Why So Sensitive?
Nerve endings in our teeth help us “feel” what we are biting and chewing. A small degree of dental sensitivity like this is normal. However, if you have ever had an ice-cold beverage, or maybe a hot coffee, and experienced immediate, sometimes excruciating dental pain, there may be something wrong with your teeth. Namely, the protective outer layers of your mouth, including the hard enamel on dental surfaces and the gums may be in trouble.
The underlying cause of dental sensitivity is exposure of the underlying dentin, and the nerve endings therein, to the elements.
Dentin is the bony tissue beneath the protective outer enamel that makes up the bulk of a tooth. If you were to take a section cut of a typical tooth, you would see that the protruding exposed portion of the tooth, the crown, is protected by enamel. Meanwhile, the embedded dental roots of a tooth do not have an outer layer of enamel and are instead covered by the gums. When either the enamel or the gums are somehow damaged, thinned, reduced, or removed, the underlying dentin is exposed, resulting in pain and sensitivity. Doctors often refer to this condition as dentin hypersensitivity.
"The best ways to treat dental sensitivity and prevent future sensitivity is to care for and protect your dental enamel and your gums."
--- DR. MAMALY RESHAD, DDS.
What Causes Dentin to Become Exposed?
The primary cause of dental sensitivity is not a lack of enamel but is gingival loss or gum recession, wherein the underlying dentin becomes exposed. Unlike thick dental enamel, the soft tissues of the gums are much more susceptible to being permanently damaged by trauma or by infections. The gums have only a limited ability to regenerate or repair itself. After a certain threshold, any damage becomes irreparable.
Causes of gingival recession generally fall into two categories: infection and trauma.
Infections that damage or destroy the gums are known as gum disease, or periodontal disease, which typically begins as unassuming gingivitis. Meanwhile, the primary cause of gingival trauma is simply brushing too hard, too often, or with poor technique.
Major causes of gingival loss include:
Tobacco and alcohol consumption
8 Ways To Treat Dental Sensitivity
The best ways to treat dental sensitivity and prevent future sensitivity is to care for and protect your dental enamel and your gums. That means dealing with any conditions, such as chronic teeth clenching or periodontal infections, that can damage or wear them down.
I recommend patients with bruxism wear a mouthguard while they sleep.
Those with bruxism, or teeth grinding, are particularly susceptible to sensitive teeth since the constant grinding of their teeth tends to dramatically wear down the enamel. If left untreated, severe bruxing can lead to complete dental destruction.
Acid erosion of dental enamel is a serious concern. When exposed to acidity or low PH conditions, minerals leach out of dental enamel making them weak and susceptible to damage.
Low PH conditions can be created by a variety of extrinsic factors, namely the consumption of acid foods and beverages such as fruit juices, wine, and coffee.
There are also intrinsic causes as well. One major cause of enamel erosion is acid reflux disease. Gastric acids from the gastrointestinal system are highly acidic and will destroy enamel over time.
The primary cause of gingival recession, and thus exposure of the underlying dentin, is gum disease. Treating gum disease, especially advanced periodontitis, is extremely difficult.
Once an infection has caused the gum tissues to detach from the bones, periodontal pockets can form. These pockets between the dental bone and the detached gingival tissue are highly susceptible to infection and further gingival destruction.
Once periodontitis has set in, the only course of treatment is to try to keep existing periodontal pockets as clean as possible and prevent new ones from forming. The best way to avoid this is to treat gum disease in its earliest stage known as gingivitis. In this phase, removing plaque will allow the gums to heal and repair itself.
Toothpaste for sensitive teeth does not contain the harsh ingredients found in typical toothpaste. Furthermore, these kinds of toothpaste also include fluoride to aid in remineralization of enamel.
Remember to employ a non-traumatic toothbrushing technique when brushing your teeth. Desensitizing toothpaste typically takes anywhere from a few months to several months to produce appreciable results.
Both at-home and professional dental whitening procedures typically involve the use of bleaching agents such as hydrogen peroxide.
In order to treat intrinsic staining, which is beneath the outer surface of the enamel, bleaching agents are allowed to soak through the enamel which results in exposed dentin and nerve endings in some cases. Once the bleaching treatment ends, so too does the dental sensitivity in most cases.
Toothbrush abrasion is the result of brushing too hard, too much, or with incorrect technique. Remember, over brushing does not improve dental hygiene. Instead, I recommend that all my patients brush their teeth twice a day with a soft toothbrush head and fluoridated toothpaste for no more than two (2) minutes. When brushing along the gum line, be sure to brush gently and at a 45-degree angle to avoid damaging sensitive gums.
Potassium salts have a desensitizing effect on the exposed nerve endings of exposed dentin.
Resins and varnishes can also be applied to areas of exposed dentin, typically by a dental professional. The goal of this technique is to block microscopic tubules in the dentin itself thereby preventing nerve ending from being exposed.
DR. MAMALY RESHAD
Advanced Prosthodontics - USC
Chairman - Fixed Prosthodontics and Operative Dentistry