What are Sensitive Teeth?
Teeth that are generally very sensitive to extremes of temperature (especially cold), sweets, and touch (for example, with a fingernail) may be diagnosed with sensitive teeth (dentin hypersensitivity). This diagnosis may represent the symptoms of a larger problem, such as a tooth grinding habit (bruxism), which may have contributed to receding gums, severe wear on the teeth (attrition), or abfractions. Generally, sensitive teeth are a temporary situation, but bouts with sensitivity may re-occur, especially if the underlying cause is not identified and treated.
Sensitive teeth have one thing in common: exposed dentin. One situation in which this occurs is when the gums have receded and exposed the tooth’s root. Once the root is exposed, the thin cementum layer over the tooth root is worn away, exposing the underlying dentin. This is fairly common in patients who brush their teeth aggressively, or who frequently ingest acidic food and drink.
Another situation in which widespread dentin exposure occurs is when a patient grinds their teeth (bruxism). Once the enamel layer is perforated, the underlying dentin is exposed. If a person habitually clenches their jaw muscles, it can cause stresses to concentrate near the gumline. Pieces of tooth enamel can fracture off in such areas, creating angular notches (abfractions).
Frequent exposure of the teeth to acids can erode tooth enamel in a characteristic rubbed down appearance, commonly seen on the inner surfaces of the upper front teeth of bulimic patients, and on the lower molars of some patients who suffer from gastroesophageal reflux disorder (GERD). Certain ethnic groups and individuals enjoy using lemon salts or other corrosive substances that can dissolve tooth enamel. If any of these cause dentin exposure, the patient can experience sensitive teeth.
Periodontal surgery to eliminate deep gum pockets around the teeth can cause exposed tooth roots. Generally this outcome is preferred to allowing gum pockets to remain, because patients are unable to effectively remove bacterial plaques more than four millimeters below the visible gumline. Nonetheless, the resulting sensitive teeth can be treated to make the patient more comfortable.
How does the dentist diagnose Sensitive Teeth?
Note: ToothIQ.com contains general information. Only a dentist can properly diagnose your specific condition.
The following criteria support the diagnosis of sensitive teeth:
- Frequently, multiple teeth are sensitive, not just one.
- Affected teeth have exposed dentin somewhere on the tooth—most commonly either at the gum line, or on the biting surfaces.
- Wear planes may be present on opposing tooth surfaces that suggest the patient grinds their teeth (brux). Wear such as this is called attrition.
- The patient has no cavities, and dental restorations like fillings and crowns (if any) are in good repair (except for possible wear planes).
- No significant findings are seen on X-ray images of the teeth.
- Cold stimulus applied to the exposed dentin causes a sharp pain response that quickly subsides when the cold is removed.
- Frequently tactile stimulus (e.g. rubbing the metal tip of a dental explorer on the exposed dentin) will produce a sharp pain response. Even the patient’s fingernail may cause it.
- The teeth don’t hurt all the time—only in response to stimuli as noted.
How are Sensitive Teeth treated?
Diagnosing the condition normally requires X-ray imaging to rule out other causes. Photographs may be taken to establish a point of reference to evaluate progression of wear (attrition and abrasion) over time.
Sensitive teeth can typically be treated by covering up the exposed dentin with gum grafting or fillings; plugging the exposed dentin tubules up with topical fluoride or desensitizing medication; or inhibiting the nerve’s ability to send a pain message (which is what the potassium nitrate ingredient in sensitivity-formula toothpastes does).
Treating the symptoms without treating the underlying cause (or causes) can lead to recurring episodes of tooth sensitivity, and possibly other problems.
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