What Causes Sensitive Teeth? Symptoms, Prevention, and Treatment

Most of us love ice cream. But when teeth become sensitive, eating ice cream can be a painful and difficult experience. Can sensitive teeth be treated successfully? Or, do teeth remain sensitive forever?

Tooth sensitivity is a short, sharp, aching sensation. Typically, these sensations occur in response to eating or drinking hot or cold foods. In addition to the thermal stimuli, teeth may also become sensitive to tactile, chemical, and osmotic stimuli not related to pathology. Tooth hypersensitivity can occur in various parts of the teeth, including the root, cervical, dentin, and cementum.

Causes

The external layer of the tooth is the enamel, while the intermediate layer is called dentin. Dentin has several microtubules called dentinal tubules. These tubules contain a fluid named dentinal tubular fluid. Together these structures help in pain perception.

Researchers have proposed a theory known as the hydrodynamic theory that explains the mechanism of pain and tenderness in the dentin. The presence of thermal, mechanical, or osmotic stimuli will activate intrapulpal nerve fibers resulting in the displacement of dentinal tubular contents.

Teeth can become hypersensitive when the tubular dentinal system and the exposed dentinal structures start to trigger a neural response in the pulp due to increased fluid movement. Some common reasons for dentinal structures include abrasion, erosion, and plaque.

Furthermore, the combination of abrasion, erosion, and periodontal recession can cause cervical enamel loss in sensitive teeth. Excessive brushing and periodontal treatment can also cause exposed dentinal root surfaces and loss of periodontal tissue.

Periodontal recession can also be caused by smoking. Smoking is associated with the loss of periodontal ligament attachment and increased total periodontal pocket depth. It increases gingival recession and loss of periodontal tissue strength.

Prevention

Dental and oral hygiene plays a role in preventing sensitive teeth. Poor dental hygiene will result in a bacteria buildup between the teeth, causing plaque on the teeth. If not removed, this plaque will harden over time and transform into tartar. This tartar will eventually make teeth sensitive.

Along with maintaining regular dental hygiene, the American Dental Association recommends the following preventative measures:

• Use a soft-bristled toothbrush and toothpaste containing fluoride twice a day.
• Use a toothbrush that matches the size and contour of your mouth, so you can reach the entire area of your mouth and teeth.
• Try to clean between your teeth by using an interdental cleaner daily. This strategy will help you to remove plaque and other food particles from under your gum line and between your teeth.
• When the bristles of your toothbrush have frayed, replace your toothbrush immediately. Replace a toothbrush every three months or according to your needs. A toothbrush with damaged bristles is unable to clean between the teeth properly and can even pose a risk of irritating your gums.
• Visit your dentist regularly (at least once every six months) to get professional dental and oral cleaning and care.
• Consult your dentist soon if you have sensitive teeth.

The success of sensitive tooth treatment depends on an accurate and timely diagnosis of dentin hypersensitivity. Differential diagnosis is necessary as sensitive teeth could be due to other dental pathological conditions such as cracked enamel, irreversible pulpitis pain, dentinal caries, or sensitivity after teeth whitening procedures.

To diagnose the cause of sensitive teeth, a dentist usually starts by investigating the patient's dental medical history through several questions. The dentist will gather information about the onset and timing of the pain. In addition, the dentist will get more details on the intensity and stability of the pain felt by the patient.

Along with questions, a clinical exam is usually necessary. A dentist may use pure water, pure air, or sound techniques to reconstruct the stimulus to determine the patient's degree of pain. Other clinical exams may also be performed, including using transillumination to diagnose the presence of cracked or fractured teeth.

Treatment options

Desensitizing agents are the most widely used form of treatment for sensitive teeth. Broadly speaking, desensitizing agents are classified according to their mechanism of action and route of administration. Desensitizing agents can act as a disruptor to the neural response to aching and painful stimuli in the tooth or act as a barrier to tubular drainage causing dentinal tubular occlusion.

Depending on the route of administration, desensitizing agents can help treat sensitive teeth and can be administered at home. However, some treatments can only be done in professional dental clinics, and these options are more expensive.

Some characteristics of an ideal dentin desensitizing agent are:

• Quick-acting.
• Harmless.
• Long-lasting effect.
• Painless.
• Does not stain teeth.
• Easy to apply.

Desensitizing agents are available in dental care forms such as toothpaste, chewing gum, and mouthwash. Toothpaste is the most used over-the-counter product for treating sensitive teeth.

Sensitive dental care toothpaste contains fluoride and strontium salt, which prevent tooth pain and tenderness by blocking the dentinal tubules. The desensitizing toothpaste also contains potassium citrate and potassium chloride that can block the axonic reaction of intra-dental nerve fibers. Potassium nitrate and fluoride reduce the symptoms of sensitive teeth and also come in mouthwash and chewing gum form.

Sensitive teeth therapy can be carried out through clinical procedures by altering the transmission of nerve impulse agents. Potassium nitrate and laser can be used as interfering agents for the transmission of nerve impulses in sensitive teeth. Some recent products in sensitive dental care contain an active substance called potassium oxalate. It can close the exposed dentinal tubules and modify nerve excitability to reduce pain and tenderness in sensitive teeth. Potassium oxalate is often preferred as it has a faster and longer-lasting reaction time than desensitizing toothpaste.