Sensitive teeth

What Is It?
Symptoms
Diagnosis
Expected Duration
Prevention
Treatment
When To Call a Professional
Prognosis

What Is It?

Many of us say we have “sensitive teeth.” We usually mean that we feel twinges of pain or discomfort in our teeth in certain situations. These may include:
• Drinking or eating cold things
• Drinking or eating hot things
• Eating sweets
• Touching the teeth with other teeth or the tongue
There are two types of tooth sensitivity:
Dentinal sensitivity occurs when the dentin of a tooth is exposed. Normally, the dentin is covered by enamel above the gumline and by cementum below the gumline. Dentin is made up of tiny openings called tubules. Inside each tubule lies a nerve branch that comes from the tooth’s pulp. When the dentin is exposed, cold or hot temperature or pressure can affect these nerve branches. This causes sensitivity.
Dentinal sensitivity occurs when the outer protective layers of enamel or cementum are removed, exposing the dentin. It can affect one or more teeth. Some causes of dentin exposure include:
• Brushing your teeth too hard. This wears away the enamel layer.
• Poor oral hygiene. This may allow tartar to build up at the gum line.
• Long-term tooth wear
• Untreated cavities
• An old filling with a crack or leak
• Receding gums that expose the tooth’s roots. Receding gums often are caused by periodontal diseases or by brushing too hard.
• Gum surgery that exposes a tooth’s roots
• Tooth whitening in people who have tooth roots that already are exposed
• Frequently eating acidic foods or drinking acidic beverages
Pulpal sensitivity is a reaction of the tooth’s pulp. Pulpal sensitivity tends to affect only a single tooth. Causes include:
• Decay or infection
• A recent filling
• Excessive pressure from clenching or grinding
• A cracked or broken tooth
If you feel a sharp pain upon biting, you may have a broken or cracked filling. Pain when you release a bite is a sign of a cracked tooth.
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 becomes sensitive to heat, the tooth’s nerve is dying. In this case, root canal treatment is necessary.
Diagnosis

Your dentist will look at your dental history and will examine your mouth. You also will need X-rays to show if there is decay or a problem with the nerve. He or she will ask about your oral habits. Grinding or clenching your teeth can contribute to sensitivity. Your dentist also will look for decay, deep fillings and exposed root surfaces. He or she may use an explorer — a metal instrument with a sharp point— to test teeth for sensitivity.
A tooth may be sensitive to cold for several weeks after a filling is placed. The metals in amalgam (silver) conduct the cold very well, transmitting it to the pulp. Bonded (tooth-colored) 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 now make it less likely to cause tooth sensitivity.
Your dentist can conduct tests to see if you need root canal treatment.
Expected Duration

If your tooth becomes sensitive after a deep filling is placed, the problem may go away in several weeks. Sometimes the filling is too high and that puts too much pressure on the tooth when you bite down. Your dentist can reduce the height of the filling. If the sensitivity does not go away over time, the tooth probably needs a root canal.
Sensitivity in more than one tooth may disappear in a short time or it may continue. It depends on the cause of sensitivity. Every case is different. Some people have sensitive teeth for only a month or two. Others have the condition for years.
Prevention

Dentinal sensitivity — You might be able to reduce your chances of dentinal sensitivity by:
• Brushing twice a day and flossing daily
• Using a soft or ultrasoft toothbrush and brushing gently up and down, rather than side to side
• Using a fluoride toothpaste and mouth rinse
• Using a toothpaste that provides protection against sensitivity
• Getting treatment for grinding or clenching your teeth (bruxism)
Pulpal sensitivity — If a tooth needs root canal treatment, there is no good way to prevent pulpal sensitivity other than to get the needed treatment. Delaying root canal treatment is not recommended because it may result in further problems.
Treatment

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 to protect your teeth. This temporarily reduces sensitivity. It also strengthens your teeth. Your dentist may apply an in-office treatment for sensitivity. These products block the openings (tubules) in your teeth and reduce sensitivity. A newer approach is to use a dental laser. The laser treatment also alters the tubules to reduce sensitivity.
Using fluoride toothpastes and fluoride mouth rinses at home also will help to reduce sensitivity. Toothpastes are available just 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.
Pulpal sensitivity will be treated with a root canal if the tooth’s nerve is damaged or dying. The nerve will be removed and a non-reactive substance (gutta percha) will be placed in the space where the nerve was. The tooth no longer will have a continuous protective enamel barrier. Therefore it will be restored with either a composite filling or a crown.
To reduce pain due to grinding or clenching, the dentist will make a plastic night guard that you should use while you sleep.
When To Call a Professional

If sensitivity lasts for longer than a few weeks, contact your dentist. 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 easy to treat.
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