Dr. Ivan Puljić



Toothache is the most often reason why patients visit their dentists. Pain as such is a rather uncomfortable sensitive feeling which warns on destruction of tissue. Therefore each pain which we feel in our teeth is a clear sign that something unwanted happens with our teeth and we have to visit our dentist. We will mention here possible forms of toothache connected with damages on teeth.


A great number of people suffer from this form of pain, but only a small number revert to their dentist. The pain appears from some reasons (very strong brushing, withdrawal of the gum, cracking of enamel…) when dentine, a part of tooth being under the enamel comes in contact with oral cavity. Dentine is formed of canal system in which are nerve ends and by their excitation appears a reflex pain. By character this pain is sharp  like penetrating needle and it appears when we drink cold water, inhale cold air or when we brush the teeth. It very often occures in persons who have excellent oral hygiene, but by brushing their teeth too aggressive they cause injury to the gums and consequently it retracts from tooth neck on which dentine is denuded.  It is very important to visit the dentist to avoid further advancing of the process and also aggressive grinding, because in initial phase a pain can be eliminate by simple adaptation of oral hygiene and use of toothpaste rich with fluorides and softer tooth brush.


That is how pulp – a nerve inside the tooth, reacts on outside excitations (caries, cold and hot food, drinks and grinding …) We distinguish two kinds of pulp pain:

  • Reversible pulp pain – as the name says this pain appears when pulp is inflamed, but after elimination of the cause of inflammation the pain disappears. It appears when caries has not advanced deep enough to cause a constant pulp inflammation. A pain is very sharp and very often appears when we drink cold water or drinks and stops after few seconds. When we feel this type of a pain it is a last minute to visit the dentist as to avoid irreversible damage of tooth pulp.

  • Irreversible pulp pain – for the difference of reversible this type of pain appears spontaneously and is the result of bigger damage on tooth in which case the pulp is inflamed irreversibly and the dentist shall probably have to eliminate it which will results in loss of tooth vitality. By it’s character it is a dull pain of high intensity and patient very often cannot determine which exact tooth is causing the pain. Often it is most intensive during the night and in lying position. If it is not treated in time inflammation can pass through root canal and jaw bone and cause abscess, which additionally complicates the treatment.


Periodontal pain is a consequence of periodontal inflammation – the ligament which attaches tooth to the bone. Most often it is a consequence of non treated pulp inflammation which by the penetration through tooth root canal reaches the periodontium around the root tip. By it’s character it is at the beginning a dull pain of high intensity and it often does not react on any  pain relievers. It can go together with swelling of the tissue above the tooth and sometimes  the whole side of the face. In periodontium an abscess could be formed - a limited inflammation which is the source of bacteria. If  not under therapy it can become chronic in mild form, but in any moment can be activated. So regular therapy is very important as to avoid loss of a tooth.


It is the result of gum inflammation. The most often cause is irritation – an aggressive brushing, accumulation of the plague and calculus and or bad restorations and crowns. Pain can be accompanied with bleeding specially during brushing, redness and light swelling which are most often limited to papilla between the teeth or are spread like a ring around the whole tooth neck. This pain is not of great intensity and has a burning character. A visit to the dentist is very important to eliminate the cause and prevent further development of inflammation and penetration into periodontium what can result in heavier form of disease, with high mobility of the teeth and finally their loss. Therapy in the early phase comprises elimination of calculus, professional cleaning of the teeth and education about proper oral hygiene.

Dr. Ivan Puljić



The most frequent disease today is tooth caries. It is caused by bacteria which are permanently present in oral cavity fed with sugar from the food we eat. The food rich with simple sugars (white bread, candies, bread rolls, chips etc.) stick on surface of the teeth, causing thus a layer in which the bacteria shall reside. The consequence is a thick sticky layer called plague and it is predisposition for appearance of caries. It is accumulated on surfaces of teeth, which tooth brush can hardly reach – areas between the teeth, pits and fissures on occlusal surfaces and undermined areas close to gingiva. Bacteria in plaque digest the sugars and produce acids which demineralise the surface of enamel through which than bacteria penetrate deeper into the tooth structure. Inner part of the tooth is made of dentine which is softer than enamel, its structure consists of many canals and the acids produced by bacteria demineralise it easier than enamel. At first sight the tooth looks healthy, but in fact there exist a considerable destruction of a tissue. Therefore caries is visible only when it has developed to the level that enamel is no more supported by dentine resulting in its destruction and we can see cavity on tooth. When caries has been considerably developed this is a phase when patients most often visit their dentists, and in many cases in endeavouring to eliminate it, we damage the pulp - network of nerves and blood vessels which are in the middle of a tooth, what finally results in loss of tooth vitality. Therefore the regular controls at your dentist are very important, so that professional eye can recognize caries in its early stage when it is hardly visible. Opposite to laic opinion that every dark spot on a tooth is caries, in its early stage caries is white and can only be recognized by the dentist. If recognized in its early stage, while limited only to enamel, through various therapeutic activities and nutrition changes we can stop development of caries and avoid inconvenient tooth grinding.




Using computers in dental medicine is nothing new. Like in many other areas modern dental medicine is unthinkable without computers. I work with CAD/CAM for last 10 years and still find myself suprised with very fast technology progress. 10 years ago to make ceramic crown with computer you had to be real computer wizard. Process was time consuming, inaccurate and generally difficult for technician. Situation is vey different today. Beautiful crown with natural look is just 10 minutes and few mousse clicks away. Of course, computers will never replace humans in dental medicine but they proved to be reliable partners.




I often encounter patients who are in a dilemma: cut two healthy teeth to compensate for one or install the implant. In my opinion, bridge is good solution only if adjacent teeth are destroyed to the point that they must be protected with crowns. Another problem with bridge is impossibility to adequate maintenance hygiene. Of course, many patients think that putting implants will hurt but this is not truth. After operation patient can continue with daily liabilities without any problem. Therefore, I recommend to everyone - go with the implants.

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