Oral and dental conditions

Endodontic (root canal) treatment saves a badly damaged or infected tooth by removing the pulp, cleaning, disinfecting, filling and sealing the canals. Indications include irreversible pulpitis, pulp necrosis and apical periodontitis or abscess; give analgesics, and amoxicillin or erythromycin with metronidazole when antibiotics are needed.

Tooth wear is progressive loss of tooth structure from grinding (attrition), brushing (abrasion), acids (erosion) or flexing forces (abfraction), often with sensitivity. Manage with brushing and diet advice, desensitising toothpaste, fluoride varnish, occlusal splints for bruxism and fillings or crowns for deep lesions.

Teeth are extracted for severe decay, advanced periodontal disease, impaction, fracture, failed root canal treatment or orthodontics; impacted teeth (mostly third molars and upper canines) may be observed, relocated orthodontically or surgically removed. After surgery give an antiseptic mouthwash, analgesics, and amoxicillin or azithromycin with metronidazole when needed.

Denture stomatitis is inflammation of the mucosa under a denture from poor hygiene, Candida or an ill-fitting denture, with red swollen mucosa and burning. Improve denture hygiene, remove the denture at night, clean it professionally, and use nystatin suspension or miconazole gel.

Burning mouth syndrome is burning, tingling or scalding pain of the tongue, lips or palate, often in denture wearers, with normal-looking mucosa. Adjust the denture, give psychosocial support, and use clonazepam or amitriptyline for at least 1–2 weeks.