Tooth Disorders: An Overview

What counts as a tooth disorder

Each tooth has a hard outer layer of enamel, a softer layer of dentin beneath, and a central pulp containing nerves and blood vessels. The tooth sits in the jawbone, attached by the periodontal ligament and covered at the neck by the gums. A tooth disorder can affect any of these parts. Dentists group them into:

• Diseases of the hard tissues: decay, erosion, wear and cracks
• Diseases of the pulp: inflammation and infection inside the tooth
• Diseases of the supporting tissues (periodontal disease): gingivitis and periodontitis
• Developmental and positional problems: missing, extra, malformed, crowded or impacted teeth
• Injuries: chipped, cracked, loosened or knocked-out teeth

Most common tooth disorders and their origin

Tooth decay

Bacteria such as Streptococcus mutans in plaque feed on sugars and release acid. Repeated acid attacks pull minerals out of enamel. Early decay shows as a chalky white spot, which fluoride can reverse. Once a cavity forms, it needs a filling. Untreated decay reaches the pulp, causing pulpitis and then an abscess.

Gum disease

Plaque left along the gumline inflames the gums (gingivitis), which bleed when brushed. This stage is fully reversible with better cleaning. If it continues, the inflammation destroys the ligament and bone holding the teeth (periodontitis), forming pockets, recession, bad breath and eventually loose teeth. Smoking, diabetes, pregnancy and some medicines increase the risk. See gum disease.

Wear, erosion and sensitivity

Teeth wear from grinding (attrition), aggressive brushing (abrasion) and acid (erosion). Frequent sodas, sports drinks, citrus, wine, acid reflux and repeated vomiting in eating disorders are common sources of acid. Worn teeth become sensitive and may chip.

Symptoms that suggest a tooth disorder

• Toothache, constant or triggered by biting, heat, cold or sweet foods
• Pain that lingers more than a few seconds after cold, which suggests pulp inflammation
• Visible holes, dark spots or chalky white patches
• Bleeding, swollen, red or receding gums
• Persistent bad breath or a bad taste
• Loose teeth or changes in how your teeth fit together
• Swelling of the gum, face or jaw
• Jaw or ear pain, which can be referred from a back tooth

Risk factors

• Frequent sugary snacks and drinks
• Infrequent brushing and no flossing
• Little fluoride exposure
• Dry mouth from medicines, radiotherapy or Sjögren's syndrome (xerostomia)
• Smoking and vaping
• Diabetes, pregnancy and a weakened immune system
• Grinding or clenching
• Lack of regular dental care

Diagnosis

A dentist examines each tooth with a mirror and probe, measures gum pocket depths, and checks the bite, jaw joints and soft tissues for other problems such as oral cancer. Dental X-rays show decay between teeth, bone loss and infection at the root tips. Cold tests and tapping on teeth help identify which tooth is causing pain and whether the pulp is alive.

Treatment of common tooth disorders

• Early decay: fluoride varnish, high-fluoride toothpaste and sealants
• Cavities: fillings; larger damage needs an inlay or crown
• Gingivitis: professional cleaning and better home care
• Periodontitis: deep cleaning below the gums (scaling and root planing), and sometimes antibiotics or gum surgery
• Pulpitis and abscess: root canal treatment or extraction; antibiotics only if infection is spreading
• Sensitivity: desensitizing toothpaste, fluoride and bonding over exposed roots
• Grinding: a night guard and stress management
• Cracked teeth: a crown, or root canal treatment if the pulp is involved
• Missing teeth: bridges, dentures or implants
• Crooked teeth: braces or clear aligners

For pain while waiting to see a dentist, acetaminophen (paracetamol) or ibuprofen can help; follow the label dose. Do not put aspirin against the gum, as it burns the tissue.

Prevention

• Brush twice a day for 2 minutes with fluoride toothpaste, and spit rather than rinse afterward.
• Clean between teeth daily with floss or interdental brushes.
• Limit sugary and acidic foods and drinks, especially between meals.
• Drink fluoridated tap water where available.
• Do not smoke.
• See a dentist regularly, usually every 6 to 12 months, depending on your risk.
• Wear a mouthguard for contact sports.

Frequently asked questions

What is a tooth disorder?

A tooth disorder is any condition that damages the teeth or their supporting gums and bone. It includes decay, gum disease, infections, wear, cracks, sensitivity, injuries and developmental problems such as missing or misaligned teeth. Most are caused by plaque bacteria, diet, habits or injury.

What are the most common tooth disorders?

Tooth decay and gum disease are the most common worldwide, affecting most adults at some point. Tooth sensitivity, erosion from acid, wear from grinding, cracked teeth, dental abscesses and impacted wisdom teeth are also very common reasons for dental visits.

What causes gum problems?

Most gum problems start with plaque building up along the gumline, which inflames the gums. Smoking, diabetes, hormonal changes in pregnancy, some medicines, poor brushing and genetics make gum disease more likely or more severe. Regular cleaning and dental care keep it under control.

Can tooth problems affect the rest of the body?

Yes. Untreated dental infections can spread to the face, neck and, rarely, the bloodstream. Periodontitis is linked with poorer blood sugar control in diabetes and with heart disease, although cause and effect is not fully proven. Treating gum disease is a sensible part of overall health care.

Are tooth disorders hereditary?

Some are. Enamel and dentin defects, missing teeth, jaw size and susceptibility to aggressive gum disease have genetic components. But diet, fluoride, cleaning habits and smoking have the biggest effect on whether common problems such as decay and gum disease develop.