Sensitive Teeth
What Is It?
Many of us speak of having "sensitive
teeth." We usually mean that we feel twinges
of pain or discomfort when our teeth
encounter certain stimuli, including:
▪ Cold food or drink
▪ Less often, hot food or drink
▪ Sweets
▪ Touch
There are two main types of tooth
sensitivity:
Dentinal sensitivity occurs when the dentin
(middle layer) of a tooth is exposed.
Normally, the dentin is protected. The part
of the tooth above the gumline is covered
with enamel and the tooth's roots are
covered with cementum.
The dentinal layer is made of tiny openings
called tubules. Inside each tubule lies a
tiny nerve branch that comes from the
tooth's pulp chamber in the center of the
tooth. When the dentin is exposed and a
stimulus, such as those listed above, can
reach these nerve branches, sensitivity can
occur.
Dentinal sensitivity can affect one or more
teeth, depending on the cause. Causes
include:
▪ Too-vigorous brushing that wears away the
tooth surface
(enamel and/or cementum)
▪ Poor oral hygiene that allows tartar to
build up at the gum line, leaching
minerals from the tooth
▪ Long-term tooth wear
▪ Decay
▪ An old filling with a crack or leak
▪ Gum recession, which exposes the tooth's
roots. The recession is often
caused by periodontal disease
▪ Gum surgery that exposes the tooth's roots
▪ Excessive tooth whitening in people with
root surfaces already exposed
Pulpal sensitivity is a reaction of the
tooth's pulp, a mass of blood vessels and
nerves that sits in the center of each
tooth. Pulpal sensitivity tends to affect
only a single tooth. Causes include:
▪ Decay or infection
▪ A recent filling
▪ Excessive pressure from clenching or
grinding
If you experience a sharp pain upon biting,
you may have a cracked tooth or a broken or
cracked filling.
Symptoms
Both dentinal and pulpal sensitivity usually
involve reactions to temperature or
pressure. Sensitivity to cold drinks or
foods is the most common symptom. Less
often, the teeth are sensitive to hot
temperatures. If a single tooth progresses
from cold sensitivity to hot sensitivity, it
may indicate that the tooth's nerve is
dying, and root canal treatment (endodontic
therapy) is necessary. If single-tooth
sensitivity continues for some time after
the stimulus is gone, the tooth is more
likely to require root-canal treatment than
if the sensitivity lasts only seconds.
Diagnosis
Your dentist will look at your dental
history and will examine your mouth. He or
she will ask about your oral habits because
grinding or clenching your teeth can
contribute to sensitivity. Your dentist also
will look for decay, deep metal fillings and
exposed root surfaces. He or she may use an
explorer — a metal instrument with a sharp
point — to test teeth for sensitivity.
If you have one sensitive tooth and it has
recently had a filling — either an amalgam
filling or a bonded composite resin filling
— it may be sensitive to cold for several
weeks. The metals in the amalgam conduct the
cold very well, transmitting it to the pulp.
Bonded fillings require etching the tooth
with acid before the filling is placed. In
some cases, this etching removes enough
enamel to make the tooth sensitive. However,
advances in bonding technique now make it
less likely the procedure will cause tooth
sensitivity.
Your dentist or endodontist will conduct
sensitivity tests that can determine if root
canal treatment is needed.
Expected Duration
Sensitivity that occurs after an amalgam
filling is placed will go away in several
weeks. However, if the tooth requires a root
canal, the sensitivity will not disappear
over time.
Sensitivity that occurs in multiple teeth
may disappear in a short time or may
continue. Every case is different. Some
people have sensitive teeth for only a month
or two. Others have the condition for much
of their lives.
Prevention
Pulpal sensitivity — There is no
good way to prevent pulpal sensitivity that
occurs because the tooth needs root canal
treatment. If you grind or clench your teeth
(bruxism), being treated for this condition
may help to prevent the pulp from being
overly sensitive.
Dentinal sensitivity — You might be able to
reduce your chances of dentinal sensitivity
by:
▪ Practicing good oral hygiene, which can
minimize the buildup of tartar and
prevent periodontal (gum) disease, which can lead to sensitivity
▪ Using a soft brush and brushing gently up
and down, rather than side to side,
to prevent abrasion of the enamel
▪ Using a fluoride toothpaste and mouth
rinse
▪ Using a desensitizing toothpaste that has
the American Dental Association
(ADA) Seal of Approval and provides protection against sensitivity
▪ Getting treatment for bruxism
Treatment
Pulpal sensitivity can be treated with a
root canal in cases where the sensitivity
indicates that the tooth's nerve is damaged
or dying. If the sensitivity results from a
new amalgam filling, it should subside
without treatment in several weeks.
Sensitivity caused by bruxism should
diminish as the bruxism is treated.
Dentinal sensitivity is quite treatable,
whatever the cause.
Your dentist or dental hygienist will clean
your teeth. If your teeth are too sensitive
to be cleaned, your dentist may use a local
anesthetic or nitrous oxide before the
cleaning.
After a cleaning, your dentist may apply a
fluoride varnish-based treatment to protect
your teeth. This reduces the sensitivity and
strengthens your teeth. This treatment
reduces sensitivity temporarily. Your
dentist also may apply an in-office
treatment for sensitivity. These products
contain substances that block the openings
(tubules) in your teeth and reduce
sensitivity.
At home, the use of fluoride toothpastes and
mouth rinses also will help to reduce
sensitivity. Toothpastes are also available
specifically for sensitive teeth.
Talk to your dentist about which fluoride
rinses you should use. Some over-the-counter
rinses are acidic. Others are not. You
should choose a fluoride mouth rinse that
uses neutral sodium fluoride.
When To Call A Professional
If you have sensitivity that lasts for
longer than a few weeks, contact your
dentist. Or if you have a scheduled cleaning
coming up soon, talk to your dentist then
about your sensitivity and possible causes.
Most cases of tooth sensitivity are treated
easily.
Prognosis
The outlook is different for each
individual. Some people have only short-term
tooth sensitivity, while others deal with
the condition for many years.
Additional Information
American Dental Association
211 East Chicago Ave.
Chicago, IL 60611
Phone: (312) 440-2500
Fax: (312) 440-2800
http://www.ada.org/
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