The wide and varying symptoms of an erupting wisdom tooth

MEN'S HEALTH MATTERS : Treating a troublesome tooth

MEN'S HEALTH MATTERS: Treating a troublesome tooth

Q I am 20 years old and recently had a painful episode from an erupting wisdom tooth. Will it need to be extracted and, if not, will it cause my other teeth to become crooked?

A Wisdom teeth can erupt at any time from 18 to 80. The trouble they cause can vary from none at all, to a slight discomfort as they come through the gum (rather like a baby teething) to a full blown infection of the gum around the tooth, resulting in swelling in the area and inability to open the mouth and also a raised temperature.

The lesser symptoms can be treated with warm salty mouth rinses (a level teaspoon of salt in a cup of warm water) and Ibuprofen (400mg three times daily for the duration of the discomfort). The more serious symptoms may require antibiotics in addition to the non-steroidal anti-inflammatory drugs mentioned above.

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One painful episode does not mean that the tooth should be extracted. If it is coming up in good alignment and with room, it may be a one-off event.

If there is a repeat episode within a few months, then it tends to be a recurrent problem and extraction will then have to be considered.

If the tooth is not coming through in a good alignment and is likely to cause damage to the adjacent tooth and tissues then extraction may also be the best option. Your dentist will be able to advise you.

It used to be thought that erupting wisdom teeth could make your lower teeth crooked particularly as the pain can often radiate them. This is not the case. Lower front teeth can begin to crowd as a natural phenomenon, which often occurs in the mid to late 20s. This can happen whether your wisdom teeth are extracted or not.

Q My brother is 58, a non smoker and lives in Perth, Australia and was diagnosed with cancer of the bladder. He had noticed blood in his urine. After consultations and tests, the treatment prescribed was the introduction of BCG (tuberculosis) into his bladder over six treatments. I have never read anywhere of this treatment and would be obliged for your comments as to the average success of this treatment, what is involved, the after effects and why it would be chosen over and above the usual treatments for cancer.

A BCG stands for bacillus Calmette-Guerin solution which is a vaccine for tuberculosis (TB). It is administered in a form of treatment known as intravesical (treatment administered directly into the bladder) treatment.

The doctor uses a catheter (a tube which passes through the water passage into the bladder) to put the solution into the bladder and the patient needs to hold the solution in the bladder for about one hour.

It is usually used in one of three instances - high grade (aggressive) superficial bladder cancers, low grade superficial bladder cancers that are recurring regularly and a special type of bladder cancer called carcinoma in situ (CIS).

As you mention in your question, your brother's initial treatment would have involved scraping (using an electric current) the tumour from the lining of the bladder. Based on the results from the laboratory, the BCG treatment would be commenced and he would get this initially every week for six weeks.

The specialist looking after your brother may suggest that your brother continue with his treatment for longer if he responds and can tolerate it.

BCG bladder treatment has been shown to greatly reduce the chance that cancer will recur (60 per cent) and decrease the chances of prog- ression to a more serious type of cancer by about 30 per cent.

It is not known exactly how BCG works with bladder cancer but it is felt that the BCG solution which contains live weakened bacteria may stimulate cells of the immune system to grow and become very active in the lining of the bladder. These immune cells kill off the cancer cells.

This type of treatment does not have as many side effects as having standard chemotherapy. This is because the drug tends to stay in your bladder.

Very little of it gets into the bloodstream. Side effects of this treatment are usually mild and short lived. About one in four people has blood in their urine. About one in four develops flu-like symptoms for 24-48 hours after each treatment. About two out of three have symptoms of an irritated bladder - this feels a bit like having a urine infection. About seven out of 10 people want to pass urine more often than usual.

There is also a very small chance that you may get 'flu-like symptoms such as fever, chills and night sweats, joint pains, feeling sick or vomiting and cough. This does not occur often.

This type of treatment is standard and is employed all over the world including the Republic.

• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from John Adye-Curran, dental surgeon, Rathfarnham, Dublin, and Ivor Cullen, specialist registrar in urology

• If you have a men's health- related question, e-mail: healthsupplement@irish-times.ie