mouth pain to home page.

This is an illustrated article on recurrent oral ulceration





People's stories about mouth pain...

This story appeared in a letter to the Medical Journal of Australia.

A man had been treated unsuccessfully for intractable "migraine" to the point where he had to take on a less demanding teaching position.

A new dentist took an x-ray of a root canal filled incisor tooth, found an abnormal area of bone and persuaded him to have it removed.

"Improvement was dramatic. He now (six months later) has no headaches whatever, indulges in strenuous exercise and feels completely well."



One of my patients was a good example of a pain caused by multiple factors.

She had swelling over her lower jaw, due to a tooth abcess.

face swelling from tooth abcess

This had however, settled by the time of her first consultation. The tooth was tender on percussion, so the reason was clear.

She also needed her neck treated, as her left Cervical 2-3 joint was stiff. After this was mobilized, a pain in her left wrist went immediately, and so did her jaw pain.

Her jaw pain and swelling returned 12 days later, and the abcess burst ( and I got this picture.)


Need help or have a helpful tip to share, or an experience others can learn from?

You can have your own page on this site, be anonymous if you prefer, and help other people or get useful opinions.


It's very quick and easy

What 's your page about - its title.




References for mouth pain pages

Monir Mauricea1 , Wadie Mikhaila, Medhat Aziza and Maged Barsoum
1. Aetiology of recurrent aphthous ulcers (RAU)
The Journal of Laryngology & Otology (1987), 101:917-920 Cambridge University Press

2. Dr. Whitaker's Guide to Natural Healing, Prima, 1995

3. POSTER PRESENTATIONS
Microvascular Decompression for Refractory Trigeminal Neuralgia
D. T. M. Chan, J. M. K. Lam, W. S. Poon
Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.

Mark Obermann Treatment options in trigeminal neuralgia Ther Adv Neurol Disord. 2010 March; 3(2): 107–115. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002644/

4. Cathy Wong at http://altmedicine.about.com/od/healthconditionsdisease/a/gum_disease.htm

5. http://www.naturalnews.com/024591_mouthwash_cancer_oral_cancer.html

6. Lin L C et al Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind randomized study. Int J Radiat Oncol Biol Phys 65 (3): 745-50

7. http://www.ultimate-cosmetics.com/beauty/homemade-recipes/toothpaste.htm - note the cautionary comments at the bottom of this page.

8. Bouquot JE et al Long-term effects of jawbone curettage on the pain of facial neuralgia.
J Oral Maxillofac Surg. 1995 53(4) pp 387-97

9. Carson C F et al Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis
J Antimicrobial Chemotherapy 2001 48(3) pp 450-451

10. Stanford T et al Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America Clin Infect Dis. (2012) published online: September 9, 2012

http://cid.oxfordjournals.org

11. http://journal.publications.chestnet.org/article.aspx?articleid=1187047

12. Kaaber S et al Skin sensitivity to denture base materials in the burning mouth syndrome. Contact Derm 5: 90 1979

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