Ouch! – Let's talk about Tooth Sensitivity

 

According to the March 2013 issue of the Journal of American Dentistry, 1 in 8 people suffer from Dentine sensitivity.  Eating or drinking cold, acidic, sweet, and sometimes hot things can elicit a shocking type of pain typically for seconds to several minutes known as sensitivity.

What is tooth sensitivity?

Tooth sensitivity is a type of dental pain caused by the loss of enamel on the tooth surface, exposing the underlying dentine, or by receding gums exposing the root.

 When certain food or drinks hit the tooth surface, it elicits a sharp shooting pain typically lasting a few seconds to minutes.  This can easily be tested in surgery by placing a cold substance over the tooth and timing how long the patient experiences pain.  If severe pain lingers on for several hours, other diagnoses should be explored such as pulpitis.

Causes of tooth sensitivity

The cause of dentine sensitivity is unknown. However there have been many theories as to why dentine hypersensitivity occurs, these include the ‘odontoblastic transduction theory’, the ‘neural theory’, and the ‘hydrodynamic theory’.

The hydrodynamic or fluid movement theory proposed by Brannstrom in 1964 is the widely accepted theory. Brannstorm suggests that when the dentine surface is exposed to thermal, chemical, tactile or evaporative stimuli, it causes the flow of the fluid within the little dentine tubules to increase. This fluid movement could be towards the pulp or away from it.  Changes in the flow of the fluid present in the dentine tubules can trigger the mechanoreceptors in the nerves and the pulp, causing the shock-like pain.

 

Common causes leading to Dentine sensitivity

Gingival recession or enamel loss can be caused by certain habits carried out by the patient.  Often, patients need to be educated about safe ways to brush and eat to prevent tooth tissue loss.

 

  1. Aggressive tooth brushing

Abrasive or excessive tooth brushing can cause enamel loss or gingival recession leading to tooth sensitivity.  Patients should be advised to use brushing techniques such as the modified bass technique and not to brush in an aggressive manner.  Brushing effectively twice a day with a fluoride-containing toothpaste is sufficient with daily interdental cleaning, brushing more times can actually have a negative impact on your dental health by causing tooth tissue loss.

 

  1. Acidic foods and drinks - grapes, oranges, and grapefruit.

The acid in such foods can cause the enamel to soften and making it vulnerable to being lost, exposing the underlying dentin and causing sensitivity. 

  1. Parafunctional habits

Habits such as clenching or grinding your teeth exert a large amount of frictional forces on your teeth causing enamel loss.

 

  1. Teeth whitening Kits.

The increasingly popular whitening kits can drastically improve your smile however it can leave some patients with very sensitive teeth. 

 

  1. Medical conditions

Some medical conditions can contribute to tooth surface loss.  Bulimia, an eating disorder, can lead to tooth erosion as the vomit is very acidic in nature.  Acid – reflux and pregnancy sickness can also cause the same effects.

 

  1. Periodontal treatment.

Once periodontal treatment is completed and the swollen, inflamed gingiva heals, gingival recession may occur causing sensitivity – this risk needs to be explained to the patient before commencing treatment.

 

Treatment

 

  • Desensitizing toothpaste – These work by blocking the dentine tubules.
  • Changing brushing techniques – use a soft-bristled brush with a non-aggressive brushing approach. Regularly replace the toothbrush head if worn.
  • Stop teeth whitening and use a desensitizing toothpaste or gel in the whitening trays.
  • Avoid clenching/grinding your teeth.
  • Restorations to cover the exposed surface
  • Duraphat varnish