WHAT ARE THE CAUSES AND TREATMENT OF SENSITIVE TEETH?

Introduction

People often experience sudden pain and discomfort in the teeth while eating cold or hot foods and beverages. This pain, arising in response to external stimuli such as hot or cold food or drink is known as teeth sensitivity or dental hypersensitivity. The pain is often sharp and sudden but recedes after a short time. Tooth sensitivity could be due to several preexisting dental problems of which one may be unaware. 

About 1 in 8 Americans report teeth sensitivity. Among these, women are more likely to experience it than men. It is also more common among 30–40-year-olds.

In this article, we discuss the causes of teeth sensitivity and the recommended treatment options. 

What are the symptoms of tooth sensitivity?

Tooth sensitivity is characterized by discomfort and unpleasant sensation, often due to intake of hot, cold, or acidic foods and beverages or aggressive brushing. This pain is temporary and can affect one, multiple, or all teeth in an individual. Tooth sensitivity is described as localized, sharp, and sudden pain which may vanish once the stimulus is removed. 

Why are my teeth sensitive?

Teeth sensitivity is due to wearing off of protective layers (enamel and cementum) present on teeth. The crown portion of the tooth is covered by the protective layer of enamel. The root portion of the teeth, present below the gum line is covered by the layer of cementum. The layer present underneath enamel and cementum is known as dentin, which contains several microscopic canals called dentinal tubules. These tubules are filled with fluids.

When a layer of protective enamel or cementum wears off due to damage, dentinal tubules get exposed. During this, intake of any hot, cold, or sticky foods affects the fluid flow in the dentinal tubules which stimulate the nerves, causing painful sensations or discomfort. 

What are the factors that cause tooth sensitivity?

Several factors cause damage to the enamel or cementum, making teeth sensitive to cold, hot, or acidic food and beverages. These include: 

• Faulty tooth-brushing technique: Aggressive or incorrect brushing using a hard brush for a prolonged time can damage the enamel present on the teeth surface.
• Tooth erosion: Regular intake of acidic foods and beverages such as citrus fruits, soft drinks, sports drinks, and repeated vomiting (due to eating disorders such as gastro-esophageal reflux disease) wear away the enamel present on the surfaces of teeth. This condition is known as tooth erosion. 
• Decayed teeth and dislodged fillings: The presence of tooth cavities, broken teeth, and dislodged fillings expose the layer of dentin present on the tooth surface causing sensitivity.
• Receded gums: Poor periodontal health (health of tooth-supporting tissues) due to gum infections, faulty fillings, or incorrect tooth brushing may cause receding of gums, exposing the root surface. The cementum layer gets easily removed from the surface of the exposed root surface during aggressive toothbrushing, scaling, or intake of acidic foods. This causes sensitivity.
• Bruxism: The habit of grinding teeth (also known as bruxism) in the night wears off the layer of enamel present, causing sensitivity. 
• Dental work: Routine dental procedures such as scaling, fillings (especially composites), crowns, and bleaching of teeth may cause teeth sensitivity.
• Psychological factors: Research suggests that psychological factors such as psychic tension or emotional strain may reduce the tolerance to extreme cold or hot temperatures. 

How does a dentist diagnose tooth sensitivity?

Here are some of the ways that a dentist may use to diagnose tooth sensitivity:

• Visual assessment: Visual assessments aid in the identification of the dentin layer which gets exposed once the enamel is damaged.
• Patient history: Assessment of an individual’s medical history, dietary habits, and oral hygiene practice help understand the reason for sensitive teeth. For instance, excessive intake of citrus foods, carbonated drinks, or aggressive tooth brushing can damage the enamel layer present on the tooth surface. Inadequate oral hygiene maintenance may cause gum infections leading to receding of gums. Even patients with a history of bulimia (an eating disorder that causes vomiting after eating food) and dryness of the mouth often complain of tooth sensitivity.
• Diagnostic tests: The use of diagnostic tools and tests helps identify the causes of tooth sensitivity.  
  • Air blast test: The dentist blows a blast of air from the air-water syringe on multiple tooth surfaces to identify the causative tooth. Air stimulation usually indicates dental hypersensitivity. 
  • Tooth tap test: The dentist uses a small diameter blunt instrument and taps on teeth to identify tender or painful teeth. Hypersensitive tooth on tapping may indicate inflammation of tissues around the tooth.
  • Thermal tests: The dentist uses a piece of ice and touches all the teeth to detect teeth sensitive to cold. If the tooth doesn’t react to cold then it is considered dead. Meanwhile, a tooth that is hypersensitive to cold indicates the presence of irritated tissues within the tooth.
  • Bite stress test: The dentist will ask the patient to bite on a cotton ball for a few seconds between different teeth in the mouth. Pain or discomfort experienced after releasing the bite may indicate the presence of a cracked tooth. On the contrary, pain experienced while biting indicates the presence of inflammation around the teeth. 
• Radiographic examination: Radiographs help diagnose the cavities, fractured teeth, or gum infections that cause tooth sensitivity. 

What is the treatment for teeth sensitivity?

Your dentist may suggest one of the following treatments for teeth sensitivity: 

• Dietary modification: In cases of mild sensitivity due to tooth erosion or traumatic toothbrushing, the dentist may ask the individual to modify their dietary (reducing the intake of acidic foods) practices and improve brushing techniques along with oral hygiene practices.
• Desensitizing toothpaste: Desensitizing fluoride-based toothpaste or mouthwash for sensitive teeth may be recommended for home use at least for 4 to 6 weeks. Desensitizing paste cover the exposed tubules to desensitize nerves. 
• Fluoride gel application: If a desensitizing toothpaste isn’t effective then the dentist may recommend fluoride gel application in the dental clinic. (e.g., Duraphat)
• Identification of the cause and treating the tooth sensitivity: In individuals with a severe form of sensitivity, the exact cause of the tooth sensitivity needs to be identified and treated. Here are some of the treatments recommended to patients:
  • Tooth-colored fillings (using composite) may be recommended in individuals with severe tooth erosion in single or multiple teeth.
  • Restoration of decayed teeth dislodged fillings, or fractured teeth is advised.
  • Root canal treatment may be recommended in severe or hypersensitive teeth.
  • Gum-related surgeries may be advised in individuals with gum infections or receded gums.
  • Individuals with bulimia or psychological disorders may be referred to concerned specialists. 

How to prevent tooth sensitivity

Here are some of the ways to prevent tooth sensitivity: 

• Brush and floss teeth twice daily.
• Use a soft-bristled toothbrush and perform brushing with the correct technique.
• Avoid regular or excessive intake of acidic foods or beverages.
• Rinse your mouth immediately with water after eating or drinking something acidic and brush your teeth after 60 minutes. 
• Visit a dentist for regular checkups and professional cleaning of teeth.

Frequently asked questions

Why are my teeth sensitive all of a sudden?

Tooth sensitivity may occur as the protective layer of enamel wears off from the tooth surface, exposing the underlying structures of the dentin layer. The exposed dentin layer when comes in contact with extremely low or high temperatures, stimulates nerves to produce a sudden and sharp pain sensation. 

How to stop sensitive teeth pain immediately? 

Here are some of the ways to reduce sensitive teeth pain immediately: 

• Desensitizing toothpaste: Apply fluoride-based desensitizing toothpaste to the affected tooth. Wait for a minute and brush your teeth using a soft bristle toothbrush. Ingredients present in desensitizing paste (e.g., stannous fluoride) cover the exposed dentinal tubules and block the pain signals traveling from nerves in the tooth to the brain. Rinsing the mouth with a desensitizing mouthwash is also helpful. 
• Salt water rinse: Swish your mouth for 30 seconds using lukewarm salt water (½ tsp of salt to a glass of lukewarm water) twice daily. This helps in reducing inflammation and temporarily provides relief from pain. 
• Clove oil: The application of clove oil in small quantities can reduce tooth pain. Eugenol present in clove oil act as a natural anesthetic that helps relieve the pain.
• Oil pulling: Swishing mouth with 1 tablespoon of coconut oil for 20 minutes helps reduce pain. The analgesic and anti-inflammatory properties of coconut oil help reduce pain.
• Over-the-counter painkillers: If the sensitive teeth pain doesn’t subside, take an over-the-counter painkiller for immediate relief. Later consult your dentist for evaluation. 

What is the best toothpaste for sensitive teeth?

Some of the commonly recommended toothpaste for sensitive teeth used in the US include - Colgate Sensitive Pro-Relief Enamel Repair, Sensodyne repair and protect, Squigle Tooth Builder Sensitive Toothpaste, and Tom's of Maine Rapid Relief Sensitive.  

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References:

• Dawson, T. (2012). Sensitive teeth: Causes, prevention and treatment. Dental Nursing, 8(5), 274–276.
• For the dental patient. Sensitive teeth: causes and treatment. J Am Dent Assoc. 2003 Jun;134(6):787. PMID: 12839416.
• Walters PA. Dentinal hypersensitivity: a review. J Contemp Dent Pract. 2005 May 15;6(2):107-17. PMID: 15915210.
• Pranati, T & Ariga, Padma & Ganapathy, Dhanraj & Arthanari, Abirami. (2022). Etiology and Management of Hypersensitivity of Teeth -A Review. Journal of Pharmaceutical Research International. 34. 317-329.
• Bartold PM. Dentinal hypersensitivity: a review. Aust Dent J. 2006 Sep;51(3):212-8; quiz 276.
• https://www.ada.org.au/getattachment/Your-Dental-Health/Resources-for-Professionals/Resources-for-Teens-12-17/Ouch-I-have-sensitive-teeth/Ouch!-I-have-sensitive-teeth.pdf.aspx
• Cunha-Cruz J, Wataha JC, Heaton LJ, Rothen M, Sobieraj M, Scott J, Berg J; Northwest Practice-based Research Collaborative in Evidence-based DENTistry. The prevalence of dentin hypersensitivity in general dental practices in the northwest United States. J Am Dent Assoc. 2013 Mar;144(3):288-96. doi: 10.14219/jada.archive.2013.0116. PMID: 23449905; PMCID: PMC3819160.
• https://www.mouthhealthy.org/en/az-topics/s/sensitive-teeth
• https://www.colgate.com/en-us/oral-health/tooth-sensitivity/what-causes-sensitive-teeth
• https://www.gskhealthpartner.com/en-us/oral  health/conditions/sensitivity/diagnosis/

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